The ovary option

There has been a media blitz surrounding recent discussion of the pros and cons of surgical removal of the ovaries during hysterectomy (see Cochrane article below). But the most important issue has yet to be addressed: the uterus should rarely be removed in the first place.

The article below perpetuates a dangerous myth through the subliminal message that if your ovaries are left intact you’ll be fine if only your uterus is removed. Those who are unaware of the aftermath of hysterectomy, with or without castration, can join more than 400,000 others who have watched the HERS
12-minute video by clicking here: “Female Anatomy: the Functions of the Female Organs.”

If the analysis was a sincere effort to provide women with the information they need to make informed decisions about whether or not to allow a doctor to remove their ovaries, the article would have used the word castration, which conveys an immediate understanding of the gravity of their decision. The ovaries are the female gonads, the same as the testicles are the male gonads. The medically correct term for removal of the gonads is castration.

In the HERS Foundation’s ongoing study “Adverse Effects Data,” the experiences of hysterectomized women whose ovaries are left intact are strikingly similar to the women who are also castrated at the time of the surgery. Part of the reason for similar responses with or without castration is that in hysterectomized women whose ovaries aren’t removed, about 35-40% of the time the ovaries cease to function after hysterectomy, resulting in a de facto castration.

This information is public knowledge and has been published in peer-reviewed medical journals for more than a century, so neither journalists nor doctors who hold themselves out as experts in gynecology should get it wrong.

The response to these articles would be far different if the headlines read, “Should women be castrated during removal of other sex organs?”

Removing ovaries during hysterectomy: effects remain unknown
During hysterectomy operations, surgeons often remove a woman’s ovaries as well as her uterus. Cochrane Researchers now say there is no evidence that removing the ovaries provides any additional benefit and warn surgeons to consider the procedure carefully.

“Until more reliable research is available, removal of the ovaries at the time of hysterectomy should be approached with caution,” says lead researcher, Dr. Leonardo Orozco of the OBGYN Women’s Hospital San José in Costa Rica.

Of those women who undergo hysterectomies aged 40 or above, around half also have their ovaries removed. This amounts to more than 300,000 women a year in the US alone. The reason most commonly given for carrying out an oophorectomy at the same time is that it prevents ovarian cancer. However the ovaries produce not only estrogen, but also important hormones such as androgens that may have important clinical effects which have yet to be identified.

The researchers say there is little evidence to support the idea that removing the ovaries during a hysterectomy provides an overall health benefit. They identified only one controlled trial, involving 362 women. This compared hysterectomies with oophorectomies to hysterectomies without oophorectomies. Although this trial showed a very slight positive effect on psychological well-being when oophorectomies were performed, the team say much more data is required before any conclusions can be drawn.

“There could be a real benefit or harm associated with oophorectomy, but it has not been identified, more research of higher methodological quality is needed.” says Dr. Orozco.

Orozco LJ, Salazar A, Clarke J, Tristan M. Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD005638. DOI: 10.1002/14651858.CD005638.pub2. Cochrane Menstrual Disorders and Subfertility Group.