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Removal of the ovaries at hysterectomy
Title:Hysterectomy, oophorectomy, and endogenous sex hormone levels in older women: the Rancho Bernardo Study
Author: G. Laughlin, et al.
Address: La Jolla, California
Source: The Journal of Clinical Endocrinology & Metabolism 85: 645-651 (February) 2000
Summary: This study examines the cross-sectional association of hysterectomy and oophorectomy status, chronological age, and years since menopause with plasma levels of total and bioavailable testosterone and estradiol, androstenedione, estrone, and sex hormone-binding globulin (SHBG) in 684 postmenopausal women not using ERT. After adjustment for age and body mass index, both total and bioavailable testosterone levels were reduced by more than 40% in hysterectomized women with bilateral oophorectomy compared to those in intact women, with intermediate levels observed in hysterectomized women with ovarian conservation. Androstenedione levels were about 10% lower in hysterectomized women with or without ovarian conservation compared to intact women. Total estradiol levels tended to be lower in bilaterally oophorectomized women. Levels of bioavailable estradiol, estrone, and SHBG did not differ by hysterectomy and oophorectomy status. Among intact women, total testosterone levels increased with age, reaching premenopausal levels for the 70-79 decade with relatively stable levels thereafter. Among oophorectomized women, total and bioavailable testosterone levels did not vary with age and were 40-50% lower than those in intact women throughout the 50-89 yr. age range. Androstenedione levels decreased 27% and SHBG levels increased 30% with age in intact women. Stratification by years since menopause or surgery yielded similar results. The postmenopausal ovary is a critical source of androgen throughout the lifespan of older women.
Comment: Clearly elective removal of the ovaries markedly reduces the risk of ovarian cancer and is generally thought to be the standard of care after age 50, perhaps age 45. While the ovaries produce only minimal amounts of estrogen, they continue to produce androgen. It is very difficult to weigh a potential for an improvement in sense of well being and quality of life in many against preventing the real risk of fatal ovarian cancer in a few.