The New York Times: Women Who Keep Ovaries Live Longe
April 28, 2009
By RONI CARYN RABIN
Each year, hundreds of thousands of women who undergo hysterectomies have their ovaries removed along with their uterus, a practice meant to protect them from ovarian cancer. But a new study has found that women who keep their ovaries live longer.
While women who had their ovaries removed developed fewer breast cancers and almost entirely eliminated their risk of ovarian cancer over 24 years of follow-up, they were more likely to develop heart disease than women who kept their ovaries, and they were more likely to die. The new findings — from an analysis of data in the famous Nurses’ Health Study, published in the May issue of the journal Obstetrics & Gynecology — raises questions about a widespread practice. Some 300,000 American women a year, about half of those who have hysterectomies, have their ovaries removed.
“This finding is contrary to 35 years of teaching in gynecology,” said the lead author, Dr. William H. Parker of the John Wayne Cancer Institute in Santa Monica, Calif.
Continue reading at: http://www.nytimes.com/2009/04/28/health/research/28ovar.html
CBS: Study Questions Ovary Removal
Only On The Web: Dr. William Parker, from Santa Monica's St. John's Health Center, discusses his recently released study which questions commonly held beliefs concerning women and their ovaries.
April 22, 2009 6:36 PM
Los Angeles Times: Routine removal of ovaries is questioned by new research
Women who have their healthy ovaries taken out during hysterectomy face a higher risk of death than those who keep them, a new study finds.
By Deborah L. Shelton
April 21, 2009 Reporting from Chicago -- Women who have their healthy ovaries removed when they have a hysterectomy face a higher risk of death -- including death from coronary heart disease and lung cancer -- than women who keep their ovaries, according to new research.
The finding from a study published in the May issue of the journal Obstetrics & Gynecology challenges conventional wisdom that removing ovaries along with the uterus offers the best chance for long-time survival.
Continue reading at: http://www.latimes.com/news/nationworld/nation/la-na-hysterectomy21-2009apr21,0,4404944.story
Reuters: Hysterectomy plus ovary removal possibly harmful
Fri Apr 24, 2009 4:09pm EDT
NEW YORK (Reuters Health) - During hysterectomy operations, surgeons often remove a woman's ovaries as well as her uterus. But new research suggests that for women are not at high risk for ovarian cancer, removing the ovaries during hysterectomy may adversely impact long-term health.
Removal of the ovaries at the time of hysterectomy for benign (non-cancerous) disease is often done to prevent the future development of ovarian cancer. While this practice can prevent ovarian cancer, there is also evidence that early menopause induced by ovary removal increases a woman's risk of developing heart disease.
Continue reading at: http://www.reuters.com/article/healthNews/idUSTRE53N60I20090424
WebMD: Hysterectomy - Spare Ovaries, Boost Health?
Ovary Removal Decreases Ovarian Cancer Risk but Increases Risk of Heart Disease and Death, Study Says
By Kathleen Doheny
WebMD Health News
Reviewed by Louise Chang, MD
April 21, 2009 -- Ovary removal during a hysterectomy is often done to reduce the risk of ovarian cancer. But doing so also boosts the risk of heart disease and death long-term, according to a new study.
For women without a strong family history of ovarian cancer or genetic predisposition to it, these heart disease and death risks appear to outweigh the benefit of the decreased cancer risk, says William H. Parker, MD, the study's lead author and a gynecologic surgeon and researcher at the John Wayne Cancer Institute at St. John's Health Center, Santa Monica, Calif. The study is published in the May issue of Obstetrics & Gynecology.
It's time to rethink the routine removal of ovaries, Parker says. "For the past 35 years, any woman over 40 or 45, when they needed a hysterectomy, would be told by the doctor, 'We should take out the ovaries to prevent ovarian cancer,'" Parker tells WebMD.
The Guardian (UK): US study - Women who have ovaries removed face increased risk of death
Finding challenges the notion that removing ovaries along with the uterus offers the best chance for long-time survival
Women who have their healthy ovaries removed when they have a hysterectomy face a higher risk of death, including death from coronary heart disease and lung cancer, than women who keep their ovaries, according to new research.
