Intervention: Oophorectomy
ICD-10 code:
ICD-9 code:	65.3 - 65.6
MeSH	D010052
Other codes:

Oophorectomy (or ovariectomy) is the surgical removal of an ovary or ovaries. The International Classification of Health Interventions (ICHI is a system of classifying Procedure codes being developed by the World Health Organization. ICD-9-CM Volume 3 is a system of Procedural codes. It is a subset of ICD-9-CM (volumes 1 and 2 are used for Diagnostic codes. Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Procedure codes are numbers or alphanumeric codes used to identify specific health interventions taken by medical professionals Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental "Ovaria" redirects here This is also a proposed section and a Synonym of Solanum. In the case of animals, it is also called spaying and is a form of sterilization. Neutering, from the Latin neuter (of neither sex is the removal of an animal's Reproductive organ, either all of it or a considerably large part Sterilization (also spelled sterilisation) is a surgical technique leaving a male or female unable to reproduce. Removal of the ovaries in women is the biological equivalent of castration in males, and the term is occasionally used in the medical literature instead of oophorectomy.

In the case of humans, oophorectomies are most often performed due to diseases such as ovarian cysts or cancer; prophylactially to reduce the chances of developing ovarian cancer or breast cancer; or in conjunction with removal of the uterus.

The removal of an ovary together with a Fallopian tube is called salpingo-oophorectomy or bilateral salpingo-oophorectomy if both ovaries and tubes are removed. The Fallopian tubes, also known as oviducts, uterine tubes, and salpinges ( singular salpinx) are two very fine tubes lined with ciliated Oophorectomy and salpingo-oophorectomy are not common forms of birth control in humans; more usual is tubal ligation, in which the Fallopian tubes are blocked but the ovaries remain intact. Birth control, sometimes synonymous with contraception, is a regimen of one or more actions devices or Medications followed in order to deliberately prevent Tubal ligation (informally known as getting one's "tubes tied" is a permanent form of female sterilization, in which the Fallopian tubes are severed In many cases, surgical removal of the ovaries is performed concurrently with a hysterectomy. The surgery is then called "ovariohysterectomy" casually or "total abdominal hysterectomy with bilateral salpingo-oophorectomy" (sometimes abbreviated TAH-BSO), the more correct medical term. However, the term "hysterectomy" is often used colloquially yet incorrectly to refer to removal of any parts of the female reproductive system, including just the ovaries.

Contents 1 Hormone replacement 2 Benefits 2.1 Reduced breast cancer risk 2.2 Reduced ovarian cancer risk 2.3 Reduced problems of endometriosis 3 Risks 3.1 Longevity Risk 3.2 Cardiovascular Risk 3.3 Bone Density Risk 3.4 Sexuality Risk 4 Statistics 5 Technique 6 Managing side effects of prophylactic oophorectomy 6.1 Non-hormonal treatments 6.2 Hormonal treatments 7 See also 8 References 9 External links

Hormone replacement

In general, hormone replacement therapy is somewhat controversial due to the known carcinogenic and coagulative properties of estrogen; however, many physicians and patients feel the benefits outweigh the risks in women who may face serious health and quality of life issues as a consequence of early surgical menopause. Hormone replacement therapy may refer to Hormone replacement therapy (menopause Hormone replacement therapy (female-to-male The term carcinogen refers to any substance Radionuclide or radiation that is an agent directly involved in the promotion of Cancer or in the fatation of its propagation Coagulation is a complex process by which Blood forms Clots It is an important part of Hemostasis (the cessation of blood loss from a damaged vessel whereby Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, The ovarian hormones of estrogen, progesterone, and testosterone are involved in the regulation of hundreds of bodily functions; it is believed by some doctors that hormone therapy programs mitigate surgical menopause side effects such as increased risk of cardiovascular disease ^[1], and female sexual dysfunction ^[2]. There are many options for hormone replacement currently available and a considerable controversy exists in regards to synthetic versus natural or bio-identical regimens.

