Introduction
Benefits of Oophorectomy
- Ovarian cancer prevention
- Reduced risk of future ovarian surgery
- Prevention of breast cancer
Given the poor compliance of oral contraceptives and the low accuracy of screening tests in early detection of ovarian cancer, prophylactic oophorectomy is warranted in at-risk and postmenopausal women. Prophylactic oophorectomy performed during hysterectomy for benign conditions has been associated with loss of ovarian sex steroid hormones due to the onset of surgical menopause. To assess the need for local guidelines on prophylactic oophorectomy at the time of hysterectomy for benign disease.
Two hundred and two (81%) of the participants indicated that they benefited after reading the results of the WHI study on HRT and subsequently changed their practice of prophylactic oophorectomy after hysterectomy for benign conditions. Participants in this study favored oophorectomy especially in relation to age greater than 50 years with a family history of cancer and patients who requested removal of the ovaries. The majority of participants in this study were male (71%), specialist gynecologists (79%) and working in the private sector.
The results of this study show that the participants, regardless of the years of experience of the gynecologist (figure 5), or university in which postgraduate teaching was carried out, still performed prophylactic oophorectomy in patients over 50 years of age. Oram, Prevention of ovarian cancer: a survey of the practice of prophylactic oophorectomy by fellows and members of the Royal College of Obstetricians and Gynaecologists.
Disadvantage of oophorectomy
- Cardiovascular disease
- Osteoporosis/ hip fracture
- Cognitive function
- Mental health and Sexual function
Statement of the problem
The study was approved by the University of KwaZulu Natal Biomedical Research Ethics and Postgraduate Committees. The mean age (range SD +) at which specialists, registrars and health professionals recommend prophylactic oophorectomy to patients after hysterectomy for benign conditions was 55 ±3.9 years, respectively. There were no differences between specialists, registrars and health workers regarding the age at which patients are recommended prophylactic oophorectomy after hysterectomy for benign conditions (p = 0.45).
The results of this study showed that prophylactic oophorectomy was performed in patients over 50 years of age. 81% of participants in this study reported that they had benefited from the WHI study and 64% had postponed premature administration of HRT. The results of this study show that 97% of participants were aware of the WHI study and that 64% would delay unnecessary administration of HRT to patients as a result of the study outcomes (Table 3).
Instead, they used family history of cancer and patient age to guide their decision to operate, with 38% using international guidelines, 9% using departmental guidelines, and 10% using departmental guidelines. The results of this study identify prophylactic oophorectomy as the treatment of choice for patients over 50 years of age with benign gynecological conditions. Particular attention should be paid to the advantages and disadvantages of prophylactic oophorectomy for benign conditions.
Seventy-six (41%) of the participants did not use any guidelines, but used the family history of cancer and the patient's age as a guide to decide on surgery. Factors influencing specialists, physicians and registrars to choose prophylactic oophorectomy at the time of hysterectomy included family history of ovarian/breast/colon cancer (94%) followed by patient selection (48%), presence of ovarian cysts (45%), presence of endometriosis (37%), presence of peri-menopausal symptoms (35%), follicle-stimulating hormone > 10 (17%) and other causes (10%). There was no difference between specialists, registrars and physicians in terms of age over 50 years at which they recommended patients to have prophylactic oophorectomy after hysterectomy for benign conditions.
Brand, A.H., The RANZCOG college statement on prophylactic oophorectomy in older women undergoing hysterectomy for benign disease: is the evidence sufficient to change practice. Mezzopane, R., et al., Attitudes and clinical practice of Italian gynecologists towards prophylactic oophorectomy during hysterectomy for benign conditions. Do you think there is a need for local guidelines on prophylactic oophorectomy at the time of.
Methodology
Research design
Study population
Sampling and data
- Inclusion criteria
- Exclusion criteria
In 129 (64%) of the 202 participants stated that after reading the WHI results they would delay the unnecessary prescribing and use of HRT. Estrogen utilization rates continue to decline among women with bilateral oophorectomy [31] , despite the positive benefits of the hormone in patients undergoing BSO. The majority of participants (85%) indicated the need for local guidelines to allow uniformity of diagnosis, clear decision-making, guide practices and prevent medico-legal issues and unnecessary operations.
The study was conducted at an Obstetrics and Gynecology conference with a select number of participants as such a limited number of doctors were present and the majority of the medical doctors were specialists from the private sector. Lokkegaard, E., et al., The relationship between early menopause and risk of ischemic heart disease: influence of hormone therapy. Madalinska, J.B., et al., The impact of hormone replacement therapy on menopausal symptoms in younger high-risk women after prophylactic salpingo-oophorectomy.
Date, collection and methods
Data analysis
The data collected will be captured and subsequently analyzed using the Statistical Package for Social Sciences (SPSS version 19). Descriptive statistics such as mean, standard deviation, frequencies and percentages will be used to summarize results. Pearson Chi-square test or Fisher's exact test will be used to test for association level of experience and current practice.
Two independent sample tests or the Mann Whitney test will be used to test whether there is any association between current practice and physician age.
Ethical considerations
Prophylactic oophorectomy was generally performed along with an elective hysterectomy for women over 50 years of age, as it was believed that this would reduce the patient's risk of subsequent development of ovarian cysts, carcinomas, and repeat operations. Prophylactic oophorectomy performed in the premenopausal woman has been associated with a higher incidence of osteoporosis and hip fracture,[29] cognitive impairment, [30] and cardiovascular mortality. Prophylactic oophorectomy has been shown to be beneficial in patients with BRCA1 and BRCA2 genes in preventing the development of breast and ovarian cancer, but in low-risk women without a family history of cancer, it has been associated with a high risk of morbidity and mortality.
The recommended age for prophylactic oophorectomy of 50 years as recommended by this study is also partially supported by two studies conducted in Great Britain by Jacobs et al [33] and in Italy by Mezzapane et al [34], which reported approx. 20% of gynecologists who routinely perform prophylactic oophorectomies on patients aged 45-50 years.