The finding, from a study published in the May issue of the journal Obstetrics & Gynecology, challenges conventional wisdom that removing ovaries along with the uterus offers the best chance for long-time survival.
Continue reading at: http://www.guardian.co.uk/science/2009/apr/21/ovary-removal-hysterectomy-death
More Magazine: The Endangered Uterus
If someone suggested that you undergo an elective procedure that could keep you out of work -- and in pain -- for six weeks, might leave you incontinent, deep-six your sex life, increase your risk of osteoporosis and heart disease, and possibly shorten your life span, would you do it? Maybe not -- but what if your trusted ob-gyn told you it was a good move?
Chances are you would agree to it. In fact, every day, as often as 11 times every 10 minutes, women in the United States struggling with noncancerous pelvic conditions -- including fibroids, endometriosis, and heavy periods -- agree to resolve the problem by getting rid of their reproductive organs. Ninety percent of hysterectomies in this country are performed for reasons other than cancer treatment, and the vast majority involve major open abdominal surgery. Women between 40 and 54 are most at risk, and not just because the onset of many pelvic disorders occurs during the years leading up to menopause. The hysterectomy rate is so high because many of us take our doctor's word that once we are finished bearing babies, it's no great loss if our problematic uterus, and maybe even our ovaries, are removed. Don't believe it. And don't believe that there are no alternatives to open abdominal surgery. The question is, why isn't your doctor telling you about them?
Continue reading at: http://www.more.com/4488/2382-the-endangered-uterus
More Magazine: You Really Do Need Your Ovaries
The latest research confirms that our reproductive organs help keep us healthy long after midlife.
I spent several months last year reporting for More about the many alternatives to hysterectomy that are now available to women who are struggling with noncancerous pelvic conditions like fibroids, uterine bleeding, and endometriosis. (See The Endangered Uterus for the full dope on why your doctor may not be telling you about these options.)
The fact remains, however, that sometimes, when other treatments fail, a hysterectomy is the best choice and can provide the relief a woman so desperately needs. Here's the problem: In the majority of cases, women don't just lose their uterus when they go in for a hysterectomy. "Their doctor advises them that they might as well have their ovaries out, too, so they can avoid ovarian cancer," says William H. Parker, M.D., of the John Wayne Cancer Institute at Saint John’s Health Center in Santa Monica, CA.
Continue reading at: http://www.more.com/4488/5442-important-hysterectomy-news--hold-onto
Keeping Ovaries After Hysterectomy Boosts Survival
By Kathleen Doheny
MONDAY, Aug. 1 (HealthDay News) -- Removing the ovaries along with the uterus during a hysterectomy done for noncancerous conditions is common in women over the age of 45, but a new study suggests it may not be the wisest course for long-term survival.
Keeping the ovaries is clearly best for women up to age 65 who are at average risk of getting ovarian cancer and get a hysterectomy for noncancerous conditions, said study author Dr. William Parker, a staff gynecologist at Santa Monica-UCLA Medical Center in Los Angeles. His finding appears in the August issue of Obstetrics & Gynecology .
In his review of 20 years of published data from various sources, Parker and his team found that preserving the ovaries in this group of women reduces their risk for heart disease and hip fractures.
"Twenty-five times more women die from heart disease every year than from ovarian cancer," Parker said.
For many years, the prevailing medical wisdom has been to remove the ovaries when the uterus is removed if women are past childbearing age to prevent ovarian cancer, Parker said. About half of women have their ovaries removed during hysterectomy.
However, the ovaries keep making small amounts of estrogen for years after natural menopause. Ovarian testosterone and androstenedione, two hormones, have been documented in some women in their 80s. Muscle and fat cells turn testosterone into circulating estrogen, in turn protecting against heart disease and osteoporosis.
Each year in the United States , more than 600,000 hysterectomies are performed. Ninety percent are performed for benign diseases, Parker said, such as uterine fibroids or endometriosis, in which the lining of the uterus begins to grow on the outside of the uterus and on nearby organs.
