The pendulum has swung the other way. Historically,
any woman aged 40 or older undergoing a hysterectomy
for benign disease was offered an elective bilateral salpingooophorectomy
(BSO). This is the only intervention that is
successful in dramatically reducing the chance of developing
ovarian cancer, the most lethal gynecologic malignancy due to
its poor early detection rates.1 Between 1965 and 1999, the
percentage of benign hysterectomies performed with a concomitant
BSO increased from 25% to 55%. More recently,
however, elective BSO rates have declined, particularly in
women aged 45–49 years.2 This practice change possibly occurred
in response to the revised recommendation released by
the American College of Obstetricians and Gynecologists,
which stated that strong consideration should be made for
retaining normal ovaries in premenopausal women who are
not at increased genetic risk of ovarian cancer.3 Overall, in
these younger women, the negative effects of ovarian hormone
deprivation are thought to outweigh the beneficial effects
on ovarian cancer, although conflicting data exist,
particularly with regard to coronary heart disease