Should I Have My Ovaries Removed During My Hysterectomy?

Posting Date: 07/17/2000

Mary: My gynecologist says I need a hysterectomy because I have atypical cells. He says I should also decide if I want to have my ovaries and fallopian tubes removed at the same time to prevent future cancers.

How do I go about making a decision like this?

Dr. Dean: First of all let me say that atypical cells are a valid reason for removing your uterus -- doing a hysterectomy.

It is also true that taking out your ovaries will prevent ovarian cancer. Of course, having all your teeth pulled will prevent cavities, and having a prophylactic mastectomy will prevent breast cancer.

This is a tough decision. If the risk of cancer is high, a preventative oophorectomy has its place. But the risk of cancer is very small unless there is a family history of hormone-related cancers like breast and prostate cancer.

On the other hand, the risk of needing hormone replacement therapy after an oophorectomy is very high, because removal of the ovaries causes a significant drop in testosterone production leading to a loss of libido and a damaged sense of well being.

Some gynecologists think that removal of the ovaries should be a routine part of a hysterectomy, but for every case of ovarian cancer that routine removal prevents, a much higher number of women have their ovaries removed unnecessarily.

To be worthwhile, any preventative surgery has to prevent enough cases of disease to balance the effects of the high numbers of unnecessary surgeries. For example, we have to ask ourselves if preventing a bladder infection in one infant is worth circumcising a hundred other babies.

You should ask yourself if your risk of ovarian cancer is high enough to warrant having your healthy ovaries removed. If you were my wife, and you did not have a family history of hormonal cancer, I wouldn't find it necessary.

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