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Cited by 640Menopause: Health Impacts and TreatmentsUterine Myomas and TreatmentsOvarian cancer diagnosis and treatment

Ovarian conservation at the time of hysterectomy and long-term health outcomes in the Nurses’ Health Study

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Parker, William H., Broder, Michael S., Chang, Eunice, Feskanich, Diane, Farquhar, Cindy, Liu, Zhimae, Shoupe, Donna, Berek, Jonathan S. +2 more·2009·Obstetrics & Gynecology
DOI 10.1097/aog.0b013e3181a11c64PMC PMC3791619
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Abstract

OBJECTIVE: To report long-term health outcomes and mortality after oophorectomy or ovarian conservation. METHODS: We conducted a prospective, observational study of 29,380 women participants of the Nurses' Health Study who had a hysterectomy for benign disease; 16,345 (55.6%) had hysterectomy with bilateral oophorectomy, and 13,035 (44.4%) had hysterectomy with ovarian conservation. We evaluated incident events or death due to coronary heart disease (CHD), stroke, breast cancer, ovarian cancer, lung cancer, colorectal cancer, total cancers, hip fracture, pulmonary embolus, and death from all causes. RESULTS: Over 24 years of follow-up, for women with hysterectomy and bilateral oophorectomy compared with ovarian conservation, the multivariable hazard ratios (HRs) were 1.12 (95% confidence interval [CI] 1.03-1.21) for total mortality, 1.17 (95% CI 1.02-1.35) for fatal plus nonfatal CHD, and 1.14 (95% CI 0.98-1.33) for stroke. Although the risks of breast (HR 0.75, 95% CI 0.68-0.84), ovarian (HR 0.04, 95% CI 0.01-0.09, number needed to treat=220), and total cancers (HR 0.90, 95% CI 0.84-0.96) decreased after oophorectomy, lung cancer incidence (HR=1.26, 95% CI 1.02-1.56, number needed to harm=190), and total cancer mortality (HR=1.17, 95% CI 1.04-1.32) increased. For those never having used estrogen therapy, bilateral oophorectomy before age 50 years was associated with an increased risk of all-cause mortality, CHD, and stroke. With an approximate 35-year life span after surgery, one additional death would be expected for every nine oophorectomies performed. CONCLUSION: Compared with ovarian conservation, bilateral oophorectomy at the time of hysterectomy for benign disease is associated with a decreased risk of breast and ovarian cancer but an increased risk of all-cause mortality, fatal and nonfatal coronary heart disease, and lung cancer. In no analysis or age group was oophorectomy associated with increased survival.

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  1. [1]American College of Obstetricians and Gynecologists 1 2008 Practice Bulletin number 89
  2. [2]Healthcare Cost and Utilization Project (HCUP), 1988-2001 A Federal-State-Industry Partnership in Health Data 7 2003 Agency for Healthcare Research and Quality Rockville, MD http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5105a1.htm 21413206

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Authors
Parker, W. H., Broder, M. S., Chang, E., Feskanich, D., Farquhar, C., Liu, Z., Shoupe, D., Berek, J. S., Hankinson, S., & Manson, J. E.
Affiliations
  • University of Southern California (US)
  • University of California, Los Angeles (US)
  • Partnership for Health Analytic Research (US)
  • Brigham and Women's Hospital (US)
  • University of Auckland (NZ)
  • Stanford Medicine (US)
ORCID
Venue
Obstetrics & Gynecology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2009-05
Volume
113
Issue
5
Pages
1027-1037
ISSN
0029-7844 (ISSN-L)
DOI
10.1097/aog.0b013e3181a11c64
PMC
PMC3791619
OpenAlex
W2001532410
Semantic Scholar
699e0bfd69d23b36c9c032449b46644357fe5f5f
Cited by
640
References
28
Citations by year
2026: 19 · 2025: 21 · 2024: 30 · 2023: 30 · 2022: 27 · 2021: 38 · 2020: 35 · 2019: 42 · 2018: 38 · 2017: 45 · 2016: 49 · 2015: 37 · 2014: 38 · 2013: 48 · 2012: 42
FWCI
34.72
Type
journal article
Language
en
Open access
Locations
  • Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • ResearchSpace (University of Auckland) (submittedVersion)
Funders
National Heart, Lung, and Blood Institute (R01HL034594)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
  • Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian cancer diagnosis and treatment
Keywords
oophorectomy, bilateral oophorectomy, ovarian preservation, hysterectomy, benign gynecologic disease, coronary artery disease, stroke, breast cancer, ovarian cancer, lung cancer, cancer mortality, all-cause mortality, estrogen therapy, long-term health effects, Nurses' Health Study, surgical menopause, hip fracture, pulmonary embolism, colorectal cancer, colorectal cancer mortality
MeSH terms
Adult, Cardiovascular Diseases, Female, Follow-Up Studies, Hip Fractures, Humans, Hysterectomy, Middle Aged, Neoplasms, Nurses, Ovariectomy, Postoperative Complications, Prospective Studies, Risk Factors, Survival Rate, Outcome Assessment, Health Care, Risk Assessment, Disease-Free Survival

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