Nearly 1 in
3 women undergo oophorectomy during premenopausal hysterectomy in absence of
appropriate indication, reports a study published ahead of print May 8, 2017 in
North American Menopausal Society (NAMS) journal Menopause.
Bilateral
Oophorectomy before the age of menopause is associated with increased the risk
of parkinsonism, cognitive impairment or dementia, and anxiety or depression.
These women, particularly those who were below 45 years at the time of
oophorectomy face 67% increase risk of all-cause mortality.
Analysis of
data from Nurses’ Health Study also revealed that in 24 years follow up, women who
were below 45 years at the time of surgery had 17% increased chances of
non-fatal CHD.
In-fact,
evidence suggests that at no age, oophorectomy shows any survival benefit.
The current
study was a cross sectional analysis of data-base from California Office of
Statewide Health Planning Development during a span of 6 years. (2008-2011).
Appropriate
indications for oophorectomy with hysterectomy in the study were ovarian cyst,
breast cancer susceptibility gene carrier status, and other diagnoses.
A total of
57,776 benign premenopausal hysterectomies with oophorectomies were performed during
the 6-year study period.
Out of these
57,776, 21,783 were found to be ‘inappropriate’ as no indication was found
among the records.
Through the
6 years of study, the researchers observed a decreasing trend to perform
oophorectomy with hysterectomy, but the percentage remain unchanged.
Women with Hispanic
and African American ethnicity were more likely to undergo oophorectomy as
compared to white women. (P < 0.001).
The authors
concluded that, “the rate of inappropriate oophorectomy in California has not
changed since the 2008 American College of Obstetricians and Gynecologists
guidelines, and over one-third undergo oophorectomy without an appropriate
indication documented”.
What does
this mean for daily clinical practice?
Prophylactic
Hysterectomy should only be done in cases were preponderance of evidence
suggests that it will be beneficial to patient.
All patients
should be counselled in detail before the surgery regarding the pros and cons
of retaining the ovaries at the time of hysterectomy.
ACOG also
recommends in favor of retaining normal ovaries in premenopausal women who are
not at increased genetic risk of ovarian cancer.
In women with
endometriosis, pelvic inflammatory disease, and chronic pelvic pain a decision should
be taken after balancing the risk of reoperation vs the benefits of ovarian retention.
ACOG further
recommends considering prophylactic salpingectomy in those women who are at
population risk for ovarian cancer, and who opt for retention of ovaries.
