Keep or Remove Your Ovaries During a Hysterectomy?What Long-Term Studies Found

If you’re having a hysterectomy for fibroids, heavy bleeding or another noncancerous reason, you may be asked whether to remove your ovaries too. Removing both ovaries (bilateral oophorectomy) eliminates most ovarian cancer risk. But healthy ovaries keep making hormones for years, even after menopause. Here is what long-term research found.

The Nurses’ Health Study

Researchers followed about 30,000 nurses who had a hysterectomy for a noncancerous condition, comparing those who had both ovaries removed with those who kept them.¹²

What went down after removal:¹²

• Ovarian cancer risk dropped sharply, and ovarian cancer deaths were rare (4 deaths vs. 44).
• Breast cancer risk was lower.

What went up:¹²

• Overall deaths: after 28 years, 16.8% of women who had their ovaries removed had died, compared with 13.3% who kept them.
• Heart disease and lung cancer were more common.

At no age was removing the ovaries linked to longer survival.¹²

Age and estrogen matter

The extra risk was clearest in women under 50 who never used estrogen therapy.¹² For women who had used estrogen, the increase in deaths wasn’t seen.²

A Mayo Clinic study of women who had their ovaries removed before 50 found that those who had it before 46 developed more chronic conditions over about 14 years, including depression, high cholesterol, heart rhythm problems, heart disease, arthritis and osteoporosis.³ Several of these links were weaker in women who took estrogen.³

When removal may make sense

These studies are about women at average risk. If you carry a BRCA gene change or another inherited syndrome, or have a strong family history of ovarian or breast cancer, removing the ovaries can be lifesaving. Ask about genetic counseling before surgery.

Some surgeons also discuss removing the fallopian tubes while keeping the ovaries. Ask whether that’s an option for you.

Questions to ask your surgeon

1. Why do you recommend removing, or keeping, my ovaries?
2. Should I have genetic testing before deciding?
3. If my ovaries are removed before natural menopause, should I take estrogen, and for how long?
4. What about removing just the tubes?

Our guides to hysterectomy approaches, hormone therapy after hysterectomy and ovarian cancer screening cover related decisions.

Try: “I’m 48 and scheduled for a hysterectomy for fibroids. Do I need to lose my ovaries too, given that no one in my family has had ovarian or breast cancer?”

My Body Changed. Now What? includes a Visit Brief. Use it to list your family cancer history and questions before your surgical consultation. See the book.