Bilateral oophorectomy at hysterectomy for benign disease increases all-cause mortality, coronary disease and lung cancer — roughly one extra death per nine operations (Parker 2013, Nurses' Health Study).
Original statement
باركر في Nurses' Health Study على 30,117 ممرضة وثّق ارتفاع الوفيات الكلية ومرض الشريان التاجي وسرطان الرئة بعد استئصال المبيضين الثنائي لمرض حميد.
verbatim according to source. Translation by the project; the Arabic wording is authoritative.
Translation
Bilateral oophorectomy at hysterectomy for benign disease increases all-cause mortality, coronary disease and lung cancer — roughly one extra death per nine operations (Parker 2013, Nurses' Health Study).
Origin
- Source status
- Archive editors
- Attribution
- Archive editors (eltayebat.com); not necessarily Elawady's own words
- Origin
- https://eltayebat.com/rule/unnecessary-organ-removal/
- Attribution uncertainty
- Editorial summary/narrative and study selection written by the archive operators; the archive states that the cited research documents harm independently of Dr. Diaa's words.
- Claimed mechanism
Loss of ovarian hormones.
- Claimed health effect
Higher mortality, CHD, lung cancer.
- Population concerned
Women undergoing benign hysterectomy
- Geographic restriction by Elawady
not applicable
Scientific assessment
Mostly true – Correct at its core, but with limitations or minor inaccuracies.
Certainty of evidence: low – Further research is likely to change the assessment considerably.
1. What was claimed?
Oophorectomy raises mortality, CHD and lung cancer; NNH about 9.
2. What is demonstrably correct?
All-cause death 16.8% vs 13.3% (HR 1.13); in women <50 never using estrogen HR 1.41 with NNH 8 (A-ORG-13); multimorbidity HR 1.22 (A-ORG-15); meta-analysis: total CVD HR 1.18, CHD 1.17 (I-ORG-10).
3. What is wrong or exaggerated?
The NNH '9' is not reported; the paper's NNH (8) is restricted to a subgroup and does not apply to all women. Oophorectomy also reduced ovarian cancer deaths (4 vs 44). In the meta-analysis (I-ORG-10), excess all-cause mortality was seen only for BSO before age 50 (HR 1.22, I2 85%) and not after 50 (HR 0.98, 0.91-1.05); lung cancer was not among the pooled outcomes, and no 'one extra death per nine operations' figure is supported; the same review reports strong reductions in ovarian cancer (HR 0.11) and breast cancer before 45 (HR 0.78).
4. What remains unclear?
Causality (reasons for oophorectomy unknown).
5. Which studies support it?
6. Which studies contradict it?
I-ORG-10 (mortality heterogeneity; breast cancer benefit).
7. What applies to Germany and Europe?
Most cited cohorts are Scandinavian (Denmark, Sweden) and directly European; RCTs from the UK and Finland are directly transferable. Guidelines in Europe also emphasize defined indications (not verified here in detail).
8. What is known about Egypt?
No Egypt-specific data on rates or outcomes of tonsillectomy, cholecystectomy, hysterectomy, splenectomy or thyroid surgery were identified in this review.
9. What practical conclusion is appropriate?
Removing healthy ovaries at benign hysterectomy in younger women has long-term costs; decisions should be individual.
Assessment details
- Rationale for certainty of evidence
Consistent observational evidence and a meta-analysis for CVD; mortality evidence heterogeneous; NNH misquoted.
- Source quality
Direction correct. 'One extra death per nine operations' is not in the paper; NNH 8 applies only to women <50 who never used estrogen.
- Regional transferability
US data; European registers similar for CVD.
- Individual exceptions
No excess mortality among estrogen users in Parker; oophorectomy lowers ovarian and (before 47.5) breast cancer death; women with high genetic risk (e.g., BRCA) are a different situation.
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 26 October 2026 provisional
Scientific evidence in detail
True only under certain conditions – The claim holds only for certain doses, groups of people, preparations or circumstances.
Research question: In women undergoing hysterectomy for benign disease, does bilateral oophorectomy (vs ovarian conservation) increase all-cause mortality, coronary disease and lung cancer, by about one extra death per nine operations?
