Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women

Orozco LJ, Salazar A, Clarke J, Tristán M

Published Online:

November 10, 2010

Removing the ovaries at the time of hysterectomy could potentially improve longevity as it reduces the risk of ovarian cancer and the need for future gynaecological procedures. However, women who have had their ovaries removed have also been reported to have an increase in cardiovascular disease. Currently, there are no good quality studies of the benefits or harms of removing the ovaries at the time of hysterectomy. Until well-designed studies that compare women undergoing hysterectomy with women undergoing hysterectomy and removing ovaries are undertaken, removing the ovaries at the time of hysterectomy should be approached with caution.

Abstract (click to read)

Background:

Prophylactic oophorectomy alongside hysterectomy in premenopausal women is common. The decision to remove or conserve the ovaries is often based on the perceived risk for ovarian cancer and the need for other additional gynaecological surgical interventions. The benefits or harms of prophylactic bilateral oophorectomy at the time of hysterectomy in premenopausal women are unknown.

Objectives:

To determine whether premenopausal women with hysterectomy without oophorectomy for benign gynaecological conditions versus hysterectomy plus bilateral oophorectomy would have a higher mortality rate and future gynaecological surgical interventions.

Search strategy:

We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (December 2005 to October 2007) and the following electronic databases: CENTRAL (The Cochrane Library 2007, Issue 4), MEDLINE (January 1966 to October 2007), EMBASE (January 1985 to October 2007), LILACS (January 1982 to October 2007), Biological Abstracts (January 1968 to October 2007), NHS Economic Evaluation Database (inception to October 2007), Health Technology Assessment Database (inception to October 2007), and the Meta RCTs (inception to October 2007). Reference lists of relevant articles were also searched.

Selection criteria:

Randomised controlled and controlled trials of hysterectomy (using any surgical approach) without oophorectomy versus hysterectomy (using any surgical approach) with bilateral oophorectomy in premenopausal women with benign gynaecological conditions.

Data collection and analysis:

Three review authors independently assessed trials for inclusion, determined study quality and extracted data. Study authors were contacted where information was unclear.

Main results:

Of the 119 studies identified, only one controlled trial was included. Therefore, a quantitative meta-analysis was not feasible. The results of this study (with two publications) including 362 women were summarised in a narrative format. No randomised controlled trials were found.

Neither publication reported on the primary outcomes stated in this review. The trial showed evidence of very low quality of a positive effect on psychological well-being for both groups at one year follow up. No significant differences were found between the groups of women studied regarding any aspect of their sexuality.

Authors' conclusions:

The conclusions of this review are limited by the lack of data. More research of higher methodological quality is needed.

This record should be cited as:

Orozco LJ, Salazar A, Clarke J, Tristán M. Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD005638. DOI: 10.1002/14651858.CD005638.pub2

Assessed as up to date:

March 30, 2008

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Primary Review Group:

Menstrual Disorders and Subfertility Group

Health topics:

Gynaecology > Surgery

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women

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