Hysterectomy versus hysterectomy plus ovary removal for premenopausal women

Review question: Cochrane authors reviewed the evidence on the risks and benefits of the removal or conservation of ovaries at the time of hysterectomy for benign gynaecological disease in premenopausal women.

Background: removing the ovaries at the time of hysterectomy could potentially reduce the risk of ovarian cancer and the need for future gynaecological procedures. However, premenopausal women who have had their ovaries removed have also been reported to have an increased risk of cardiovascular disease and other complications due to early menopause. It is not clear yet whether premenopausal women should be advised to have their ovaries removed or conserved at the time of hysterectomy.

Study characteristics: studies were sought up to January 2014. No randomised studies were available that compared hysterectomy without removal of the ovaries versus hysterectomy plus removal of the ovaries.

Key results: because of the lack of appropriate studies this review does not provide evidence to support removal or conservation of the ovaries at the time of hysterectomy in premenopausal women. Therefore, until evidence is available prophylactic removal of the ovaries should be regarded with caution.

Authors' conclusions: 

The conclusions of this review are limited by a lack of RCTs. Although no evidence is available from RCTs, there is growing evidence from observational studies that surgical menopause may impact negatively on cardiovascular health and all cause mortality.

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Background: 

Prophylactic oophorectomy alongside hysterectomy in premenopausal women is a common procedure. The decision to remove or conserve the ovaries is often based on the perceived risk for ovarian cancer and the need for additional gynaecological surgical interventions, and is weighed against the perceived risk of negative health effects caused by surgically induced menopause. The evidence needed to recommend either prophylactic bilateral oophorectomy or conservation of ovaries at the time of hysterectomy in premenopausal women is limited. This is an update of the original version of this systematic review published in 2008.

Objectives: 

To compare hysterectomy alone versus hysterectomy plus bilateral oophorectomy in women with benign gynaecological conditions, with respect to rates of mortality or subsequent gynaecological surgical interventions.

Search strategy: 

We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (December 2005 to January 2014) and the following electronic databases: CENTRAL (The Cochrane Library 2013, Issue 12), MEDLINE (January 1966 to January 2014), EMBASE (January 1985 to January 2014), and PsycINFO (1806 to January 2014).

Selection criteria: 

Randomised controlled trials (RCTs) of hysterectomy alone versus hysterectomy with bilateral oophorectomy in premenopausal women with benign gynaecological conditions were eligible. Any surgical approach could be used.

Data collection and analysis: 

Three review authors independently assessed trials for inclusion. Study authors were contacted if information was unclear.

Main results: 

Only one RCT comparing the benefits and risks of hysterectomy with or without oophorectomy was identified. The results of this pilot RCT have not been published and we have not been able to obtain the results. Therefore, no data could be included in this review.

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