Research question in detail (PECO)
- Population
- Women undergoing hysterectomy for benign disease
- Intervention or exposure
- Bilateral (salpingo-)oophorectomy
- Comparison
- Ovarian conservation
- Geographic scope
- universal biology; age- and estrogen-dependent
- Outcomes
- All-cause mortality
- CHD
- Lung cancer
Study results as reported by the authors. Our assessment follows below.
What speaks for the claim?
Removing ovaries at hysterectomy and long-term survival
Cusimano MC et al.. BMJ 2021 · PMID 34880044 · DOI 10.1136/bmj-2021-067528 Cohort studyfull text checkednewly addedCusimano 2021 Ontario cohort (200,549 women): BSO before 50 linked to higher all-cause mortality.
- Actual result
- HR 1.31 (1.18-1.45) < 45, NNH 71 at 20 years; HR 1.16 at 45-49.
- Methodological quality
- high (population cohort, full text)
- Relevance
- direct
- Limitations
- Observational; no effect >= 50.
Nurses' Health Study: removing both ovaries at hysterectomy
Parker WH et al.. Obstet Gynecol 2013 · PMID 23635669 · DOI 10.1097/AOG.0b013e3182864350 Cohort studyfull text checkedParker 2013 Nurses' Health Study: all-cause death 16.8% vs 13.3% over 28 years.
- Actual result
- HR 1.13 (1.06-1.21); NNH 8 only in < 50 never-users of estrogen.
- Methodological quality
- moderate (cohort, full text)
- Relevance
- direct
- Limitations
- Self-reported surgery.
Meta-analysis: removing ovaries at hysterectomy
Hassan H et al.. Am J Obstet Gynecol 2024 · PMID 37364803 · DOI 10.1016/j.ajog.2023.06.043 Meta-analysisfull text, structured risk-of-bias assessmentMeta-analysis: CVD and CHD increased after BSO under 50.
- Actual result
- CHD < 50 HR 1.17 (1.10-1.25).
- Methodological quality
- moderate (MA, full text)
- Relevance
- direct
- Limitations
- Observational.
What speaks against the claim?
Ovary removal and death rates in Californian teachers
Duan L et al.. Fertil Steril 2012 · PMID 22088205 · DOI 10.1016/j.fertnstert.2011.10.004 Cohort studyabstract checkednewly addedCalifornia Teachers Study: no increased mortality after surgical menopause.
- Actual result
- All-cause RR 0.86-0.87.
- Methodological quality
- moderate (cohort)
- Relevance
- indirect (natural menopause comparator)
- Limitations
- Survivor bias.
Removing ovaries at hysterectomy and long-term survival
Cusimano MC et al.. BMJ 2021 · PMID 34880044 · DOI 10.1136/bmj-2021-067528 Cohort studyfull text checkednewly addedSame Ontario cohort: no excess mortality when BSO done at 50 or later.
- Actual result
- HR 0.83 (50-54); 0.92 (>= 55).
- Methodological quality
- high
- Relevance
- direct
What does the overall evidence say?
Editorial assessment based on the studies above – not itself a study result.
Which position is better supported?
BSO at benign hysterectomy is associated with higher mortality when performed before about age 50 (and without estrogen therapy), not afterwards; the excess is much smaller than one death per nine operations.
Why some studies weigh more
Cusimano 2021 (incident exposure, validated codes, propensity weighting) outweighs prevalent-exposure designs.
Is a causal relationship established? Probable Consistent cohorts, dose-response with age at surgery, plausible estrogen mechanism; observational only.
Remaining uncertainty
Role of estrogen therapy; residual confounding.
Justified conclusion
Direction supported for premenopausal women; numbers and generalisation not.
Why do studies seem to disagree?
Duan 2012 compared surgical with natural menopause among baseline survivors; Cusimano and Parker compared BSO with ovarian conservation from the time of surgery. Different comparators and survivor bias explain the discrepancy.
Does this depend on the country?
- General biological effects
- Universal; depends on age at surgery and estrogen use.
- Eating habits
- Not relevant to this claim.
- Origin of the food
- Not applicable.
- Contaminants
- Not applicable.
- National production conditions
- Not applicable.