Parker's team tried to find out the age-specific risks for five conditions linked to the presence or absence of ovaries, including ovarian cancer, breast cancer, heart disease, hip fractures and stroke. They compared four strategies for hypothetical groups of women aged 40 to 80 who had a hysterectomy: ovary conservation with or without estrogen therapy later, and ovary removal with or without estrogen therapy later.
For women at average risk of ovarian cancer, heart disease, osteoporosis, breast cancer and stroke, the probability of survival to age 80 after hysterectomy at ages 50 to 54 ranged from 62 percent for those who kept their ovaries but didn't take estrogen, to 53 percent for those who had their ovaries removed but didn't take estrogen.
Keeping the ovaries without estrogen therapy reduced the percent of women dying by age 80 of heart disease from 15 percent to 7 percent, and those dying of hip fractures from nearly 5 percent to 3 percent.
The reductions in those two diseases, Parker said, far outweigh the increase in ovarian cancer deaths by age 80.
"If you take out the ovaries, the risk of ovarian cancer goes to zero," Parker said, "but you lose the protection against heart disease and the prevention of osteoporosis."
Was he surprised? "Yes. I really did think that taking out the ovaries wasn't beneficial for [overall] mortality," Parker said. "But I didn't suspect that leaving them in would be so clearly beneficial."
Another expert familiar with the new study, Dr. Richard Paulson, a professor of reproductive medicine at the University of Southern California, Los Angeles, praised the work. "It's wonderful," he said. "When I first read it, my first thought was, why has this not been done before?"
"What has been lacking up to this point was a good analysis for the data. You've got the cancer doctors saying, 'You can't leave them behind, the patient is going to get cancer [of the ovaries] and die.' On the other hand, you have the hormone doctors, the endocrinologists who are saying that the postmenopausal ovaries make important hormones, and we should leave them intact. What was needed was for someone to crunch the numbers and come up with relative risks."
Neither Paulson nor Parker think practice will change overnight. But the new study is food for thought, and women aged 45 and above who are facing a hysterectomy for noncancerous conditions should be aware of the new analysis, they said.
Conserving Ovaries at Hysterectomy May Boost Long-Term Survival
By Megan Rauscher
NEW YORK (Reuters Health) Aug 03 - The results of a Markov decision analytic model indicate that leaving both ovaries intact in women 65 years old or younger has long-term survival benefits in patients at average risk for ovarian cancer who undergo hysterectomy for benign disease.
"Prophylactic oophorectomy is often recommended concurrent with hysterectomy for benign disease," Dr. William H. Parker from the University of California , Los Angeles , and colleagues note in the August issue of Obstetrics and Gynecology.
The model they developed, however, shows that women who undergo oophorectomy before age 55 have 8.58% excess mortality by age 80. Those who undergo oophorectomy before age 59 have 3.92% excess mortality.
There is "sustained, but decreasing," benefit of ovarian conservation until the age of 75, "when excess mortality for oophorectomy is less than 1%," the authors report. "These results were unchanged following multiple sensitivity analyses and were most sensitive to the risk of coronary artery disease," according to the team.
"The important point," Dr. Parker said, "is that gynecologists who have been looking at the issue of oophorectomy have focused on one thing -- ovarian cancer. Women are living longer and the major killer of women is heart disease, taking 25 times more women's lives than ovarian cancer."
"The ovaries produce testosterone and androstenedione for 30 years after menopause," he continued, "and these hormones are converted into estrogen, continuing the protection of the heart and bones. So, I think we need to look at the bigger picture, including the long-term implications of oophorectomy."
"Our study does shows that oophorectomy may be harmful if performed before age 65 and may be of no benefit at any age," Dr. Parker told Reuters Health. "These results, of course, do not apply to women at high risk of ovarian cancer," he emphasized.
Obstet Gynecol 2005;106:219-226.
Removal of Ovaries Increases Heart Disease Risk
The common practice of removing the ovaries during hysterectomy should be discouraged, new research sustains. Oophorectomy, the removal of ovaries, seems to harm rather than help, and may actually shorten the lives of the female patients undergoing it.
Hysterectomy implies the removal of the uterus and sometimes the cervix (total hysterectomy) and is performed particularly when cancer threatens, but also, more recently, for reasons that are not life-threatening - fibroid tumors, excessive menstrual bleeding, although there are more options for these disorders then hysterectomies. 90% of the 615,000 hysterectomies performed each year are for non-cancerous reasons.
