Prophylactic bilateral salpingo-oophorectomy (BSO) during hysterectomy for a benign condition should be avoided in younger women, suggests a study published in the Annals of Internal Medicine.¹

Researchers from the Danish Cancer Society Research Center and the University of Copenhagen undertook this study to compare long-term outcomes in 22,974 women in Denmark who underwent BSO during hysterectomy for benign indications such as fibroids, bleeding disorders, prolapse and endometriosis versus 120,011 women who did not undergo this procedure from 1977 to 2017. Data for the trial was obtained from a national Danish health register. Women who had earlier undergone oophorectomy (uni or bilateral), those who had been diagnosed with cancer and women with a family history of cancer were not included in the trial. Because of the lack of menopausal data, age was used to determine the menopausal status of the participants, which the authors note is a limitation of their study.

Women who were aged 45 years or younger at the time of BSO were more likely to be hospitalized for cardiovascular disease within 10 years compared to women without BSO with a risk difference of 1.19 percentage points. Women with BSO were also at a higher risk for occurrence of cancer within 10 years with a risk difference of 0.73 percentage points for those aged 45-54 years; the risk difference was 1.92 percentage points in women aged 55-64 years and 2.54 in women aged ≥65 years. The all-cause mortality risk in the next decade was increased in women of all age groups with BSO, though the risk was statistically significant only for the age group 45-54 years with risk difference of 0.79 percentage point. “The mortality at 20 years was inconsistent with that at 10 years in women aged 65 years or older.”

These findings support conservation of ovaries during hysterectomy for a benign indication in premenopausal women without a high risk for ovarian cancer given that the risks outweigh the benefits. The authors also suggest “a cautious approach in postmenopausal women” given the high risk of cancer and mortality in this age group. Patients, especially those in the age group of 45 to 54 years, should be counselled about not undergoing BSO during hysterectomy for a benign indication.

Reference

1. Mathilde Gottschau, et al. Long-term health consequences after ovarian removal at benign hysterectomy: a nationwide cohort study. Ann Intern Med. 2023 Apr 18. doi: 10.7326/M22-1628.