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Elective oophorectomy or ovarian conservation at the time of hysterectomy

Susan D Reed, MD, MPH
Barbara Goff, MD
Section Editor
Howard T Sharp, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Hysterectomy (surgical removal of the uterus) is the second most common major surgical procedure (cesarean section is the most common) performed among United States women [1]. Women undergo oophorectomy at the time of hysterectomy less frequently than in the past [2]. A 2005 United States nationwide study reported that unilateral or bilateral oophorectomy was performed in 68 percent of women at the time of abdominal hysterectomy, 60 percent at laparoscopic hysterectomy, and 26 percent at vaginal hysterectomy [3]. A study from 2013 to 2014 showed that 44 percent of women younger than 51 years had oophorectomy at the time of hysterectomy for benign disease (outcomes were: normal ovaries 23 percent; ovarian cancer 0.2 percent; and benign pathology 21 percent).

Historically, it had been common practice to counsel women in their mid-40s or older who were planning hysterectomy for benign indications to undergo concomitant bilateral salpingo-oophorectomy [4]. The rationale for this approach was that oophorectomy greatly decreases the risk of ovarian cancer and the need for future ovarian surgery, and that there is little disadvantage of ovarian preservation, since women in this age range are close to or beyond menopause. This approach also assumed nearly universal treatment with postmenopausal hormone therapy.

A growing understanding of the potential long-term health risks of elective oophorectomy and potential advantages of elective salpingectomy in premenopausal women has changed clinical practice [5,6]. In the setting of benign disease, the decision to retain or remove tubes and ovaries should be based upon the long-term health effects. The pendulum has swung toward ovarian conservation in women under age 51 [4,7].

For women with a gynecologic malignancy, there are often clear indications for salpingo-oophorectomy. For those at high genetic risk of ovarian cancer, risk-reducing salpingo-oophorectomy or salpingectomy may be indicated.

An evidence-based approach to management of the tubes and ovaries at the time of hysterectomy for benign disease will be reviewed here. Techniques for salpingectomy and oophorectomy, risk-reducing salpingectomy and oophorectomy for women with a hereditary ovarian cancer syndrome, and general principles of menopause are discussed separately. (See "Oophorectomy and ovarian cystectomy" and "Risk-reducing bilateral salpingo-oophorectomy in women at high risk of epithelial ovarian and fallopian tubal cancer" and "Clinical manifestations and diagnosis of menopause".)

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Literature review current through: Dec 2017. | This topic last updated: Sep 26, 2016.
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