Oophorectomy is the surgical removal of one or both ovaries. It is also called ovariectomy. If one ovary is removed, a woman may continue to menstruate and have children. If both ovaries are removed, menstruation stops and a woman loses the ability to have children.
Description
Oophorectomy is done under general anesthesia. It is performed through the same type of incision, either vertical or horizontal, as an abdominal hysterectomy. Horizontal incisions leave a less noticeable scar, but vertical incisions give the surgeon a better view of the abdominal cavity.
After the incision is made, the abdominal muscles are pulled apart, not cut, so that the surgeon can see the ovaries. Then the ovaries, and often the fallopian tubes, are removed.
Oophorectomy can sometimes be done with a laparoscopic procedure. With this surgery, a tube containing a tiny lens and light source is inserted through a small incision in the navel. A camera can be attached that allows the surgeon to see the abdominal cavity on a video monitor. When the ovaries are detached, they are removed though a small incision at the top of the vagina. The ovaries can also be cut into smaller sections and removed.
The advantages of abdominal incision are that the ovaries can be removed even if a woman has many adhesions from previous surgery. The surgeon gets a good view of the abdominal cavity and can check the surrounding tissue for disease. A vertical abdominal incision is mandatory if cancer is suspected. The disadvantages are that bleeding is more likely to be a complication of this type of operation. The operation is more painful than a laparoscopic operation and the recovery period is longer. A woman can expect to be in the hospital two to five days and will need three to six weeks to return to normal activities.
Who Performs the Procedure and Where Is It Performed?
Oophorectomies are usually performed in a hospital operating room by a gynecologist, a medical doctor who has completed specialized training in the areas of women's general health, pregnancy, labor and childbirth, prenatal testing, and genetics.
Questions to Ask the Doctor
Why is a oophorectomy being recommended?
How will the procedure be performed?
Will I have a remaining ovary (or portion of ovary)?
What alternatives to oophorectomy are available to me?
Definition
Unilateral oophorectomy (also called an ovariectomy) is the surgical removal of an ovary. If one ovary is removed, a woman may continue to menstruate and have children. If both ovaries are removed, a procedure called a bilateral oophorectomy, menstruation stops and a woman loses the ability to have children.
In an oophorectomy, one or a portion of one ovary may be removed or both ovaries may be removed. When an oophorectomy is done to treat ovarian cancer or other spreading cancers, both ovaries are removed (called a bilateral oophorectomy). Removal of the ovaries and fallopian tubes is performed in about one-third of hysterectomies (surgical removal of the uterus), often to reduce the risk of ovarian cancer.
Oophorectomies are sometimes performed on premenopausal women who have estrogen-sensitive breast cancer in an effort to remove the main source of estrogen from their bodies. This procedure has become less common than it was in the 1990s. Today, chemotherapy drugs are available that alter the production of estrogen and tamoxifen blocks any of the effects any remaining estrogen may have on cancer cells.
Until the 1980s, women over age 40 having hysterectomies routinely had healthy ovaries and fallopian tubes removed at the same time. This operation is called a bilateral salpingo-oophorectomy. Many physicians reasoned that a woman over 40 was approaching menopause and soon her ovaries would stop secreting estrogen and releasing eggs. Removing the ovaries would eliminate the risk of ovarian cancer and only accelerate menopause by a few years.
In the 1990s, the thinking about routine oophorectomy began to change. The risk of ovarian cancer in women who have no family history of the disease is less than 1%. Meanwhile, removing the ovaries increases the risk of cardiovascular disease and accelerates osteoporosis unless a woman takes prescribed hormone replacements.
Under certain circumstances, oophorectomy may still be the treatment of choice to prevent breast and ovarian cancer in certain high-risk women. A study done at the University of Pennsylvania and released in 2000 showed that healthy women who carried the BRCA1 or BRCA2 genetic mutations that pre-disposed them to breast cancer had their risk of breast cancer drop from 80% to 19% when their ovaries were removed before age 40. Women between the ages of 40 and 50 showed less risk reduction, and there was no significant reduction of breast cancer risk in women over age 50. A 2002 study showed that five years after being identified as carrying BRCA1 or BRCA2 genetic mutations, 94% of women who had received a bilateral salpingo-oophorectomy were cancer-free, compared to 79% of women who had not received surgery.
