Should my ovaries be removed at hysterectomy?

If the hysterectomy is undertaken abdominally, there is a choice of conserving or removing the ovaries (Figure 24.4). When the hysterectomy is undertaken vaginally as part of treatment for prolapse, the ovaries are not usually removed.

In a young woman, the ovaries are likely to have longer remaining function than in a woman around the age of fifty. There is, therefore, more advantage in conserving the ovaries in a young woman compared to a woman approaching her menopause. Some women, even beyond the age of fifty are very keen to keep their ovaries, if they appear healthy. Provided they have had the opportunity to make an informed choice, their decision must be accepted.

In recent years, it has been found that following hysterectomy, ovaries that have not been removed lose their function, usually within five years. This observation may be partially explained by the fact that some women develop heavy periods within the few years leading up to the menopause and the ovaries appear to lose their function early after the hysterectomy because the menopause was imminent anyway.

Even if there is no history of pelvic pain before hysterectomy, many women (about 1 in 20) will develop pain if their ovaries are conserved and return to have a second operation to remove the offending ovaries later.

Statistically we now know that when the ovaries are conserved at the time of hysterectomy, one woman out of every two hundred and fifty is likely to develop cancer of the ovary at some time in her life. This is not as a result of the hysterectomy but simply reflects the chance of a woman developing this disease. Once or twice each year I see women in their fifties or sixties with ovarian cancer who have had their ovaries conserved at the time of hysterectomy.

Cyclical symptoms (premenstrual syndromePremenstrual Syndrome - PMS) are usually improved or cured when the ovaries are removed and hormone replacement therapy is commenced.

Finally, hormone replacement therapy has advanced to the stage that, with few exceptions, an entirely satisfactory treatment is available following removal of the ovaries. Every patient undergoing hysterectomy should give these facts careful consideration and indicate at the time of signing consent for operation whether she wishes to keep her ovaries if they appear healthy. If the ovaries appear unhealthy the gynaecologist would generally wish to remove them.

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

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