Removal of Ovaries and Fallopian Tubes without consent is a straightforward breach of duty. Early onset surgically induced menopause can increase the rate at which a woman loses bone and may develop osteoporosis. There’s a concern that younger women who go into menopause might be at an increased risk of heart disease later in life. It could also affect cognitive function.
In a recent case the claimant, aged 49 years at the date of the operation underwent a hysterectomy. She had completed her family and did not intend to have any more children. During the course of the procedure, the surgeon also performed a bilateral salpingo-oophorectomy (removal of ovaries and fallopian tubes) without the claimant’s consent. Compensation was assessed around £10,000.
The protection afforded by the ovaries is important to women even after menopause. Surgical menopause causes:
Surgical menopause may have other adverse effects on health including affecting mood (increased depression), cognition (thinking), dementia and potential increased risk of Parkinson’s disease. Large population based studies have reached different conclusions about whether surgical menopause impacts on cardiovascular, cancer or all cause mortality.
Removal of Ovaries and Fallopian Tubes is not required unless there is a clinically supportive reason for removal. In cases of heavy menstrual bleeding, fibroids or uterine prolapse a hysterectomy may be the last surgical resort after other conservative options have been explored. Removing ovaries and fallopian tubes is not part of that hysterectomy process.
Removing ovaries and fallopian tubes has been shown to be beneficial in women with an inherited increased chance of developing ovarian cancer (gene mutations such as BRCA1 or BRCA2 or HNPCC) (3), and for some women with very strong family histories of ovarian cancer.
Otherwise, there is no justification for removing ovaries and fallopian tubes at the same time. It is not recommended as the disadvantages of removing normal ovaries is likely to be greater than their very small risk of ovarian cancer.
Some premenopausal women will be advised to have their ovaries removed for other indications, such as endometriosis or chronic pelvic pain. Depending on the circumstances, removal of the ovaries may improve pain, but it is not always effective. Some doctors may suggest a trial of a drug to bring on a short term “chemical menopause” before surgery to try and mimic the effects of surgical menopause. However, it is not currently possible to predict how surgical menopause will affect individual women.
Recurrent ovarian cysts and premenstrual syndrome are other reasons that removal is recommended. The evidence to support a benefit for this is weak and normal ovaries should not be removed from younger women for these indications.
Although surgical menopause is common, there have been remarkably few studies which have followed women before and after oophorectomy to try and understand how surgery affects their menopausal symptoms and short and long term health.
Hormone replacement therapy (HRT) is advised for all women who undergo a surgical menopause under the age of 45. However this is only advisable if they do not have contraindications to HRT such as:
Within these categories they should not use HRT and should be advised before surgery not have ovaries and fallopian tubes removed.
If the ovaries and fallopian tubes are removed it is important to discuss evidence based lifestyle strategies for maintaining bone and cardiovascular health with women. These may include, diet, exercise, smoking cessation and adequate calcium and Vitamin D levels.
Women should also ensure that vasomotor symptoms and vaginal dryness are effectively managed. Younger women may require higher doses of oestrogen to manage their symptoms. Low doses should be used in the first instance to minimise exposure.
Women who are below the age of 45 years are entitled to Medicare Bone Density (DXA) scans. These should be performed at 2 yearly intervals. MHT (unless contraindicated) is the best management option for these women with low bone density.
Due to the increased risk of cardiovascular disease associated with early menopause assessment of cardiovascular risk factors should be considered. This includes blood pressure, serum fasting glucose and fasting lipid levels.
For many women psychological support in view of the potential increased risk of depression is necessary. Being plunged into surgical menopause is often described as ‘falling of a cliff’. The menopause symptoms come all at once.
If you think you may have a claim following removal of ovaries and fallopian tubes then call us in confidence to discuss your issue. We are happy to talk through what has happened and advise you on a potential claim. Call us for FREE on 0800 470 2009 or email Dr Victoria Handley at firstname.lastname@example.org