This blog post is based on the TOG article Oophorectomy or Ovarian Conservation at the Time of Hysterectomy for Benign Disease published in April 2022. This is one of the important and most debated aspects of the care of women undergoing hysterectomy due to benign conditions. This has almost always been a grey area in gynaecology, where clinical evaluation and judgment plays an essential role in the crucial decision to conserve or remove ovaries in women above the age of 40 years. This article provides the latest evidence related to this topic.
I hope you will find this quick summary helpful not only the exam preparation but also for your clinical practice as well.
Thanks.
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Introduction
- When a perimenopausal or menopausal woman is undergoing a hysterectomy for benign conditions, one of the concerns is whether to remove or conserve the ovaries. Leaving the ovaries can be associated with the risk of ovarian cancer later in life. However, the removal is also associated with some ill effects. All this will be discussed as follows.
Ovarian cancer has poor prognosis
- Diagnosis of cancer at 70 years — associated with 80% mortality
- Incidence — increases with age 10 in 100 000 in 40s 50 in 100 000 in 50s
- > 50% of women diagnosed at the advanced metastatic disease
- The lifetime risk of ovarian cancer - 1.4%
- With hereditary ovarian cancer syndromes risk is 25-50% for epithelial ovarian cancer
- BRCA mutation — associated with 90% of hereditary ovarian cancers but overall makeup only 10-15% of all ovarian cancers
- If this high-risk group is excluded, then the incidence for low-risk women <1%
Non-inherited risk factors
- Obesity & PCO
- Ovarian endometriosis can transform into cancer in 2.5% of cases
Ovarian function in the menopause
- Ovaries continue their endocrine function
- After menopause, women with intact ovaries have higher amounts of androgens