Benefits

Reduced breast cancer risk

Women with a risk of breast cancer, especially those women with mutated BRCA1 and/or BRCA2 genes, have been shown to have a significantly reduced risk of developing breast cancer after prophylactic oophorectomy^[3]. Prophylaxis ( Greek "προφυλάσσω" to guard or prevent beforehand) is any medical or Public health procedure whose purpose In addition, removal of the uterus in conjunction with prophylactic oophorectomy allows estrogen-based HRT to be prescribed to aid the woman through her transition into surgical menopause, instead of mixed hormone HRT, which has a significant contribution to breast cancer as well^[4].

Reduced ovarian cancer risk

Women with a risk of ovarian cancer, especially those women with mutated BRCA1 and/or BRCA2 genes, have been shown to have a significantly reduced risk of developing ovarian cancer after prophylactic oophorectomy. Prophylaxis ( Greek "προφυλάσσω" to guard or prevent beforehand) is any medical or Public health procedure whose purpose Risk is not reduced to zero, however, because the possibility of developing primary peritoneal cancer (ovarian cancer that begins outside the ovaries) does persist. Primary peritoneal cancer or carcinoma ("PPCa" is a Cancer of the cells lining the Peritoneum, or abdominal cavity

Reduced problems of endometriosis

In rare cases, oophorectomy can be used to treat endometriosis. Endometriosis (from endo, "inside" and metra, " Womb " is a common medical condition characterized by growth beyond or outside the uterus This is done to remove a source of hormones that fuel uterine lining growth, thus reducing the overgrowth responsible for endometriosis. Oophorectomy for endometriosis is usually a last-resort surgery, since hormonal agonists such as Lupron are usually prescribed first to alter the hormonal cycle. Leuprorelin ( INN) or leuprolide acetate ( USAN) is a Gonadotropin-releasing hormone agonist ( GnRH agonist) Oophorectomy for endometriosis is often done in conjunction with a hysterectomy as a final shot at removing all traces of endometriosis in cases where non-surgical treatments such as hormonal agonists have failed to stop the uterine overgrowth.

Ovarian cyst removal not involving total oophorectomy is often used to treat milder cases of endometriosis when non-surgical hormonal treatments fail to stop cyst formation. Removal of ovarian cysts through partial oophorectomy is also used to treat extreme pelvic pain from chronic hormonal-related pelvic problems.

Risks

Longevity Risk

Removal of ovaries causes hormonal changes and symptoms similar to, but generally more severe than, menopause. Menopause is the permanent shutting down of the female Reproductive system, a considerable length of time before the end of the lifespan Women who have had an oophorectomy are usually encouraged to take hormone replacement drugs to prevent other conditions often associated with menopause. Hormones (from Greek ὁρμή - "impetus" are chemicals released by cells that affect cells in other parts of the body Women younger than 45 who have had their ovaries removed face a mortality risk 170% higher than women who have retained their ovaries. ^[5]. Retaining the ovaries when a hysterectomy is performed is associated with greater longevity. ^[6] However, hormone therapy is commonly believed by many doctors to mitigate the mortality risks of oophorectomy ^[7].

Women who have had bilateral oophorectomy surgeries lose most of their ability to produce the hormones estrogen and progesterone, and lose about half of their ability to produce testosterone, and subsequently enter what is known as "surgical menopause" (as opposed to normal menopause, which occurs naturally in women as part of the aging process). Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, Progesterone is a C-21 Steroid Hormone involved in the Female Menstrual cycle, Pregnancy (supports Gestation Menopause is the permanent shutting down of the female Reproductive system, a considerable length of time before the end of the lifespan "Surgical menopause" differs from naturally occurring menopause in several respects: Surgical menopause is the result of surgery, while menopause is a natural event. A menopausal woman has intact functional female organs, a woman with surgical menopause does not. In natural menopause the ovaries generally continue to produce low levels of hormones, while in surgical menopause the ovaries and their hormones are absent, which can explain why surgical menopause is generally accompanied by a more sudden and severe onset of symptoms than natural menopause, symptoms which may continue until natural age of menopause arrives ^[8]. These symptoms are commonly addressed through hormone therapy, utilizing various forms of estrogen, testosterone, progesterone or a combination of them.