The value of ovary removal in preventing both breast and ovarian cancer has been documented. However, there are disagreements within the medical community about when and at what age this treatment should be offered. Preventative oophorectomy, also called prophylactic oophorectomy, is not always covered by insurance. One study conducted in 2000 at the University of California at San Francisco found that only 20% of insurers paid for preventive bilateral oophorectomy (PBO). Another 25% had a policy against paying for the operation, and the remaining 55% said that they would decide about payment on an individual basis.
Demographics
Overall, ovarian cancer accounts for only 4% of all cancers in women. But the lifetime risk for developing ovarian cancer in women who have mutations in BRCA1 is significantly increased over the general population and may cause an ovarian cancer risk of 30% by age 60. For women at increased risk, oophorectomy may be considered after the age of 35 if childbearing is complete.
Other factors that increase a woman's risk of developing ovarian cancer include age (most ovarian cancers occur after menopause), the number of menstrual periods a woman has had (affected by age of onset, pregnancy, breastfeeding, and oral contraceptive use), history of breast cancer, diet, and family history. The incidence of ovarian cancer is highest among Native American (17.5 cases per 100,000 population), white (15.8 per 100,000), Vietnamese (13.8 per 100,000), white Hispanic (12.1 per 100,000), and Hawaiian (11.8 per 100,000) women; it is lowest among Korean (7.0 per 100,000) and Chinese (9.3 per 100,000) women. African American women have an ovarian cancer incidence of 10.2 per 100,000 population.
Description
Oophorectomy is done under general or regional anesthesia. It is often performed through the same type of incision, either vertical or horizontal, as an abdominalhysterectomy. Horizontal incisions leave a less noticeable scar, but vertical incisions give the surgeon a better view of the abdominal cavity. After the incision is made, the abdominal muscles are stretched apart, not cut, so that the surgeon can see the ovaries. Then the ovaries, and often the fallopian tubes, are removed.
Oophorectomy can sometimes be done with a laparoscopic procedure. With this surgery, a tube containing a tiny lens and light source is inserted through a small incision in the navel. A camera can be attached that allows the surgeon to see the abdominal cavity on a video monitor. When the ovaries are detached, they are removed though a small incision at the top of the vagina. The ovaries can also be cut into smaller sections and removed.
The advantages of abdominal incision are that the ovaries can be removed even if a woman has many adhesions from previous surgery. The surgeon gets a good view of the abdominal cavity and can check the surrounding tissue for disease. A vertical abdominal incision is mandatory if cancer is suspected. The disadvantages are that bleeding is more likely to be a complication of this type of operation. The operation is more painful than a laparoscopic operation and the recovery period is longer. A woman can expect to be in the hospital two to five days and will need three to six weeks to return to normal activities.
Diagnosis/Preparation
Before surgery, the doctor will order blood and urine tests, and any additional tests such as ultrasound or x rays to help the surgeon visualize the woman's condition. The woman may also meet with the anesthesiologist to evaluate any special conditions that might affect the administration of anesthesia. A colon preparation may be done, if extensive surgery is anticipated.
On the evening before the operation, the woman should eat a light dinner, then take nothing by mouth, including water or other liquids, after midnight.
Aftercare
After surgery a woman will feel discomfort. The degree of discomfort varies and is generally greatest with abdominal incisions, because the abdominal muscles must be stretched out of the way so that the surgeon can reach the ovaries. In order to minimize the risk of postoperative infection, antibiotics will be given.
When both ovaries are removed, women who do not have cancer are started on hormone replacement therapy to ease the symptoms of menopause that occur because estrogen produced by the ovaries is no longer present. If even part of one ovary remains, it will produce enough estrogen that a woman will continue to menstruate, unless her uterus was removed in a hysterectomy. To help offset the higher risks of heart and bone disease after loss of the ovaries, women should get plenty of exercise, maintain a low-fat diet, and ensure intake of calcium is adequate.
Return to normal activities takes anywhere from two to six weeks, depending on the type of surgery. When women have cancer, chemotherapy or radiation are often given in addition to surgery. Some women have emotional trauma following an oophorectomy, and can benefit from counseling and support groups.
