Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women.
BACKGROUND
Prophylactic oophorectomy alongside hysterectomy in premenopausal women is common. The decision to remove or conserve the ovaries is often based on the perceived risk for ovarian cancer and the need for other additional gynaecological surgical interventions. The benefits or harms of prophylactic bilateral oophorectomy at the time of hysterectomy in premenopausal women are unknown.


OBJECTIVE
To determine whether premenopausal women with hysterectomy without oophorectomy for benign gynaecological conditions versus hysterectomy plus bilateral oophorectomy would have a higher mortality rate and future gynaecological surgical interventions.


METHODS
We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (December 2005 to October 2007) and the following electronic databases: CENTRAL (The Cochrane Library 2007, Issue 4), MEDLINE (January 1966 to October 2007), EMBASE (January 1985 to October 2007), LILACS (January 1982 to October 2007), Biological Abstracts (January 1968 to October 2007), NHS Economic Evaluation Database (inception to October 2007), Health Technology Assessment Database (inception to October 2007), and the Meta RCTs (inception to October 2007). Reference lists of relevant articles were also searched.


METHODS
Randomised controlled and controlled trials of hysterectomy (using any surgical approach) without oophorectomy versus hysterectomy (using any surgical approach) with bilateral oophorectomy in premenopausal women with benign gynaecological conditions.


METHODS
Three review authors independently assessed trials for inclusion, determined study quality and extracted data. Study authors were contacted where information was unclear.


RESULTS
Of the 119 studies identified, only one controlled trial was included. Therefore, a quantitative meta-analysis was not feasible. The results of this study (with two publications) including 362 women were summarised in a narrative format. No randomised controlled trials were found. Neither publication reported on the primary outcomes stated in this review. The trial showed evidence of very low quality of a positive effect on psychological well-being for both groups at one year follow up. No significant differences were found between the groups of women studied regarding any aspect of their sexuality.


CONCLUSIONS
The conclusions of this review are limited by the lack of data. More research of higher methodological quality is needed.
Orozco
Leonardo J
LJ
OBGYN Women's Hospital San José, Costa Rica., Caja Costarricense Seguro Social (CCSS)., Bo california, San José, San Pedro Montes de Oca, Costa Rica, 1677-2100. loscr@yahoo.com
Salazar
Arturo
A
Clarke
Jane
J
Tristan
Mario
M
D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010052:Ovariectomy / Q000379:methods*; D017697:Premenopause