Management of adnexae (RANZCOG)

Question 1

What was the conclusion from the nurses Health Study regarding adnexal management?

Answer 1

compared with ovarian conservation, bilateral oophorectomy at the time of hysterectomy for benign disease is associated with decreased risk of breast and ovarian cancer, but increased risk of all cause mortality and fatal/nonfatal coronary heart disease.

Question 2

At what age did the Nurses Health study find that survival was not decreased by oophorectomy?

Answer 2

55yo

Question 3

List 5 potential risks of oophorectomy at time of hysterectomy for benign disease.

Answer 3

1. increased mortality due to coronary artery disease
2. increased morbidity and mortality due to osteoporosis related fracture
3. increased risk of cognitive dysfunction, including dementia
4. Increased risk of depressive/anxiety symptoms
5. if premenopausal: severe and prolonged vasomotor symptoms, reduction in libido or sexual functions

Question 4

What is the consensus on bilateral salpingectomy at time of hysterectomy for benign disease?

Answer 4

RANZCOG now recommends consideration be given to bilateral salpingectomy at the time of hysterectomy for benign gynaecological disease and that the risks and benefits be discussed with the patient on a case-by-case basis.
Furthermore, consideration should be given to bilateral salpingectomy instead of tubal occlusive procedures for female sterilisation

Question 5

What factors may influence decision making regarding oophorectomy?

Answer 5

• woman real or perceived risk of ovarian cancer
• indications for hysterectomy and planned approach
• personal risk factors for CHD, osteoporosis and depression
• absolute and relative personal contraindications to oestrogen therapy

Question 6

At what age does RANZCOG state that the potential risks and benefits should be considered before performing BSO?

Answer 6

65 years or below.