You Really Do Need Your Ovaries

I spent several months last year reporting for More about the many alternatives to hysterectomy that are now available to women who are struggling with noncancerous pelvic conditions like fibroids, uterine bleeding, and endometriosis.
The fact remains, however, that sometimes, when other treatments fail, a hysterectomy is the best choice and can provide the relief a woman so desperately needs. Here’s the problem: In the majority of cases, women don’t just lose their uterus when they go in for a hysterectomy. "Their doctor advises them that they might as well have their ovaries out, too, so they can avoid ovarian cancer," says William H. Parker, M.D., of the John Wayne Cancer Institute at Saint John’s Health Center in Santa Monica, CA.
Now, a major study coauthored by Parker has provided the best evidence yet that this thinking is, to put it simply, dead wrong. "We based our observations on nearly 30,000 participants in the Nurses’ Health Study who underwent hysterectomy for benign disease. Over 24 years of follow up, we found that the women who had their ovaries removed did not live as long as the women who kept their ovaries," says Parker. The primary reason: Getting rid of ovaries may very well do away with the risk of ovarian cancer, but it  increases our chances of developing heart disease—which is a far more common killer. "The fact is that you are about 30 times more likely to die of heart disease than you are of ovarian cancer. So if you’re looking at odds, you’re generally better off keeping your ovaries,” says Parker, who is also the author of A Gynecologist’s Second Opinion.

What, you may wonder, is the ovary-heart connection? And what can ovaries possbily do but cause trouble after we’ve gone through menopause? Here’s the explanation in a nutshell: While our ovaries might produce a diminishing amount of estrogen after we go through menopause, they continue to produce testosterone and androstenedione, which still provide crucial protection against heart disease. (Never mind that testosterone also helps preserve our sex drive, bolster energy levels and maintain lean body tissue.) Women in Parker’s study who did not take any therapeutic estrogen after their ovaries were removed faced an even higher risk of heart disease and stroke. Not for nothing, women who had bilateral oopherectomy along with their hysterectomy also had higher rates of lung cancer, according to Parker’s research.

There are, of course, exceptions to this "hold onto your ovaries" mantra: If you have a strong family history of cancer, especially breast or ovarian (even if you don’t have the “breast cancer gene”) you might be better off without them. “There are also women who have lost close friends to ovarian cancer and are terrified of the disease. For them, keeping their ovaries might not be worth it if they are going to spend the rest of their lives miserable with worry.”  
Parker’s study has been well received by the medical brass. A global faculty of experts has, in fact, reviewed the research and issued a recommendation that ob/gyns change their clinical practice with regards to prophylactic removal of ovaries during hysterectomy for benign disease. But don’t assume that your doc is going to be up to speed and eager to embrace this advice. It’s a disturbing truth that it takes about 15 years for new standards and techniques to become common practice in the medical profession. “If we wait that long, about 4.5 million women who undergo hysterectomy will lose perfectly healthy ovaries and perhaps unknowingly shorten their lifespan,” says Parker. The best advice? Forward Parker’s study to anyone you know who might be considering a hysterectomy. And bookmark it for yourself, just in case.
 

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