Removal of ovaries at time of hysterectomy- RANZCOG

Question 1

Benefits of ovarian conservation

Answer 1

The postmenopausal ovaries are physiologically active and continue to produce oestradiol (at low levels)
and testosterone.

Question 2

Disadvantages of ovarian conservation

Answer 2

Reduce risk of breast and ovarian ca

Question 3

Summary of evidence from trials listed in RANZCOG guideline:

Answer 3

• Modelling study in 2005 concluded that “women
  younger than 65 years of age clearly benefit from ovarian conservation, and at no age is there a clear
  benefit from prophylactic oophorectomy”

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Question 4

Risks of BSO

Answer 4

1. Increased mortality due to Coronary Heart Disease (CHD)6
2. Increased morbidity and mortality due to osteoporosis related fracture
3. Increased risk of cognitive dysfunction, including dementia
4. Increased risk of depressive and anxiety symptoms
5. In premenopausal women:  More severe and prolonged vasomotor symptoms than those seen following natural
   menopause.  Reduction in libido and sexual dysfunction.

With the exception of osteoporosis related fracture, it is unclear whether the incidence and severity of
the above conditions are ameliorated by oestrogen replacement therapy

Risk may be increased in women aged under 65

Question 5

Factors that may affect decision making for BSO

Answer 5

The factors that will influence the decision making are likely to be:
 The woman’s risk (real or perceived) of ovarian cancer.
 Indications for hysterectomy and the planned surgical
approach.
 Personal risk factors for CHD, osteoporosis and depression.
 Absolute and relative personal contraindications to
oestrogen therapy.