As we enter menopause and estrogen levels drop, we have greater risk for uterine prolapse—a troublesome disorder where the uterus drops down and presses into the vaginal area. It’s been thought that menopausal women who undergo hysterectomy (surgical removal of the uterus) as well as removal of both ovaries (a procedure known as bilateral salpingo-oophorectomy) are a greater risk for prolapse than women who undergo hysterectomy only. New research, however, suggests quite the opposite: women who have their ovaries removed actually have a lower risk of prolapse.
Uterine prolapse occurs if the muscles, ligaments, and other structures that the hold the uterus in the pelvis become weak. If this happens, the uterus drops down and presses into the vaginal area, causing several unpleasant symptoms (problems during sex, leaking urine, low backache, and repeated bladder infections, to name a few). Your risk of prolapse is greater if you’ve had one or more vaginal birth.
There’s been debate over when women may benefit from removal of ovaries at hysterectomy. If the ovaries are cancerous, there’s clearly a need to remove them. Removal is also known to reduce risk of breast cancer and significantly reduce risk of ovarian cancer. In other situations and when there’s no increased risk of breast or ovarian cancer, however, there’s more gray area. Some research suggests that taking out the ovaries may increase a woman’s risk of several other conditions—such as death, cardiovascular disease, lung cancer, and osteoporosis—and may interfere with cognitive ability and sexual function. In addition, it’s been thought that removal of the ovaries might increase risk for uterine prolapse. With these concerns in mind, it’s understandable that a woman my resist ovarian removal, even when it might dramatically improve her health and well-being.
In this recent study, researchers evaluated almost 9,000 women who had either undergone hysterectomy alone or hysterectomy plus removal of ovaries and had or had not undergone hormone therapy after surgery. They found that women who had their ovaries removed when they had a hysterectomy did not have a greater risk of uterine prolapse, particular if they didn’t receive subsequent hormone therapy. Instead, factors that appeared to increase risk for prolapse included older age, multiple births, higher body-mass index, higher waist-to-hip ratio (a measure of body fat), and being a race or ethnicity other than African American.
If, due to certain health conditions, your doctor has recommended that you undergo hysterectomy with removal of your ovaries, this new evidence suggests that you may not be raising your risk for uterine prolapse. In fact, you may even be lowering your chances of prolapse.
Reference: David S, Bela KI, Iglesia Chery IB, et al. Effects of Bilateral Salpingo-Oophorectomy at the Time of Hysterectomy on Pelvic Organ Prolapse: Results from the Women’s Health Initiative Trial. Menopause [early online publication]. November 24, 2014.