Hysterectomies can be performed with or without ovarian removal. Removing the uterus stops periods. Removing the ovaries cuts off all estrogen and progesterone production and most testosterone production. Supplementing with hormones after hysterectomy can modify risks and benefits of ovarian removal, but the research is not as clear on how much benefit that would confer.
Questions are the following: What are the risks of leaving the ovaries or taking the ovaries, and what are the benefits of leaving the ovaries or taking the ovaries. How old you are, your prior gynecologic history, the shape your ovaries are in at the time of hysterectomy is very important. Removing both the ovaries has a different risk than removing one ovary, and it’s different still if you have previously had one ovary removed. Risks and benefits vary depending upon age. It is more risky to remove your ovaries if you are younger than age 45 at the time of your hysterectomy. If you have had children your risks and benefits are different from someone who never did.
Surgery is more complicated with ovarian removal, and slightly increases risks of the surgery itself. Bleeding, infection, and damage to the ureters all at a higher rate than leaving the ovaries.
If you leave the ovaries, the process of surgery may compromise them anyway. The past studies of how healthy a woman’s ovaries are after hysterectomy concluded that hysterectomy may lead to ovarian damage. The PROOF study showed using the AMH level that hormone levels do decline from the ovaries after a hysterectomy. They used AMH to determine this as it is a blood test and can help watch your hormone balance over time.
1. Removal of both the ovaries at the time of hysterectomy for a woman who is still ovulating puts a woman at risk for certain diseases low hormone levels, but very importantly it reduces her risk of ovarian cancer by about 98%. There is significantly less risk of breast cancer as well.
2. It has also been shown that losing both ovaries will have various negative neurological consequences including increased risk of Parkinson’s disease, increase her risk of declining cognitive function and increase her risk of fatal coronary artery disease, decrease her quality of life, and increase her risk of all-cause mortality.
3. Adding in bioidentical or other types of estrogen therapy will moderate the risk of any of the above consequences for a woman when she loses her ovaries, even if the remaining ovaries are not as healthy as they were prior to the hysterectomy surgery. Testosterone is also lost with ovarian removal.
4. Too few women consult for hormone therapy after they get a hysterectomy with ovarian removal. It is true that the risks of these conditions can be reduced by restoring natural estrogen use with the use of estrogen supplementation. But the fears about the risks of estrogen have driven many women away from appropriate estrogen supplementation after premenopausal ovarian removal. Only about 7% of women take hormone therapy, even those who go through what is a premature surgical menopause. The most common age for a hysterectomy is age 40-45. The natural age of menopause is 51.4 so the average woman who has a hysterectomy with her ovaries taken out loses a decade of ovarian function.
5. Menopause Vol 21, 2014, has proposed the idea of keeping just one ovary instead of two at the time of hysterectomy. The questions are many, we don’t usually discuss whether a woman will need hormones after keeping just one ovary, and we don’t discuss whether one ovary is superior to the other, or whether one ovary is more likely to get cancer than the other ovary.
6. We may not know which ovary is the best one to take. In the new study mentioned above it is discussed that the right ovary is just a bit more likely to get ovarian cancer, but endometriosis is a bit more likely in the left ovary than in the right. The right ovary ovulates more than the left, about 65-80% of the time is a woman ovulating on the right alone. And fertility clinics report, according to Dr. Brown, more pregnancies from right sided ovulation, especially with IVF, at over 3 times the rate of pregnancies. The final conclusion is that you should discuss all medical decisions with your gyno as there may be particulars of your personal case to discover.
7. The information from the Rochester Epidemiology Project database is that all women after hysterectomy have higher risks of heart disease whether or not they keep their ovaries. This higher risk also extends to more risk of elevated blood lipids, increased risk of diabetes and increased risk of hypertension.
8. In a study of long term outcomes of hysterectomy published in the January 2024 journal Obstetrics and Gynecology, has found that in spite of decreased risk of breast and ovarian cancer, there is a increase in colorectal cancer, thyroid cancer, and renal cancer after both ovaries are removed.
As with other surgical decisions, women need to discuss with their providers their overall health, genetics, and health history, when making those final decisions regarding whether to elect to remove ovaries at the time of a hysterectomy.
More on Age of Menopause, See the Book Making Peace With Change
