Association of bilateral salpingo-oophorectomy with all cause and cause specific mortality: population based cohort study

Objectives To determine if bilateral salpingo-oophorectomy, compared with ovarian conservation, is associated with all cause or cause specific death in women undergoing hysterectomy for non-malignant disease, and to determine how this association varies with age at surgery. Design Population based cohort study. Setting Ontario, Canada from 1 January 1996 to 31 December 2015, and follow-up to 31 December 2017. Participants 200 549 women (aged 30-70 years) undergoing non-malignant hysterectomy, stratified into premenopausal (<45 years), menopausal transition (45-49 years), early menopausal (50-54 years), and late menopausal (≥55 years) groups according to age at surgery; median follow-up was 12 years (interquartile range 7-17). Exposures Bilateral salpingo-oophorectomy versus ovarian conservation. Main outcomes measures The primary outcome was all cause death. Secondary outcomes were non-cancer and cancer death. Within each age group, overlap propensity score weighted survival models were used to examine the association between bilateral salpingo-oophorectomy and mortality outcomes, while adjusting for demographic characteristics, gynaecological conditions, and comorbidities. To account for comparisons in four age groups, P<0.0125 was considered statistically significant. Results Bilateral salpingo-oophorectomy was performed in 19%, 41%, 69%, and 81% of women aged <45, 45-49, 50-54, and ≥55 years, respectively. The procedure was associated with increased rates of all cause death in women aged <45 years (hazard ratio 1.31, 95% confidence interval 1.18 to 1.45, P<0.001; number needed to harm 71 at 20 years) and 45-49 years (1.16, 1.04 to 1.30, P=0.007; 152 at 20 years), but not in women aged 50-54 years (0.83, 0.72 to 0.97, P=0.018) or ≥55 years (0.92, 0.82 to 1.03, P=0.16). Findings in women aged <50 years were driven largely by increased non-cancer death. In secondary analyses identifying a possible change in the association between bilateral salpingo-oophorectomy and all cause death with advancing age at surgery, the hazard ratio gradually decreased during the menopausal transition and remained around 1 at all ages thereafter. Conclusion In this observational study, bilateral salpingo-oophorectomy at non-malignant hysterectomy appeared to be associated with increased all cause mortality in women aged <50 years, but not in those aged ≥50 years. While caution is warranted when considering bilateral salpingo-oophorectomy in premenopausal women without indication, this strategy for ovarian cancer risk reduction does not appear to be detrimental to survival in postmenopausal women.

Effect of Laparoscopic Hysterectomy on Female Sexual Functions by Comparing their Preoperative and Post-Operative Sexual Performances using Female Sexual Function Index

Background: Hysterectomy is the most commonly performed gynecological procedure. It can affect female sexual functions in a number of ways mainly because of disruption of local nerve and blood supply and intimate anatomical relationship of pelvic organs. We intend to evaluate the effect of total laparoscopic hysterectomy (TLH) on female sexual function by comparing their preoperative and postoperative sexual performances using female sexual function index (FSFI). Materials and methods: The study was carried out in 50 hysterectomised patients over the duration of one year. Their sexual functions were assessed preoperatively prior to their admission in hospital. Then once hysterectomy is done, their postoperative sexual performances were assessed over the last four weeks period at least four months after their hysterectomy, using FSFI. Results: Out of 50 patients, 39 patients had undergone TLH with ovarian conservation and 11 had undergone TLH with bilateral salpingoophorectomy (BSO). Out of 50 participants, 27 had scores of less than 26 using FSFI, but after hysterectomy, 14 participants had scores of less than 26. The overall score using FSFI was improved from 24.26±2.2 to 28.11±2.2 (p-value <0.0001). Conclusion: Women can be positively reassured that hysterectomy performed for benign reasons does not negatively affect sexuality. TLH is less invasive in terms of causing damage to various pelvic nerves and vessels and hence causes less-to-no effect on female sexual functions. Key words: Hysterectomy, Sexual functions, Dyspareunia, Libido

When to Cryopreserve Ovarian Tissue: Effects of Chemotherapy on the Ovarian Reserve by Studying Follicular Density, Tissue Damage and Follicular Apoptosis

BackgroundPatients scheduled to receive chemotherapy should be counseled on fertility preservation. Known gonadotoxic chemotherapies such as alkylating agents have a high risk of altering ovarian reserve. In some cases, the urgency of treatment requires the use of chemotherapy before fertility preservation, which will be carried out at a later stage. Most often the ovarian tissue is cryopreserved. The aim of our study is to investigate the impact of chemotherapies on follicular density, tissue damage and apoptosis of reserve follicles.ResultsWe included 140 patients: 63 patients, mean age 18.8 years, were included in the group no chemotherapy (group A) and 77 patients, mean age 17.1 years, in the group presence of chemotherapy before ovarian conservation (group B). None of the patients had had pelvic radiotherapy prior to ovarian cryopreservation. The histological parameters studied were: follicular density, the presence of cortical fibrosis and the presence of vessel abnormalities. We selected 12 patients from group A and 15 patients from group B, comparable in age and pathology, for whom we evaluated follicle apoptosis by immunostaining cleaved caspase 3. We demonstrated an inverse relationship between follicular density and age (p<0.0001), as well as a lack of effect of chemotherapy on follicular density (p=0.87). There was no difference in other histological parameters. On the other hand, we showed an impact of chemotherapies, especially alkylating agents, on the apoptosis of ovarian follicles (p<0.0001).ConclusionOur study is the largest cohort reported to date. This work underlines that conservation of ovarian tissue after chemotherapy remains possible.

Elective Bilateral Oophorectomy Versus Ovarian Conservation at the Time of Benign Hysterectomy

The Nurses’ Health Study prospectively evaluated long-term mortality associated with oophorectomy versus ovarian conservation at the time of benign hysterectomy in women with no history of gynecologic cancer, other cancers, coronary heart disease, stroke, or pulmonary embolus. The study showed that performing a bilateral oophorectomy at the time of a benign hysterectomy is associated with an increased risk of all-cause mortality as well as mortality from coronary heart disease, lung cancer, and colorectal cancer. Concurrent oophorectomy is associated with a decreased risk of ovarian cancer. It was also found to reduce the risk of breast cancer when performed in women younger than 47.5 years of age. This study has been supported by further research showing that bilateral oophorectomy is not associated with improved all-cause mortality and is associated with greater mortality particularly in younger, premenopausal women.