title: Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women.
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.
authors.affiliation: OBGYN Women’s Hospital San José, Costa Rica, Caja Costarricense Seguro Social (CCSS) & Central American Cochrane Center, San José, Costa Rica.
authors.forename: Leonardo J
authors.initials: LJ
authors.lastname: Orozco
authors.forename: Mario
authors.initials: M
authors.lastname: Tristan
authors.forename: Maria M T
authors.initials: MM
authors.lastname: Vreugdenhil
authors.forename: Arturo
authors.initials: A
authors.lastname: Salazar
mesh_terms: D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010052:Ovariectomy / Q000379:methods*; D017697:Premenopause
references.citation: Obstet Gynecol. 2013 Apr;121(4):717-726
references.pmid: 23635670
references.citation: N Engl J Med. 2002 May 23;346(21):1616-22
references.pmid: 12023993
references.citation: Obstet Gynecol. 2007 Feb;109(2 Pt 1):347-54
references.pmid: 17267835
references.citation: BMJ. 2005 Jun 25;330(7506):1478
references.pmid: 15976422
references.citation: Maturitas. 2005 Aug 16;51(4):349-57
references.pmid: 16039407
references.citation: Lancet Oncol. 2006 Oct;7(10):821-8
references.pmid: 17012044
references.citation: Menopause. 2009 Jan-Feb;16(1):15-23
references.pmid: 19034050
references.citation: Acta Obstet Gynecol Scand. 2010;89(1):65-70
references.pmid: 19900131
references.citation: Fertil Steril. 2005 Apr;83(4):1021-8
references.pmid: 15820815
references.citation: BJOG. 2012 Jun;119(7):810-6
references.pmid: 22531019
references.citation: Cochrane Database Syst Rev. 2013 Apr 30;(4):CD002229
references.pmid: 23633307
references.citation: Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005638
references.pmid: 18646133
references.citation: Obstet Gynecol. 2013 May;121(5):1069-1074
references.pmid: 23635745
references.citation: J Clin Endocrinol Metab. 1974 Dec;39(6):1020-4
references.pmid: 4430702
references.citation: Obstet Gynecol. 2013 Apr;121(4):709-716
references.pmid: 23635669
references.citation: Obstet Gynecol. 2005 Aug;106(2):214-5
references.pmid: 16055566
references.citation: J Natl Cancer Inst. 2013 Jun 5;105(11):812-22
references.pmid: 23628597
references.citation: Eur J Obstet Gynecol Reprod Biol. 1997 May;73(1):67-70
references.pmid: 9175692
references.citation: Obstet Gynecol. 2009 May;113(5):1027-1037
references.pmid: 19384117
references.citation: Neurology. 2007 Sep 11;69(11):1074-83
references.pmid: 17761551
references.citation: Cochrane Database Syst Rev. 2012 Jul 11;(7):CD004143
references.pmid: 22786488