Cardiovascular Risk

When the ovaries are removed a woman is at a seven times greater risk of cardiovascular disease, ^{[9][10][11] [12]} but the mechanisms are not precisely known. The hormones produced by the ovaries cannot be truly replaced. The ovaries produce hormones a woman needs throughout her entire life, in the quantity they are needed, at the time they are needed, and released directly into the blood stream in a continuous fashion, in response to and as part of the complex endocrine system.

Bone Density Risk

In women under the age of 50 who have undergone oophorectomy, hormone supplements (usually estrogen) are often prescribed as part of hormone replacement therapy (HRT) to offset the negative effects of sudden hormonal loss (most notably an increased risk for early-onset osteoporosis) as well as menopausal problems like hot flushes (also called "hot flashes") that are usually more severe than those experienced by women undergoing natural menopause. Hormone replacement therapy may refer to Hormone replacement therapy (menopause Hormone replacement therapy (female-to-male Osteoporosis is a Disease of Bone that leads to an increased risk of fracture. Hot flashes (also known as hot flushes or night sweats if they happen at night are a symptom of the changing Hormone levels that are considered to be

Some studies have found that increased bone loss or fracture risk is associated with oophorectomy. ^{[13] [14] [15] [16] [17]} Reduced levels of testosterone in women is predictive of height loss, which may occur as a result of reduced bone density,^[18]

Sexuality Risk

Oophorectomy very rarely impacts sexuality in women, it does not greatly reduce or eliminate the ability to have an orgasm, however occasionally there is a lowering of sexual desire. This reduction is greater than that seen in women undergoing natural menopause ^[19]. Some of these problems can be addressed by taking hormone replacement. Increased testosterone levels in women are associated with a greater sense of sexual desire, and oophorectomy greatly reduces testosterone levels. ^[20] Reduction in sexual wellbeing was reported in women who had been given a hysterectomy with both ovaries removed. ^[21]

Statistics

According to the Center for Disease Control, 454,000 women in the United States underwent this type of operation in 2004. The Centers for Disease Control and Prevention (or CDC) is an agency of the United States Department of Health and Human Services based in unincorporated

Technique

When performed alone (without hysterectomy), an oophorectomy is generally performed by abdominal laparotomy. A laparotomy is a surgical procedure involving an incision through the Abdominal wall to gain access into the Abdominal cavity.

Managing side effects of prophylactic oophorectomy

Non-hormonal treatments

The side effects of oophorectomy may be alleviated by medicines other than hormonal replacement. Non-hormonal biphosphonates (such as Fosamax and Actonel) increase bone strength and are available as once-a-week pills. Low-dose Selective Serotonin Reuptake Inhibitors (e. g. Paxil, Prozac) alleviate vasomotor menopausal symptoms, i. e. "hot flashes". ^[22]

Hormonal treatments

Short-term hormone replacement with estrogen, in high-risk BRCA mutation carriers, was not shown to increase the risk of breast cancer in women who are post-oophorectomic. The results were published in JCO in 2004 and the conclusions were based on a computerized simulation using models of risk and benefit, a lower level of data than a randomized trial per se. ^[23] This result can probably be generalized to other women at high risk in whom short term (i. e. , one or two year) treatment with estrogen for hot flashes, may be acceptable.

See also

• Spaying and neutering
• Tubal ligation
• Birth control
• Hysterectomy
• Hormone Replacement Therapy
• Castration or orchidectomy - the male equivalent

References

External links

• Useful list of currently available hormone replacements in the US[1]
• Useful list of currently available hormone replacements in the UK [2]
• A. D. A. M Medical Encyclopedia [http://www.nlm.nih.gov/medlineplus/ency/article/002915.htm Article on Oophorectomy
• A Survivor's Guide to Surgical Menopause: Collected information on managing post-surgical menopause conditions
• Encyclopedia of Surgery Article on Hysterectomy

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