From the Guidelines
Yes, it is definitely possible to perform a hysterectomy without removing the ovaries (oophorectomy), and this approach is often recommended to avoid precipitating menopause and associated cardiovascular risks, as stated in the 2024 study 1. When considering a hysterectomy, the decision to preserve or remove the ovaries depends on various factors, including the patient's age, reason for the hysterectomy, family history of ovarian cancer, and personal preferences.
- The 2024 study 1 suggests that if there is no other indication for removal, the ovaries should be left in place to avoid precipitating menopause and associated cardiovascular risks.
- Preserving the ovaries is particularly beneficial for premenopausal women, as they continue to produce hormones that help prevent issues like bone loss, cardiovascular disease, and menopausal symptoms.
- However, if there's a high risk of ovarian cancer or existing ovarian disease, removing them might be advised, as mentioned in the 2025 study 1, which notes that oophorectomy should not be performed concurrently with hysterectomy unless there is evidence of ovarian pathology. The 2024 study 1 also highlights the importance of considering the least invasive route for hysterectomy, with vaginal and laparoscopic approaches associated with shorter operating times, faster return to normal activities, and better quality of life compared to abdominal hysterectomy.
- Ultimately, the decision to perform a hysterectomy without oophorectomy should be made on a case-by-case basis, taking into account the individual patient's needs and medical history, and weighing the benefits and risks based on the most recent and highest quality evidence, such as the 2024 study 1.
From the Research
Hysterectomy Without Oophorectomy
- It is possible to perform a hysterectomy without oophorectomy, as evidenced by studies that have examined the association between hysterectomy with and without oophorectomy and various health outcomes 2, 3, 4.
- A study published in the American Journal of Obstetrics and Gynecology found that hysterectomy without oophorectomy was associated with an increased risk of all-cause mortality in women under 35 years old, but a decreased risk in women over 35 years old 2.
- Another study published in Human Reproduction Update found that there is limited evidence to support oophorectomy in most cases, and that ovarian conservation may be beneficial for women's long-term health 3.
Considerations for Hysterectomy Without Oophorectomy
- The decision to perform a hysterectomy without oophorectomy should be made on an individual basis, taking into account the woman's age, medical history, and other factors 3, 5.
- Women who have undergone hysterectomy without oophorectomy may still experience menopausal symptoms, and hormone therapy may be necessary to alleviate these symptoms 6, 5.
- A study published in the International Journal of Gynecological Cancer found that vaginal hysterectomy with or without bilateral salpingo-oophorectomy may be an alternative treatment option for women with endometrial cancer who have medical co-morbidities that preclude standard surgical procedures 4.
Hormone Therapy After Hysterectomy Without Oophorectomy
- Women who have undergone hysterectomy without oophorectomy may require hormone therapy to alleviate menopausal symptoms, and estrogen-only therapy may be sufficient in these cases 6, 5.
- A study published in Menopause found that regimens containing both estrogen and progestogen may be associated with a greater relative risk of breast cancer, and that estrogen-only therapy may be a better option for women without a uterus 5.