Oophorectomy vs ovarian conservation with hysterectomy

January 01, 0001

Oophorectomy vs ovarian conservation with hysterectomy

Elective bilateral salpingo-oophorectomy (BSO) is routinely performed with hysterectomy for benign conditions despite conflicting data on long-term outcomes. These US authors report a prospective cohort of 25,448 postmenopausal women aged 50 to 79 years enrolled in the Women's Health Initiative Observational Study who had a history of hysterectomy and BSO (n = 14 254 {56.0%}) or hysterectomy with ovarian conservation (n = 11 194 {44.0%}) and no family history of ovarian cancer. Multivariable Cox proportional hazards regression models were used to examine the effect of BSO on incident cardiovascular disease, hip fracture, cancer, and death.

They found: "Current or past use of estrogen and/or progestin was common irrespective of BSO status (78.6% of cohort). In multivariable analyses, BSO was not associated with an increased risk of fatal and nonfatal coronary heart disease (hazard ratio, 1.00), coronary artery bypass graft/percutaneous transluminal coronary angioplasty (0.95), stroke (1.04), total cardiovascular disease (0.99), hip fracture (0.83), or death (0.98). Bilateral salpingo-oophorectomy decreased incident ovarian cancer (0.02% in the BSO group; 0.33% in the ovarian conservation group; number needed to treat, 323) during a mean follow-up of 7.6 years, but there were no significant associations for breast, colorectal, or lung cancer."

The authors concluded: "In this large prospective cohort study, BSO decreased the risk of ovarian cancer compared with hysterectomy and ovarian conservation, but incident ovarian cancer was rare in both groups. Our findings suggest that BSO may not have an adverse effect on cardiovascular health, hip fracture, cancer, or total mortality compared with hysterectomy and ovarian conservation."

These results suggest that it really doesn’t matter much whether oophorectomy is performed or not at the time of hysterectomy.

For the full abstract, click here.

Arch Intern Med 171(8):760-768, 25 April 2011
© 2011 to the American Medical Association
Oophorectomy vs Ovarian Conservation With Hysterectomy-Cardiovascular Disease, Hip Fracture, and Cancer in the Women's Health Initiative Observational Study. Vanessa L. Jacoby, Deborah Grady, Jean Wactawski-Wende, et al. Correspondence to Dr. Jacoby: [email protected]

Category: X. Female Genital System, Breast. Keywords: hysterectomy, oophorectomy, ovarian conservation, prospective cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 10 May 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.