- Legal rules
- Not applicable.
- Actual monitoring data
- No Egypt-specific monitoring data identified.
A regional difference that changes the conclusion is not supported by robust data.
Statistical re-check
- NNH to absolute risk; CI symmetry – 1.41% (<45) and 0.66% (45-49) absolute excess over 20 years; CIs symmetric recalculated
- Crude NNH vs claimed 'one per nine' – Crude overall NNH about 29 over 28 years; NNH 8 only in a subgroup recalculated
Certainty of the overall evidence (GRADE, simplified)
- Main outcome
- All-cause mortality after premenopausal BSO
- Starting level
- low (observational studies)
- Reasons for downgrading
- inconsistency (some null cohorts)
- Reasons for upgrading
- dose-response (age at surgery)
- Result
- low
Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.
Clinical guidelines and official statements checked
- ACOG: Committee Opinion No. 774: Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention (reaffirmed 2024) (2019) · Original publication
BSO causing surgical menopause reduces ovarian cancer risk but may increase the risk of cardiovascular disease, other cancers, osteoporosis, cognitive impairment and all-cause mortality; counselling should include oophorectomy (I-ORG-142). - ACOG: Practice Bulletin No. 89: Elective and risk-reducing salpingo-oophorectomy (2008) · Original publication could not be retrieved; content not used
Search strategy
Documented literature searches for this review (search strings in the original database syntax).
| Database | Date | Search | Looking for | Hits | Included |
|---|---|---|---|---|---|
| Europe PMC | 26 October 2026 | (TITLE:oophorectomy OR TITLE:"ovarian conservation" OR TITLE:"salpingo-oophorectomy" OR TITLE:"ovarian tissue") AND (TITLE:mortality OR TITLE:death) AND (hysterectomy) AND (cohort OR "population-based" OR "meta-analysis") | both directions | 17 |
Open questions
Effect modification by estrogen therapy.
How deeply was this checked?
6 linked studies: 3 checked in full text (1 of them with a structured risk-of-bias assessment), 3 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.
Last scientific review: 26 October 2026
History of the verdict
- 25 October 2026 · Phase 1 · Initial assessment: Mostly true (low)
- 26 October 2026 · Phase 4 (systematic evidence review) · Re-examined with extended evidence; verdict unchanged: Mostly true (low)
Unchanged (“Mostly true”, low). Cusimano 2021 confirms the direction in premenopausal women and contradicts it after 50, matching the existing judgement that the figure is misquoted and over-generalised.
New sources: I-ORG-142 I-ORG-135 I-ORG-134
In plain language
The archive says that removing both ovaries during a hysterectomy for a benign condition increases deaths and heart disease, with one extra death per nine operations. The direction is supported by large studies, especially for women under 50 who do not take estrogen. But the 'one in nine' figure is not in the study: the study gives one extra death per 8 operations only for that subgroup. Removing ovaries also lowered deaths from ovarian cancer.
Studies on this claim
Studies supporting the claim (3)
-
Nurses' Health Study: removing both ovaries at hysterectomy
Parker WH et al.. Obstet Gynecol 2013 · PMID 23635669 · DOI 10.1097/AOG.0b013e3182864350Cohort studycited by the Tayebat archivefull text checked★ key studyRemoving the ovaries was linked to somewhat higher death rates (16.8% vs 13.3% over 28 years), mainly in women under 50 who never took estrogen.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Mortality
- How was the study done?
Prospective cohort
- How many people, animals or samples were studied?
30,117
- What was actually found?
Higher mortality, especially <50 without estrogen
- How large was the observed effect?
HR 1.13; NNH 8 in subgroup
- What do the results mean in everyday life?
Keeping healthy ovaries may be better for many women
- What are the study's limitations?
Observational
- What does it say about Elawady's specific claim?
Supports direction; NNH misused
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Causation; women with BRCA etc.
-
Ovary removal and chronic diseases
Rocca WA et al.. Mayo Clin Proc 2016 · PMID 27693001 · DOI 10.1016/j.mayocp.2016.08.002Cohort studycited by the Tayebat archiveabstract checkedWomen who had both ovaries removed before 46 accumulated chronic diseases faster.
