Traditionally, in women who required a hysterectomy for a benign cause and were in perimenopause, (a few months/years before menopause), removal of the ovaries (prophylactic oophorectomy) was recommended.

The rationale was that ovarian function and hormonal production (estrogens and progesterone) were nearing their end and, in addition, incidence and death from ovarian cancer were prevented.

Ovarian cancer is the 2nd most common gynecological cancer but it is the most aggressive.

Although it is a tumor that is diagnosed as spread throughout the pelvic and abdominal cavity (advanced stage of the disease) in 80% of cases, it is rare in the general population without risk of suffering from it.

Although it is widely known that after menopause, ovarian production of estrogen ceases, little research has been done on the potential functions of the ovaries in the peri- or postmenopausal years.

Recent studies have shown that during menopause in women, the ovaries produce androgens that are converted to estrogens in fatty tissue. In this way, women who still have ovaries during menopause have a lower risk of death from cardiovascular or neurological disease in the future.

In addition, the studies showed that this benefit is more marked in the group of pre-menopausal women between 45 and 49 years of age.

In other words, this means that the risk of death from cardiovascular disease exceeds the risk of death from ovarian cancer in low-risk women.

Thus, the decision to remove the ovaries in perimenopausal women at the time of hysterectomy for benign causes should be individualized. Thus, the presence of risk factors for cardiovascular or neurological diseases should be balanced with the risk of ovarian cancer in each particular patient.

On the other hand, in women at increased risk of ovarian cancer and with known BRCA1/2 gene mutations, or affected close relatives, the benefits of preventively removing the ovaries far outweigh the risks.

Appropriate professional advice and individualized treatment will help women find more effective disease prevention strategies to ensure their best future health.