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April 8, 2013


Removal of ovaries before menopause can cause earlier death or negatively impact quality of life

For too many years the ovaries
have been considered expendable if the uterus was being removed for a medical
indication (hysterectomy). This has been despite the considerable evidence that
an early onset acute menopause brought about by surgically removing otherwise
healthy ovaries, will accelerate the development of all the true
menopause-related effects by precisely that number of years the ovaries are
removed before the expected age of menopause at 51. So why are the ovaries
removed in women undergoing hysterectomy before the onset of menopause?


The usual reason given is to
prevent later development of ovarian cancer. This is a very slim risk set at
somewhere between 1 in 1,000 to 1 in 3,000 hysterectomies. Certainly that risk fades in comparison to the fact that the majority of these
women deprived of their active ovaries will develop hot flashes, early bone
loss, and an increased risk of heart attack, and all their associated
complications. Even weaker reasons include a theory that ovaries when left
behind might stop working earlier than the expected age of menopause, which is
simply untrue for most women, or to prevent future surgery to remove ovarian
cysts, which of course might never develop.


There are some good reasons
for removing ovaries during gynecologic surgery, including nonfunctioning
ovaries in women past menopause, if the surgery is being done for pelvic
cancer, if there is a strong family history of ovarian cancer and/or breast
cancer, and when it is impossible to save them because of pelvic infection or
certain other pelvic diseases like endometriosis.


The compelling reasons to
leave healthy ovaries intact are to prevent:

·      Menopausal symptoms that follow
their removal

·      Changes in other body organs like
skin, vagina, and breasts

·      Bone loss, osteoporosis, and

·      Earlier onset of the risk of heart

·      Unnecessary psychological stress

Advise women to discuss the
fate of their ovaries with their clinician and gynecologist before agreeing to
their removal, being certain that a genuine reason exists to justify this
action. If they are to be removed, they should ask whether or not they would be
candidates for estrogen therapy after surgery. Estrogen alone after
hysterectomy, provided there is no legitimate contraindication, is remarkably
safe and should be recommended at least until the anticipated median age of


The bottom line? Women need to
be aware about the fate of their ovaries during gynecologic surgery, and if
ovaries are removed before menopause, should be made aware of the benefits of
estrogen replacement.


Happy holidays


Wulf Utian MD PhD DSc


MENOPAUSE – Why one size does not fit



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