Hysterektomi med eller uten bilateral salpingo-ooforektomi hos perimenopausale kvinner

Abstract

Background: Hysterectomy is the most common major gynaecological intervention in perimenopausal women. When should a concomitant salpingo-oophorectomy be performed at an elective procedure?

Material and methods: The intention was to get an overview over the current litterature. A handful of criteria were decided upon and a search was done in Pubmed, Cochrane and EMBASE.

Results and discussion: Among the selected articles in this overview there are some that view hysterectomy as a prophylactic procedure in relation to the risk of non-hereditary epithelial ovarian cancer. The debate includes estimates of the women possible to save from death of such cancer by always performing oophorectomy at elective hysterectomy. Arguments are the incidence and the low survival rate. There is a lack of knowledge on the potential of developing cancer in retained ovaries. One type of study argue that hysterectomy itself seem to have a longterm protective effect. Knowledge is scarce about the development from normally looking ovaries into clinical malignant ovaries and the progression of an early cancer into an advanced staged cancer.

Other articles illustrate the debate from a point of view that focuses on quality of life. This research focuses on psychological wellbeing and sexual functioning. Some of the studies integrate measurements of sexual hormones. There haven’t been found specific correlations between hormonal levels and indices and the sexual and psychological measurements. One of these studies therefore concludes that there is a lack of data to argue that concomitant oophorectomy should be avoided on these grounds.

In addition to these two main entries to the question of elective hysterectomy in this specific group, other studies try to integrate information on the use of estrogen replacement therapy, hereunder compliance. Others give estimates on the risks to die from other prevalent diseases, like cardiovascular disease. Mathematic models are included as a way of imaging the total outcome.

Interpretation: Little research is focused on and limited to the question of concomitant bilateral oophorectomy at elective hysterectomy in the group of perimenopausal women. There is a great variety of study designs and terminology on the issue. The lack of solid data makes it difficult to draw any conclusions on when concomimtant oophorectomy should be performed.