Risks
Oophorectomy is a relatively safe operation, although, like all major surgery, it does carry some risks. These include unanticipated reaction to anesthesia, internal bleeding, blood clots, accidental damage to other organs, and post-surgery infection.
Complications after an oophorectomy include changes in sex drive, hot flashes, and other symptoms of menopause if both ovaries are removed. Women who have both ovaries removed and who do not take estrogen replacement therapy run an increased risk for cardiovascular disease and osteoporosis. Women with a history of psychological and emotional problems before an oophorectomy are more likely to experience psychological difficulties after the operation.
Complications may arise if the surgeon finds that cancer has spread to other places in the abdomen. If the cancer cannot be removed by surgery, it must be treated with chemotherapy and radiation.
Normal Results
If the surgery is successful, the ovaries will be removed without complication, and the underlying problem resolved. In the case of cancer, all the cancer will be removed. A woman will become infertile following a bilateral oophorectomy.
Morbidity and Mortality Rates
Studies have shown that the complication rate following oophorectomy is essentially the same as that following hysterectomy. The rate of complications associated with hysterectomy differs by the procedure performed. Abdominal hysterectomy is associated with a higher rate of complications (9.3%), while the overall complication rate for vaginal hysterectomy is 5.3%, and 3.6% for laparoscopic vaginal hysterectomy. The risk of death is about one in every 1,000 women having a hysterectomy. The rates of some of the more commonly reported complications are:
excessive bleeding (hemorrhaging): 1.8–3.4%
fever or infection: 0.8–4.0%
accidental injury to another organ or structure: 1.5–1.8%
Because of the cessation of hormone production that occurs with a bilateral oophorectomy, women who lose both ovaries also prematurely lose the protection these hormones provide against heart disease and osteoporosis. Women who have undergone bilateral oophorectomy are seven times more likely to develop coronary heart disease and much more likely to develop bone problems at an early age than are premenopausal women whose ovaries are intact.
Alternatives
Depending on the specific condition that warrants an oophorectomy, it may be possible to modify the surgery so at least a portion of one ovary remains, allowing the woman to avoid early menopause. In the case of prophylactic oophorectomy, drugs such as tamoxifen may be administered to block the effects that estrogen may have on cancer cells.
Resources
Periodicals
Kauff, N. D., J. M. Satagopan, M. E. Robson, et al. "Risk-Reducing Salpingo-oophorectomy in Women With a BRC1 or BRC2 Mutation." New England Journal of Medicine 346 (May 23, 2002): 1609–15.
Organizations
American Cancer Society. 1599 Clifton Road NE, Atlanta, GA 30329. (800) ACS-2345. http://www.cancer.org.
American College of Obstetricians and Gynecologists. 409 12th St., SW, PO Box 96920, Washington, DC 20090-6920. http://www.acog.org.
Cancer Information Service, National Cancer Institute. Building 31, Room 10A19, 9000 Rockville Pike, Bethesda, MD 20892. (800) 4-CANCER. http://www.nci.nih.gov/cancerinfo/index.html.
"Removing Ovaries Lowers Risk for Women at High Risk of Breast, Ovarian Cancer." ACS News Today November 8, 2000. [cited May 13, 2003]. http://www.cancer.org.
Surveillance, Epidemiology, and End Results. "Racial/Ethnic Patterns of Cancer in the United States: Ovary." National Cancer Institute. 1996 [cited March 14, 2003]. http://seer.cancer.gov/publications/ethnicity/ovary.pdf.
Oophorectomy is the surgical removal of one or both ovaries. It is also called ovariectomy or ovarian ablation. If one ovary is removed, a woman may continue to menstruate and have children. If both ovaries are removed, menstruation stops and a woman loses the ability to have children.
lower the risk of cancer in a woman with a family history of ovarian or breast cancer
In an oophorectomy, one, or a portion of one, ovary may be removed or both ovaries may be removed. When oophorectomy is done to treat ovarian cancer or other spreading cancers, both ovaries are always removed. This is called a bilateral oophorectomy. Oophorectomies are sometimes performed on pre-menopausal women who have estrogen-sensitive breast cancer in an effort to remove the main source of estrogen from their bodies. This procedure has become less common than it was in the 1990s. Today, chemotherapy drugs are available that alter the production of estrogen and tamoxifen blocks any of the effects any remaining estrogen may have on cancer cells.
