By William H. Parker, MD.

Despite the suspected advantages of having women keep their ovaries, no one had studied the risks of removing ovaries versus taking them out at the time of a hysterectomy needed for benign conditions. After hearing the arguments from both sides of the debate for many years, I decided to investigate this dilemma in a scientific way. The proper study would involve about 10,000 women scheduled to have hysterectomies and would require that the women be randomized - randomly divided into two groups of women - one group that would have their ovaries removed and one group that would keep their ovaries. Certainly, in real life, this is not going to happen. No woman would give up her right to choose whether she would keep her ovaries or not. The second problem is that in order to see if removal or conservation of the ovaries had any effect on health, the women would have to be monitored for disease every year or two for 40 years. Clearly, this is not ever going to happen either. So, it was clear that a study designed like this was not going to work.

So I chose to do the next best thing. I selected a team of doctors and scientists who had an interest in this subject and who had the complimentary skills and knowledge that could perform another kind of study using data from studies that had already been published and that examined the effect of removing or conserving ovaries with regards to the different diseases we thought were the most important hormone-related causes of death for women. These conditions are heart disease, hip fracture, stroke, ovarian cancer and breast cancer.

We then reviewed about 200 published related articles and chose the 50 or so best studies on which to base our study. We took pertinent data from each article and analyzed it for each of the 5 conditions we chose to study. The data was then put into a computer program and was analyzed for the results. The results were surprising. We thought that the results would show that there was not much difference whether the ovaries were removed or conserved - that the benefit of preventing ovarian cancer if the ovaries were removed would be balanced by the benefits of preventing heart disease, stroke and hip fracture if the ovaries were conserved. However, the results showed clearly that more women would live longer lives if they kept their ovaries.

We recently published this article in the renowned journal Obstetrics and Gynecology that showed a lower risk of dying before age 80 if you choose to keep your ovaries at the time you have a hysterectomy. By performing a computer analysis of the risks for heart disease, stroke, osteoporosis, ovarian cancer and breast cancer for women who have had their ovaries removed and comparing the risks of dying from these conditions for women who still have their ovaries, we found an advantage to leaving your ovaries in until age 65. And, based on our analysis, there is no real advantage to removing the ovaries at any age unless, of course, you are at high risk of developing ovarian cancer based on family history or genetic testing.

To put our study in perspective, let's compare 10,000 women between the ages of 50 to 54 who chose to have their ovaries removed to a group of women the same ages that chose to keep their ovaries. Our findings show that by the all the women reach 80 years old, 858 more will have died in the group that had their ovaries removed; while 47 fewer women will have died from ovarian cancer, 838 more women will have died from heart disease and 158 more women will have died from the complications of hip fracture.

The Study Here is the abstract from our article published in Obstetrics and Gynecology in August, 2005: Ovarian Conservation at the Time of Hysterectomy for Benign Disease William Parker, MD, Michael Broder , MD MPH, Zhimei Liu PhD, Donna Shoupe, MD, Cindy Farquhar , MD, Jonathan Berek , MD Obstetrics and Gynecology 2005; 106:219-26 Objective : Prophylactic oophorectomy is often recommended concurrently with hysterectomy for benign disease. The appropriate age for this recommendation has not been determined. Methods : Using published age-specific data for absolute and relative risk, both with and without oophorectomy, for ovarian cancer, coronary heart disease (CHD), hip fracture, breast cancer, and stroke, a Markov decision analysis model was used to determine the optimal strategy to maximize survival. For each 5-year age group from 40-80, four strategies were compared: ovarian conservation or oophorectomy; and use of ERT or non-use. Outcomes as proportion of women alive at age 80 were measured. Sensitivity analyses were performed varying both relative and absolute risk estimates across the range of reported values. Results : Ovarian conservation benefits long-term survival for women before age 65; women with oophorectomy before age 55 have 8.38% excess mortality by age 80 and before age 59 have 3.92% excess mortality. There is sustained, but decreasing, benefit until the age of 75, when excess mortality for oophorectomy is less than 1%. These results were unchanged following multiple sensitivity analyses and were most sensitive to the risk of coronary heart disease. Conclusion : Ovarian conservation before age 65 benefits long-term survival and may have some benefit for older women.