Ovarian conservation vs removal at the time of benign hysterectomy

Am J Obstet Gynecol. 2018 Mar;218(3):269-279. doi: 10.1016/j.ajog.2017.07.037. Epub 2017 Aug 4.


Over the last 2 decades, the rate of oophorectomy at the time of hysterectomy in the United States has consistently been between 40-50%. A decline in hormone use has been observed since the release of the principal results of the Women's Health Initiative. Oophorectomy appears to be associated with an increased risk of coronary heart disease, as well as deleterious effects on overall mortality, cognitive functioning, and sexual functioning. Estrogen deficiency from surgical menopause is associated with bone mineral density loss and increased fracture risk. While hormone therapy may mitigate these effects, at no age does there appear to be a survival benefit associated with oophorectomy. Reduction of ovarian cancer risk may be accomplished with salpingectomy at the time of hysterectomy.

Keywords: morbidity; mortality; oophorectomy; ovarian cancer; ovarian conservation.

Publication types

  • Review

MeSH terms

  • Cardiovascular Diseases / mortality*
  • Cognition Disorders / epidemiology*
  • Female
  • Humans
  • Hysterectomy*
  • Life Expectancy
  • Organ Sparing Treatments
  • Osteoporotic Fractures / epidemiology
  • Ovarian Neoplasms / epidemiology
  • Ovarian Neoplasms / mortality*
  • Ovarian Neoplasms / prevention & control*
  • Ovariectomy* / trends
  • Risk Assessment
  • Sexual Dysfunction, Physiological / epidemiology
  • United States / epidemiology