COMMENTARY

Ovarian Conservation at the Time of Hysterectomy: Where Do We Stand?

Andrew M. Kaunitz, MD

Disclosures

April 30, 2014

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In 2008, the American College of Obstetricians and Gynecologists issued guidance[1] that in premenopausal women, gynecologic surgeons should practice ovarian conservation at the time of hysterectomy for benign disease. In 2012, researchers performed a survey of randomly selected obstetrician/gynecologists about their preferences with respect to ovarian conservation.[2]

For women with an average risk for ovarian cancer, aged 51-65 years, almost two thirds of respondents indicated that bilateral oophorectomy (BO) was appropriate. For patients younger than 51 years, one third recommended BO.

Most respondents would proceed with BO for women with a personal history of breast cancer or a family history of ovarian cancer. Two thirds of respondents indicated that they would perform BO if an average-risk woman in her early 30s insisted on having this procedure.

Elective BO carries risks, including a higher incidence of fatal coronary artery disease, cognitive impairment, and Parkinson disease. In women at average risk for ovarian cancer, risks from oophorectomy outweigh the reduced risk for fatal ovarian cancer associated with BO.

Although long-term use of estrogen therapy mitigates the risks of BO, few women in this setting take estrogen long-term. Obstetrician/gynecologists in the United States are performing fewer incidental oophorectomies than in previous years. Hopefully, with ongoing education, women as well as clinicians will better understand that when hysterectomy is performed for benign indications in women without deleterious mutations or ovarian pathology, conservation of the ovaries should be the norm.[3]

Thank you. I am Andrew Kaunitz.

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