What You Need to Know Before Ovarian Surgery

Ovary removal for ovarian cancer prevention carries some risk in premenopausal women

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) About one out of 70 women will be diagnosed with ovarian cancer in their lifetime. Surgically removing the ovaries is one way to prevent this cancer.

A recent review of previous studies examined the risks and benefits of removing the ovaries versus keeping them at the time of hysterectomy (surgical removal of the uterus). Either decision carries the possible risk of negatively affecting other major systems in the body. The ovaries produce the hormones that are necessary for the body to function normally.

The author of this review wanted to outline the risks and benefits of ovary removal on ovarian cancer, heart disease, hip fractures, sexual function and general cognition (basic mental ability). It was the author's hope that this review will help doctors appropriately counsel patients.

The review found that premenopausal women undergoing hysterectomy should be discouraged from ovarian removal because of the effects of hormone loss on sexual function and heart disease. Postmenopausal women were found to be generally unaffected and were recommended to get their ovaries removed to prevent the onset of ovarian cancer.

"Discuss the risks of elective ovary removal with your gynecologist."

This review was conducted at the University of North Carolina at Chapel Hill and authored by Catherine A. Matthews, MD, professor of Obstetrics and Gynecology in the UNC Department of Obstetrics and Gynecology.

Dr. Matthews conducted this review because she realized that much of the data and approaches surrounding elective ovary removal were conflicting and varied. She argued that this lack of consistency could be dangerous to women's health.

The ovaries produce the two main hormones in women called estrogen and testosterone. Many women elect to remove the ovaries to prevent ovarian cancer. However, different studies covered in this review showed that the health consequences of removal might outweigh the benefits of ovarian cancer prevention.

After menopause, estrogen production drops below the rate needed to maintain the normal function of all the internal systems of the body, especially healthy heart functioning. If the ovaries are removed, a woman is forced into menopause if she hasn't already gone through it. 

This review noted that testosterone is still produced after menopause, unless menopause was forced by ovary removal. Estrogen and testosterone both affect sexual desire and function.

Approximately 292,000 women die from heart disease each year in the United States, whereas about 22,000 women die from ovarian cancer.

Dr. Matthews found that premenopausal women, or women under the age of 50, can be strongly affected by the hormone loss that is caused by removing the ovaries. The risk of coronary heart disease increases substantially without estrogen, and the negative effects associated with this deprivation is likely to substantially outweigh the beneficial effects of removal on ovarian cancer prevention.

Study data also showed that sexual function can be negatively impacted by hormone deprivation in women under 50. Dr. Matthews concluded that premenopausal women should be discouraged from getting elective ovary removal surgery.

Postmenopausal women, or women over the age of 50, have already experienced a sharp decline in hormone production from menopause. Therefore, studies found that ovarian removal would not pose a significant risk increase for coronary heart disease or sexual dysfunction. Multiple studies suggested that the benefit of ovarian cancer prevention by removal could possibly outweigh potential negative effects on any of the health issues discussed.

The studies surrounding mental function and hip fractures were inconsistent, inconclusive, and few, especially for premenopausal women. For the most part, Dr. Matthews found that postmenopausal women who had their ovaries removed were shown to be affected very little or not at all in the areas of mental function and hip fractures.

Dr. Matthews believes that more studies need to be done in these areas.

The review noted that there is a difference between elective ovary removal and risk-reducing ovary removal. Some women have a mutation of the BRCA gene and are encouraged to undergo ovary removal because their cancer risk is very much increased.

However, most women are not genetically at risk. It is estimated that between 0.1 and 0.6 percent of women are affected by this mutation. Dr. Matthews explained that most women do not need to worry about this hereditary risk.

Dr. Matthews determined that an evidence-based standard of practice was needed to help doctors be able to adequately inform patients of the risks involved and then council them appropriately. She believes that the use of this real-life published data summary is absolutely necessary for doctors to adequately and appropriately communicate with their patients.

This study was published online in the July 18 edition of the Journal of Women's Health.

Review Date: 
August 1, 2013
Last Updated:
December 31, 2013