As for the removal of ovaries when hysterectomy is performed, federal data from the late 1990s show that 78 percent of women between ages 45 and 64 who underwent a hysterectomy had their ovaries taken out as well , though most were not at particular risk for ovarian cancer. Medical attitude is generally to take them out as a protective measure, even in women who are not at particular risk of ovarian cancer. Reasons in support of this were that childbearing was over and menopause imminent, as well as ovarian cancer particularly deadly. There is no evidence, however, that oophorectomy is beneficial for these women, this current study confirms. The ovaries can be left intact in women who have a normal risk of cancer.
The lead researcher of the study, Dr. William H. Parker, clinical professor at the University of California, Los Angeles School of Medicine, used data from other studies about women's mortality risks and from studies tracking heart attacks and bone-thinning osteoporosis in oophorectomy patients; he created a model of how women with different characteristics would fare with ovary removal at different ages.
The models suggest that, for women whose ovaries were removed before the age of 65, there was an increased risk of death from heart disease.
As many as 18,000 women a year may die prematurely because of ovarian surgery
Dr. William H. Parker
Dr. Parker found that 9% fewer women who had an oophorectomy between ages 50 and 54 reached the age of 80 than women who had a hysterectomy, but kept their ovaries. He also reached the conclusion that the older a woman was when she had her ovaries removed, the smaller was the impact on her chances of reaching 80 and the younger a woman is when she has an oophorectomy, the longer the absence of ovaries will have an impact on her health.
Surprisingly enough, women who kept their ovaries also reduced their chances of developing ovarian cancer by 40 percent, as compared with women who did not have hysterectomies at all.
Dr. Parker is hoping that doctors will now consider both the advantages and disadvantages of this practice and present both to their patients before advising them to have their ovaries removed. The findings were published in yesterday's issue of the journal "Obstetrics & Gynecology".
Study on ovaries sparks debate
Tuesday, August 02, 2005
By PATRICIA NORRIS
SPRINGFIELD - Local doctors urged the public to use common sense when digesting a new study that found thousands of women may die prematurely after their ovaries are removed.
"I would encourage women to be reluctant to give up any of their organs until someone can prove to them it is in their health's interest," said Dr. Reed Shnider, director of preventive cardiology and wellness at Baystate Medical Center .
It has been customary for surgeons to remove the ovaries of women who have a hysterectomy, particularly if they are over 45, to eliminate the risk of ovarian cancer. Ovarian cancer is uncommon but frequently deadly, because it has vague initial symptoms and often goes undiagnosed until cancer has spread throughout the body.
The study, published in the journal of Obstetrics and Gynecology, suggests patients need to be aware that ovaries provide benefits long after menopause. The ovaries apparently release small amounts of hormones that reduce heart disease and keep bones healthy, allowing women to live longer.
"The article caught my attention," said Dr. Michel Prefontaine, chief of the division of gynecological oncology at Baystate. "I treat mostly cancer so I have a jaundiced view of the subject. What I do see often enough is women who have had hysterectomies at 49 and then at 59 have ovarian cancer. I feel bad that this was a missed opportunity to prevent disease. But I don't see all of the other women who keep their ovaries and do well."
Prefontaine suggests women should know their family histories for breast and ovarian cancer. It may come down to how a patient interprets her own risk, he said.
"I had a woman today who was reading the article and she was saying, 'I don't care about the risk of heart attack. Ovarian cancer is much worse.' You may live longer but the suffering with ovarian cancer is not negligible," he said.
At the very least, the study should hammer home to doctors and patients that ovary removal should not be automatic.
"It's not going to be a one-minute discussion," Prefontaine said.
Shnider said the study also points out that ovaries know what the cardiologists don't - how to provide women with the right dose and mixture of hormones to keep their hearts healthy. Synthetic hormone replacements have been problematic, Shnider said.
"It appears the ovaries have natural wisdom that we don't have. So it is worthwhile to hold on to every organ you can within reason in order to get the benefits," he said.