Bénéfices de la conservation ovarienne post ménopausique lors d’une hystérectomie pour pathologie bénigne : mirage ou réalité ?

Lobna Ouldamer, H. Marret, Alain Jacquet, J. Denakpo, G Body
In: Journal de Gynécologie Obstétrique et Biologie de la Reproduction · 2012 · vol. 42(2) , pp. 123–129 · doi:10.1016/j.jgyn.2012.10.014 · PMID:23201029 · W2013063603
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This paper investigates the benefits of postmenopausal ovarian conservation during hysterectomy for benign pathology, questioning whether these benefits are real or illusory.

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Abstract

BackgroundThis study aimed to summarize the existing literature on the benefice-risk balance for ovarian conservation at the time of hysterectomy for benign disease in post menopausal women not at high risk for ovarian cancer.MethodsWe searched the published English and French literature using search engines from PUBMED, Medline for studies related to outcomes following hysterectomy with bilateral oophorectomy for benign disease and risk-reducing surgery for ovarian cancer.ResultsThere are in the literature arguments to support systematic bilateral oophorectomy in post menopausal women not at high risk for ovarian cancer (prevention of ovarian cancer, ovarian benign disease and chronic pelvic pain due to postoperative ovarian adhesions). There are also arguments against postmenopausal oophorectomy (effect on endocrine function, bone density, cardiovascular disease and increased mortality). Before the age of 65, there is no formal argument allowing to recommend an attitude rather than another. On the other hand, beyond the age of 65 years, the literature is clear and a bilateral salpingooophorectomy is recommended.ConclusionBefore the age of 65 years, benefits and relative risks of bilateral oophorectomy at the time of hysterectomy for benign disease even in post menopausal patients should be considered on an individual basis by clinicians and patients. Beyond the age of 65 years, the literature is clear and a bilateral salpingooophorectomy is recommended.

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