Out Go the Ovaries? Not So Fast

In an era of evidence-based medicine, we tend to assume our doctors are going by the latest research when they decide to, oh, say, remove a woman's ovaries when performing a hysterectomy. Not so, says a new analysis published Tuesday in the Cochrane Review database. There haven't been any well-conducted studies to examine the health risks and benefits of removing the ovaries during the second most common surgery performed on women. (Cesarean sections are the first, and another Cochrane Review out yesterday found there aren't enough data on this procedure to determine which surgical technique is safest.)

In essence, doctors are playing a guessing game when they decide whether or not to recommend ovary removal. An argument for keeping ovaries is that they produce estrogen, which protects the heart; an argument against is that they sometimes harbor cancerous tumors that grow silently until they've already spread. But ovarian cancer is far less common than heart disease, so weighing the true risks against the benefits becomes even more complicated. That's why research is needed, and why I think it's ridiculous that there haven't been any trials randomly assigning women undergoing hysterectomies to either have their ovaries removed or to leave them in to see whether there's any difference in terms of these diseases.

Most doctors use age as a basis for deciding in women who aren't at increased risk of ovarian cancer because of factors like family history. Women under 40 who get hysterectomies usually keep their ovaries, while those over 55 (after menopause shuts off the ovaries) usually have them removed. In between, about half of women have their ovaries removed and half do not. Given the appalling lack of data, the Cochrane researchers conclude that removing ovaries at the time of hysterectomy should be approached with caution. But many doctors may not take the time to do that, so the onus is on women to have a long conversation with their doctors carefully weighing all of the pros and cons of removing the ovaries along with the uterus. Your doctor should be looking at your heart disease risk factors (like high cholesterol), whether breast cancer runs in your family (it's sometimes linked to ovarian cancer), and whether you've had infertility problems (which are also associated with a higher ovarian cancer risk).