Strategii terapeutice actuale referitoare la ovarectomia asociată histerectomiei pentru patologia benignă

Introduction. Patients undergoing total hysterectomy for benign uterine pathology face a controversial decision of bilateral ovariectomy. Studies show that most patients feel incompletely informed about their therapeutic options. Material and methods. We have reviewed international medical databases with randomized studies, meta-analysis of current re­com­mendations and trends regarding histerectomy for benign uterine pathology and associated ovariectomy. Results. Randomized studies that included patients in the last 15 years who underwent total hysterectomy for benign pathology showed a distinct approach re­gar­ding the annexes. A series of meta-analyzes in the United States reported a 3.6% yearly decline in bi­la­teral annexectomy, from 49.7% in 2001 to 33.4% in 2011. It was standardized that patients with total hys­te­rectomy benefit from bilateral pre-menopausal sal­pin­gectomy for ovarian neoplasm prophylaxy. Also, pa­tients with familial risk of breast or ovarian neoplasia re­quire bilateral anexectomy in premenopause. The the­ra­peutic attitude is individualized in menopausal pa­tients without genital neoplasm associated risk. Conclusions. It is recommended to conserve ovaries in premenopausal patients at low risk for ovarian or breast cancer to avoid cardiovascular and sexual dys­function. For menopausal patients aged over 65 years, bilateral ovariectomy does not have benefits on cardiovascular disease, hip fracture or sexual function, which is why it is required to be associated with total hysterectomy.