Ovary removal before 45 has risks, report says

Women younger than 45 who have their ovaries removed, usually as part of a hysterectomy for noncancerous reasons, run a higher risk of premature death, Mayo Clinic researchers report in the largest analysis of its kind.

The investigation, to appear next month in the journal Lancet Oncology, is a large-scale look at what was accepted practice until recently.

Mayo Clinic researchers found that unless hormone therapy had been prescribed, the women's risk of death from all causes was 1.7 times higher than that for women whose ovaries remained intact.

The elevated death risk was mainly restricted to women younger than 45 not prescribed estrogen after the surgery to offset the loss of natural estrogen produced by the ovaries.

Those who had their ovaries removed were more likely to die of breast cancer and cardiovascular disorders, researchers found. Researchers also found an increased risk of dementia and neurological disturbances, such as Parkinson's disease.

"What came out in this study was something of a surprise, especially the findings on neurological problems and mental health," said Dr. Bobbie Gostout, a professor of obstetrics and gynecology at the Mayo Clinic.

She said the research, which involved more than 4,000 women in Olmsted County, Minn., will further analyze specific medical conditions linked to ovary removal.

The test group consisted of women who had one or both ovaries removed between 1950 and 1987. Doctors interviewed their subjects and kept detailed records on their health. Dates and causes of death were recorded. The statistics were compared with those of 2,000 women who had not undergone the surgery.

Gostout emphasized that, even though the results are startling, women younger than 45 who have disorders requiring surgical removal of the ovaries should not hesitate to undergo the operation.

That recommendation is particularly underscored for women who carry one of the two BRCA genes, associated with elevated breast-cancer risk. Physicians may recommend ovary removal as a way to blunt estrogen to stave off cancer.

"This study doesn't surprise me at all," said Dr. Steven Goldstein, a professor of obstetrics and gynecology at NYU Medical Center in Manhattan. "It has been mainly an American gynecologic phenomenon to routinely take out the ovaries with the thought of preventing ovarian cancer in healthy women.

"... This study is telling us that the good your ovaries do for you far outweigh any theoretical risk of ovarian cancer."

Dr. Jennifer Wu, an obstetrician and gynecologist at Lenox Hill Hospital in Manhattan, said the practice of removing ovaries during a hysterectomy is declining. "Many physicians are counseling their patients differently now," Wu said.