Preserving Ovaries, Preserving Health

Hysterectomies are the second most common surgeries among American women, after cesarean section deliveries.  More than half a million women, one in three, will undergo a hysterectomy before the age of 60. In addition to removing the uterus, half of those women are also advised to have an oophorectomy in which one or both ovaries are removed. Thought to provide significant protection against breast and ovarian cancer, the practice of oophorectomy may get a second look in light of groundbreaking new research.  

In a study published in this month's Obstetrics & Gynecology, researchers found that women who had their ovaries removed were at a much higher risk of death, heart disease and lung cancer than the women whose ovaries were preserved. The risk was even higher for women under the age of 50 at the time of their hysterectomy and oophorectomy. Because the ovaries continue to produce androgens which can be converted to estrogen in the body, experts believe that estrogen may play a key protective role against heart disease and this study adds to the evidence to support that suggestion.   

The authors were quick to point out that a woman with a strong family history of breast and/or ovarian cancers should still take precautions and have her ovaries removed, but this research suggests that women without a genetic predisposition for those cancers will probably fare better keeping their ovaries.  

In light of this research, will gynecologists change their practices?  Will women be informed that preserving their ovaries may preserve their health?    

Looking at the bigger picture, according to the National Women's Health Network, up to 90% of hysterectomies are medically unnecessary and yet, women are still having them. Why undergo major surgery with potential life-changing side effects like depression and loss of sex drive if it's not needed? Are women being informed about the non-surgical alternatives to hysterectomies?  Are women being told the whole story?   

Looking at the even bigger picture, evidence is emerging that environmental contaminants and chemicals in our everyday products may be contributing to a whole slew of female reproductive disorders, including fibroids, the number one reason for a hysterectomy. Protecting women against exposures to these chemicals could potentially reduce their risk of developing reproductive disorders, including cancer, and thus reduce the need for most elective hysterectomies.  

A growing body of medical professionals have taken the concerns about environmental health and reproductive health very seriously.  In September of last year, an editorial was published in American Family Physician alerting doctors to the risks of exposures to these chemicals and the need to educate patients. Similarly, the Association of Reproductive Health Professionals (ARHP) has become a clearinghouse of environmental and reproductive health information for physicians, including continuing medical education credits. Progress is being made, but it is too soon to say when the mainstream medical community will pick up these important connections and begin offering clinical advice for patients.   

Until it becomes clear to on how doctors will advise women to reduce their chemical risk for reproductive disorders, this study further strengthens a recommendation from the National Women's Health Network for women to explore non-surgical alternatives to hysterectomies.  At the very least, women considering a hysterectomy should talk to their doctors about preserving their ovaries.