Prophylactic oophorectomy: a continuing controversy

Prophylactic oophorectomy remains a controversial issue among gynecological surgeons. A woman's history of hereditary ovarian cancer syndrome is currently considered the most important indication for prophylactic oophorectomy. This is because of the high risk of ovarian cancer developing in these women and the poor prognosis that is generally associated with ovarian cancer. The purpose of prophylactic oophorectomy in women with no family history of hereditary ovarian cancer syndrome who present for hysterectomy because of other gynecological indications is, however, less clear. The attitude of the patients toward removal of normal ovaries deserves special consideration when counseling for prophylactic oophorectomy in this group of women. Knowledge about the risk of ovarian cancer in the conserved ovaries, cancer phobia, possible psychological effects of prophylactic oophorectomy, and the need for long-term hormone replacement therapy if prophylactic oophorectomy is carried out, are all important considerations in the counseling process.