Prophylactic bilateral oophorectomy jeopardizes long-term health

Disclosures The authors report no commercial or financial relationships relevant to this article. Approximately 4.5 million women in the United States have undergone bilateral oophorectomy before reaching natural menopause, yet accumulating evidence indicates that surgical removal of the ovaries increases the risk of long-term deleterious outcomes. Bilateral oophorectomy refers to the simultaneous or sequential removal of both ovaries. The surgery may be performed for a malignancy, benign disease of the ovaries (eg, endometriosis or a cyst), or prophylaxis against cancer. Oophorectomy is most commonly performed along with hysterectomy. Although age-adjusted rates of prophylactic oophorectomy have decreased over time, the proportion of hysterectomies accompanied by prophylactic oophorectomy in the United States has actually increased, from 29% in 1979 to 45% in 2004. Women who experience the premature loss of ovarian function as a result of bilateral oophorectomy performed before the onset of natural menopause are at increased risk for death, cardiovascular disease, stroke, lung cancer, cognitive impairment or dementia, parkinsonism, osteoporosis, depressive or anxiety symptoms, and sexual dysfunction. The risks appear to be greater for women who are younger at the time of oophorectomy. Some studies, however, show that even women who underwent oophorectomy after the onset of natural menopause had an increased risk of deleterious outcomes. Health care practitioners who advise women about bilateral oophorectomy need to be aware of the riskbenefit balance and counsel patients accordingly. For premenopausal women who are not at markedly increased risk for ovarian or breast cancer, prophylactic oophorectomy should be discouraged (FIGURE).