Until the 1980s, women over age 40 having hysterectomies (surgical removal of the uterus) routinely had healthy ovaries and fallopian tubes removed at the same time. This operation is called a bilateral salpingo-oophorectomy. Many physicians reasoned that a woman over 40 was approaching menopause and soon her ovaries would stop secreting estrogen and releasing eggs. Removing the ovaries would eliminate the risk of ovarian cancer and only accelerate menopause by a few years.
In the 1990s, the thinking about routine oophorectomy began to change. The risk of ovarian cancer in women who have no family history of the disease is less than 1%. Meanwhile, removing the ovaries increases the risk of cardiovascular disease and accelerates osteoporosis unless a woman takes prescribed hormone replacements.
Under certain circumstances, oophorectomy may still be the treatment of choice to prevent breast and ovarian cancer in certain high-risk women. A study done at the University of Pennsylvania and released in 2000 showed that healthy women who carried the BRCA1 or BRCA2 genetic mutations that pre-disposed them to breast cancer had their risk of breast cancer drop from 80% to 19% when their ovaries were removed before age 40. Women between the ages of 40 and 50 showed less risk reduction, and there was no significant reduction of breast cancer risk in women over age 50.
Overall, ovarian cancer still ranks low on a woman's list of health concerns: It accounts for only 4% of all cancers in women. But the lifetime risk for developing ovarian cancer in women who have mutations in BRCA1 is significantly increased over the general population and may cause an ovarian cancer risk of 30% by age 60. For women at increased risk, oophorectomy may be considered after the age of 35 if childbearing is complete.
The value of ovary removal in preventing both breast and ovarian cancer has been documented. However, there are disagreements within the medical community about when and at what age this treatment should be offered. Preventative oophorectomy, called preventative bilateral oophorectomy (PBO), is not always covered by insurance. One study conducted in 2000 at the University of California at San Francisco found that only 20% of insurers paid for PBO. Another 25% had a policy against paying for the operation, and the remaining 55% said that they would decide about payment on an individual basis.
Precautions
There are situations in which oophorectomy is a medically wise choice for women who have a family history of breast or ovarian cancer. However, women with healthy ovaries who are undergoing hysterectomy for reasons other than cancer should discuss with their doctors the benefits and disadvantages of having their ovaries removed at the time of the hysterectomy.
Description
Oophorectomy is done under general anesthesia. It is performed through the same type of incision, either vertical or horizontal, as an abdominal hysterectomy. Horizontal incisions leave a less noticeable scar, but vertical incisions give the surgeon a better view of the abdominal cavity.
After the incision is made, the abdominal muscles are pulled apart, not cut, so that the surgeon can see the ovaries. Then the ovaries, and often the fallopian tubes, are removed.
Oophorectomy can sometimes be done with a laparoscopic procedure. With this surgery, a tube containing a tiny lens and light source is inserted through a small incision in the navel. A camera can be attached that allows the surgeon to see the abdominal cavity on a video monitor. When the ovaries are detached, they are removed though a small incision at the top of the vagina. The ovaries can also be cut into smaller sections and removed.
The advantages of abdominal incision are that the ovaries can be removed even if a woman has many adhesions from previous surgery. The surgeon gets a good view of the abdominal cavity and can check the surrounding tissue for disease. A vertical abdominal incision is mandatory if cancer is suspected. The disadvantages are that bleeding is more likely to be a complication of this type of operation. The operation is more painful than a laparoscopic operation and the recovery period is longer. A woman can expect to be in the hospital two to five days and will need three to six weeks to return to normal activities.
Preparation
Before surgery, the doctor will order blood and urine tests, and any additional tests such as ultrasound or x rays to help the surgeon visualize the woman's condition. The woman may also meet with the anesthesiologist to evaluate any special conditions that might affect the administration of anesthesia. A colon preparation may be done, if extensive surgery is anticipated.
On the evening before the operation, the woman should eat a light dinner, then take nothing by mouth, including water or other liquids, after midnight.
