• Cara Murez
• Posted December 9, 2021

Removing Ovaries During Hysterectomy Before 50 Can Bring Health Risks

New research on hysterectomies among women who don't have cancer determined there is an age at which it is safer to also remove the ovaries and fallopian tubes and an age at which it isn't.

Canadian scientists studied the cases of more than 200,500 women who had a hysterectomy for noncancerous reasons. They found an increased risk of death in women under 50 when the ovaries and fallopian tubes were also removed during the surgery. But they did not find the same association in women over 50.

The data had been limited for older women, which created uncertainty for surgeons about what to recommend.

"Our core goal was to try to understand the health risks associated with bilateral salpingo-oophorectomy [removal of fallopian tubes and both ovaries] for women of different ages, and provide information that patients and surgeons need to make the right treatment decisions," lead study author Dr. Maria Cusimano said in a news release from St. Michael's Hospital of Unity Health Toronto. She is a resident physician in obstetrics and gynecology at the hospital.

Bilateral salpingo-oophorectomy (BSO) is the most common major surgery performed on non-pregnant women worldwide, according to the Organization for Economic Cooperation and Development. Patients often have the surgery to prevent the development of ovarian cancer later in life.

The researchers followed the women who had hysterectomies either with or without ovary and fallopian tube removal from 1996 to 2015. They analyzed them by age groups: under 45, 45 to 49, 50 to 54, and over 55. The median follow-up to assess survival was 12 years after the procedure.

The risks declined gradually in the years approaching menopause and were eliminated after the average age of menopause, the study found.

While researchers acknowledged it's unlikely that there's a sudden drop in mortality between women aged 49 and those who are 50, they used a more advanced modeling technique and still found the overall relationship gradually shifted from harmful to not harmful around the average age of menopause.

"We know that bilateral salpingo-oophorectomy can prevent ovarian cancer, but this benefit must be weighed against other potential risks of the procedure," said study co-author Dr. Sarah Ferguson, a professor from the University of Toronto's Division of Gynecologic Oncology.

"There are definite cancerous and noncancerous conditions where we actually do need to remove the ovaries, even if a woman is premenopausal," Ferguson said in the release. "Our study shows that surgeons need to be cautious about removing the ovaries without a clear reason in premenopausal women. However, this strategy may be a safe and effective way to prevent ovarian cancer in older postmenopausal women."

The reason the risks may be higher in younger women is because the surgery prematurely stops all ovarian hormone production, the researchers suggested. This puts patients in "sudden menopause." The production of estrogen affects multiple organs, so the loss of the hormone may predispose them to serious health problems later in life.

These same downsides would not be expected to occur in postmenopausal women, whose ovaries have already stopped producing estrogen.

The findings were published Dec. 8 in the BMJ.

More information

The U.S. National Cancer Institute has more on surgical removal of the fallopian tubes and ovaries (BSO).

SOURCE: St. Michael's Hospital of Unity Health Toronto, news release, Dec. 8, 2021