Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women

Leonardo J Orozco, Mario Tristán, Maria M T Vreugdenhil, Arturo Salazar
In: Cochrane Database of Systematic Reviews · 2014 · vol. 2014(8) , pp. CD005638 · doi:10.1002/14651858.cd005638.pub3 · PMID:25101365 · PMC7388914 · W2143901638
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This review found insufficient randomized controlled trial evidence comparing hysterectomy alone versus hysterectomy with bilateral oophorectomy in premenopausal women.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This Cochrane systematic review assessed randomized controlled trials comparing hysterectomy alone versus hysterectomy plus bilateral oophorectomy in premenopausal women with benign gynecological conditions, focusing on mortality and subsequent gynecological surgical interventions, with searches through major databases up to January 2014. The review identified only one eligible RCT, described as a pilot trial whose results were not published and could not be obtained, so no trial data were included. As a result, the authors concluded that there is no evidence from RCTs to support either ovarian removal or conservation at the time of hysterectomy, while noting observational evidence suggesting possible harms of surgical menopause such as cardiovascular and all-cause mortality impacts. Relevance to endometriosis: the paper cites ACOG guidance that ovarian retention versus removal after hysterectomy may consider a higher risk of re-operation among women with endometriosis (as well as pelvic inflammatory disease and chronic pain), though the review’s main focus is prophylactic oophorectomy at hysterectomy for benign conditions rather than endometriosis-specific outcomes.

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Abstract

Background Prophylactic oophorectomy alongside hysterectomy in premenopausal women is a common procedure. The decision to remove or conserve the ovaries is often based on the perceived risk for ovarian cancer and the need for additional gynaecological surgical interventions,and is weighed against the perceived risk of negative health effects caused by surgically induced menopause. The evidence needed to recommend either prophylactic bilateral oophorectomy or conservation of ovaries at the time of hysterectomy in premenopausal women is limited. This is an update of the original version of this systematic review published in 2008.Objectives To compare hysterectomy alone versus hysterectomy plus bilateral oophorectomy in women with benign gynaecological conditions,with respect to rates of mortality or subsequent gynaecological surgical interventions.Search methods We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (December 2005 to January 2014) and the following electronic databases: CENTRAL (The Cochrane Library 2013, Issue 12), MEDLINE (January 1966 to January 2014),EMBASE (January 1985 to January 2014), and PsycINFO (1806 to January 2014).Selection criteria Randomised controlled trials (RCTs) of hysterectomy alone versus hysterectomy with bilateral oophorectomy in premenopausal women with benign gynaecological conditions were eligible. Any surgical approach could be used.Data collection and analysis Three review authors independently assessed trials for inclusion. Study authors were contacted if information was unclear.Main results Only one RCT comparing the benefits and risks of hysterectomy with or without oophorectomy was identified. The results of this pilot RCT have not been published and we have not been able to obtain the results. Therefore, no data could be included in this review. Authors' conclusions The conclusions of this review are limited by a lack of RCTs. Although no evidence is available from RCTs, there is growing evidence from observational studies that surgical menopause may impact negatively on cardiovascular health and all cause mortality.

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