Aftercare
After surgery a woman will feel discomfort. The degree of discomfort varies and is generally greatest with abdominal incisions, because the abdominal muscles must be stretched out of the way so that the surgeon can reach the ovaries.
When both ovaries are removed, women who do not have cancer are started on hormone replacement therapy to ease the symptoms of menopause that occur because estrogen produced by the ovaries is no longer present. If even part of one ovary remains, it will produce enough estrogen that a woman will continue to menstruate, unless her uterus was removed in a hysterectomy. Antibiotics are given to reduce the risk of post-surgery infection.
Return to normal activities takes anywhere from two to six weeks, depending on the type of surgery. When women have cancer, chemotherapy or radiation are often given in addition to surgery. Some women have emotional trauma following an oophorectomy, and can benefit from counseling and support groups.
Risks
Oophorectomy is a relatively safe operation, although like all major surgery, it does carry some risks. These include unanticipated reaction to anesthesia, internal bleeding, blood clots, accidental damage to other organs, and post-surgery infection.
Complications after an oophorectomy include changes in sex drive, hot flashes, and other symptoms of menopause if both ovaries are removed. Women who have both ovaries removed and who do not take estrogen replacement therapy run an increased risk for cardiovascular disease and osteoporosis. Women with a history of psychological and emotional problems before an oophorectomy are more likely to experience psychological difficulties after the operation.
Normal Results
If the surgery is successful, the ovaries will be removed without complication, and the underlying problem resolved. In the case of cancer, all the cancer will be removed.
Abnormal Results
Complications may arise if the surgeon finds that cancer has spread to other places in the abdomen. If the cancer cannot be removed by surgery, it must be treated with chemotherapy and radiation.
Resources
Books
Beers, Mark H., MD, and Robert Berkow, MD, editors. "Endometriosis." Section 18, Chapter 239 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2002.
Beers, Mark H., MD, and Robert Berkow, MD, editors. "Ovarian Cancer." Section 18, Chapter 241 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2002.
Periodicals
de Carvalho, M., J. Jenkins, M. Nehrebecky, and L. Lahl. "The Role of Estrogens in BRCA1/2 Mutation Carriers: Reflections on the Past, Issues for the Future." Cancer Nursing 26 (December 2003): 421–430.
Itoh, H., A. Ishihara, H. Koita, et al. "Ovarian Pregnancy:Report of Four Cases and Review of the Literature." Pathology International 53 (November 2003): 806–809.
Lane, G. "Prophylactic Oophorectomy: Why and When?" Journal of the British Menopause Society 9 (December 2003): 156–160.
Sainsbury, R. "Ovarian Ablation as a Treatment for Breast Cancer." Surgical Oncology 12 (December 2003): 241–250.
Organizations
American Cancer Society National Headquarters. 1599 Clifton Road NE, Atlanta, GA 30329. (800)ACS-2345. .
Cancer Information Service, National Cancer Institute. Building 31, Room 10A19, 9000 Rockville Pike, Bethesda, MD 20892. (800)4-CANCER. .
Excision of one or both ovaries; called also ovariectomy. The procedure is done for sterilization, tumors, severe infection, or other disorders of the ovary. Removal of the ovaries from a sexually immature animal prevents the development of secondary sex characters. If both ovaries are removed from an adult animal reproduction is not possible and the female sex hormones estrogen and progesterone are no longer produced.
Oophorectomy (or ovariectomy) is the surgical removal of an ovary or ovaries. In the case of non-human animals, it is also called spaying and is a form of sterilization. Removal of the ovaries in women is the biological equivalent of castration in males, and the term is occasionally used in the medical literature instead of oophorectomy.
In the case of humans, oophorectomies are most often performed due to diseases such as ovarian cysts or cancer; prophylactically to reduce the chances of developing ovarian cancer or breast cancer; or in conjunction with removal of the uterus.
The removal of an ovary together with a Fallopian tube is called salpingo-oophorectomy or bilateral salpingo-oophorectomy if both ovaries and tubes are removed. Oophorectomy and salpingo-oophorectomy are not common forms of birth control in humans; more usual is tubal ligation, in which the Fallopian tubes are blocked but the ovaries remain intact. In many cases, surgical removal of the ovaries is performed concurrently with a hysterectomy. The surgery is then called "ovariohysterectomy" casually or "total abdominal hysterectomy with bilateral salpingo-oophorectomy" (sometimes abbreviated TAH-BSO), the more correct medical term. However, the term "hysterectomy" is often used colloquially yet incorrectly to refer to removal of any parts of the female reproductive system, including just the ovaries.
In general, hormone replacement therapy is somewhat controversial due to the known carcinogenic and coagulative properties of estrogen; however, many physicians and patients feel the benefits outweigh the risks in women who may face serious health and quality of life issues as a consequence of early surgical menopause. The ovarian hormones of estrogen, progesterone, and testosterone are involved in the regulation of hundreds of bodily functions; it is believed by some doctors that hormone therapy programs mitigate surgical menopause side effects such as increased risk of cardiovascular disease [1], and female sexual dysfunction [2]. There are many options for hormone replacement currently available and a considerable controversy exists in regards to synthetic versus natural or bio-identical regimens.
Benefits
Reduced breast cancer risk
Women with a risk of breast cancer, especially those women with mutated BRCA1 and/or BRCA2 genes, have been shown to have a significantly reduced risk of developing breast cancer after prophylactic oophorectomy[3]. In addition, removal of the uterus in conjunction with prophylactic oophorectomy allows estrogen-based HRT to be prescribed to aid the woman through her transition into surgical menopause, instead of mixed hormone HRT, which has a significant contribution to breast cancer as well[4].
Reduced ovarian cancer risk
Women with a risk of ovarian cancer, especially those women with mutated BRCA1 and/or BRCA2 genes, have been shown to have a significantly reduced risk of developing ovarian cancer after prophylactic oophorectomy. Risk is not reduced to zero, however, because the possibility of developing primary peritoneal cancer (ovarian cancer that begins outside the ovaries) does persist.
Reduced problems of endometriosis
In rare cases, oophorectomy can be used to treat endometriosis. This is done to remove a source of hormones that fuel uterine lining growth, thus reducing the overgrowth responsible for endometriosis. Oophorectomy for endometriosis is usually a last-resort surgery, since hormonal agonists such as Lupron are usually prescribed first to alter the hormonal cycle. Oophorectomy for endometriosis is often done in conjunction with a hysterectomy as a final shot at removing all traces of endometriosis in cases where non-surgical treatments such as hormonal agonists have failed to stop the uterine overgrowth.
Ovarian cyst removal not involving total oophorectomy is often used to treat milder cases of endometriosis when non-surgical hormonal treatments fail to stop cyst formation. Removal of ovarian cysts through partial oophorectomy is also used to treat extreme pelvic pain from chronic hormonal-related pelvic problems.
Premenstrual Dysphoric Disorder
Oophorectomy or the onset of menopause are the only complete cures for PMDD. However, hormone therapy is usually then needed to mimic natural hormone levels.
Risks
Longevity Risk
Removal of ovaries causes hormonal changes and symptoms similar to, but generally more severe than, menopause. Women who have had an oophorectomy are usually encouraged to take hormone replacement drugs to prevent other conditions often associated with menopause. Women younger than 45 who have had their ovaries removed face a mortality risk 170% higher than women who have retained their ovaries. [5]. Retaining the ovaries when a hysterectomy is performed is associated with greater longevity.[6]. However, hormone therapy is commonly believed by many doctors to mitigate the mortality risks of oophorectomy [7].
Women who have had bilateral oophorectomy surgeries lose most of their ability to produce the hormones estrogen and progesterone, and lose about half of their ability to produce testosterone, and subsequently enter what is known as "surgical menopause" (as opposed to normal menopause, which occurs naturally in women as part of the aging process). "Surgical menopause" differs from naturally occurring menopause in several respects: Surgical menopause is the result of surgery, while menopause is a natural event. A menopausal woman has intact functional female organs, a woman with surgical menopause does not. In natural menopause the ovaries generally continue to produce low levels of hormones, while in surgical menopause the ovaries and their hormones are absent, which can explain why surgical menopause is generally accompanied by a more sudden and severe onset of symptoms than natural menopause, symptoms which may continue until natural age of menopause arrives [8]. These symptoms are commonly addressed through hormone therapy, utilizing various forms of estrogen, testosterone, progesterone or a combination of them.
Cardiovascular Risk
When the ovaries are removed a woman is at a seven times greater risk of cardiovascular disease, [9][10][11][12] but the mechanisms are not precisely known. The hormone production of the ovaries currently cannot be sufficiently mimicked by drug therapy. The ovaries produce hormones a woman needs throughout her entire life, in the quantity they are needed, at the time they are needed, and released directly into the blood stream in a continuous fashion, in response to and as part of the complex endocrine system.
Bone Density Risk
In women under the age of 50 who have undergone oophorectomy, hormone supplements (usually estrogen) are often prescribed as part of hormone replacement therapy (HRT) to offset the negative effects of sudden hormonal loss (most notably an increased risk for early-onset osteoporosis) as well as menopausal problems like hot flushes (also called "hot flashes") that are usually more severe than those experienced by women undergoing natural menopause.
Some studies have found that increased bone loss or fracture risk is associated with oophorectomy. [13]. [14]. [15]. [16][17] Reduced levels of testosterone in women is predictive of height loss, which may occur as a result of reduced bone density,[18].
Sexuality Risk
Oophorectomy very rarely impacts sexuality in women, it does not greatly reduce or eliminate the ability to have an orgasm, however occasionally there is a lowering of sexual desire. This reduction is greater than that seen in women undergoing natural menopause [19]. Some of these problems can be addressed by taking hormone replacement. Increased testosterone levels in women are associated with a greater sense of sexual desire, and oophorectomy greatly reduces testosterone levels. [20]. Reduction in sexual well-being was reported in women who had been given a hysterectomy with both ovaries removed.[21].
Statistics
According to the Center for Disease Control, 454,000 women in the United States underwent this type of operation in 2004.
Technique
When performed alone (without hysterectomy), an oophorectomy is generally performed by abdominal laparotomy.
Managing side effects of prophylactic oophorectomy
Non-hormonal treatments
The side effects of oophorectomy may be alleviated by medicines other than hormonal replacement. Non-hormonal biphosphonates (such as Fosamax and Actonel) increase bone strength and are available as once-a-week pills. Low-dose Selective Serotonin Reuptake Inhibitors (e.g. Paxil, Prozac) alleviate vasomotor menopausal symptoms, i.e. "hot flashes".[22]
Hormonal treatments
Short-term hormone replacement with estrogen, in high-risk BRCA mutation carriers, was not shown to increase the risk of breast cancer in women who are post-oophorectomic. The results were published in JCO in 2004 and the conclusions were based on a computerized simulation using models of risk and benefit, a lower level of data than a randomized trial per se.[23] This result can probably be generalized to other women at high risk in whom short term (i.e., one or two year) treatment with estrogen for hot flashes, may be acceptable.
^ Rosenberg, L, et al. Early menopause and the risk of myocardial infarction Am. J. Obstet. Gynecol. 1981 p.47-51
^ Centerwall, B.S. Premenopausal hysterectomy and cardiovascular disease Am. J. Obstet. Gynecol. 1981 p.58-61
^ Parish, H.M., et al. Time interval from castration in premenopausal women to development of excessive coronary atherosclerosis Am. J. Obstet. Gynecol. 1967 p.155-162
^ Colditz, G.A., et al. Menopause And The Risk of Coronary Heart Disease In Women The New England Journal of Medicine 1987 p.1106-1110
^ Levin, R.J. The Physiology of Sexual Arousal in the Human Female: A recreational and Procreational Synthesis Archives of Sexual Behavior 2002 p.405-411
^ Masters, W.H., et al. The Uterus, Physiological and Clinical Considerations Human Sexual Response 1966 p.111-140
^ Armstrong K, Schwartz JS, Randall T, Rubin SC, Weber B (2004). "Hormone replacement therapy and life expectancy after prophylactic oophorectomy in women with BRCA1/2 mutations: a decision analysis". J. Clin. Oncol.22 (6): 1045–54. doi:10.1200/JCO.2004.06.090. PMID 14981106.
External links
Useful list of currently available hormone replacements in the US[1]
Useful list of currently available hormone replacements in the UK [2]