Does the study support the specific claim? Yes · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Multimorbidity
- How was the study done?
Cohort
- How many people, animals or samples were studied?
n/a
- What was actually found?
Faster accumulation
- How large was the observed effect?
HR 1.22
- What do the results mean in everyday life?
Possible broad health cost
- What are the study's limitations?
Baseline differences
- What does it say about Elawady's specific claim?
Supports
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Causation
-
US gynaecologists on removing ovaries
American College of Obstetricians and Gynecologists (ACOG). ACOG Committee Opinion 2019Guideline / position statementindependent cross-checkabstract checkedRemoving both ovaries before menopause may raise risks of heart disease, bone loss, memory problems and death, so it should be discussed carefully.
ACOG lists possible increases in CVD, cognitive impairment and mortality after BSO-induced surgical menopause.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Guide salpingectomy and oophorectomy counselling
- How was the study done?
Committee opinion
- How many people, animals or samples were studied?
n/a
- What was actually found?
BSO may increase several long-term risks
- How large was the observed effect?
n/a
- What do the results mean in everyday life?
Keeping healthy ovaries is often preferred before menopause
- What are the study's limitations?
Only abstract read
- What does it say about Elawady's specific claim?
Supports the direction of the claim
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Not quantitative
No study in this group is marked as key.
Studies contradicting or limiting the claim (1)
-
Ovary removal and death rates in Californian teachers
Duan L et al.. Fertil Steril 2012 · PMID 22088205 · DOI 10.1016/j.fertnstert.2011.10.004Cohort studyindependent cross-checkabstract checkedWomen whose menopause came from ovary removal did not die more often than women with natural menopause.
No mortality increase versus natural menopause; weaker design than Cusimano 2021.
Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Compare mortality after surgical vs natural menopause
- How was the study done?
Prospective cohort
- How many people, animals or samples were studied?
About 41,000 women
- What was actually found?
No increase in mortality
- How large was the observed effect?
All-cause RR 0.86-0.87
- What do the results mean in everyday life?
Shows the harm is not seen in every study
- What are the study's limitations?
Survivor bias, different comparator
- What does it say about Elawady's specific claim?
Contradicts the claim
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Cannot rule out harm in young women without estrogen
No study in this group is marked as key.
Studies with mixed or unclear results (2)
-
Meta-analysis: removing ovaries at hysterectomy
Hassan H et al.. Am J Obstet Gynecol 2024 · PMID 37364803 · DOI 10.1016/j.ajog.2023.06.043Meta-analysisindependent cross-checkfull text, structured risk-of-bias assessment★ key studyLinked to less breast cancer but more heart disease, dementia and other conditions in younger women; effect on death was inconsistent.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
BSO outcomes
- How was the study done?
Meta-analysis
- How many people, animals or samples were studied?
n/a
- What was actually found?
Trade-offs
- How large was the observed effect?
CVD HR 1.18; dementia HR 1.70
- What do the results mean in everyday life?
Removing healthy ovaries in young women has costs and some benefits
- What are the study's limitations?
Observational studies, few per outcome, fixed-effect pooling, no study-level risk-of-bias assessment
- What does it say about Elawady's specific claim?
Supports risks; mortality unclear
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Causation; harm after age 50; absolute risk
-
Removing ovaries at hysterectomy and long-term survival
Cusimano MC et al.. BMJ 2021 · PMID 34880044 · DOI 10.1136/bmj-2021-067528Cohort studyindependent cross-checkfull text checked★ key studyRemoving both ovaries before age 50 was linked to more deaths over 20 years (about 1 extra death per 71 women under 45), but not after 50.
Excess mortality only when BSO done before 50 (NNH 71 at < 45); none at >= 50.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Check whether ovary removal at hysterectomy affects survival
- How was the study done?
Population cohort with propensity weighting
- How many people, animals or samples were studied?
200,549 Ontario women
- What was actually found?
Higher mortality under 50, not over 50
- How large was the observed effect?
HR 1.31 (<45), NNH 71 at 20 y
- What do the results mean in everyday life?
Keeping healthy ovaries matters mainly before menopause
- What are the study's limitations?
Observational; some confounders missing
- What does it say about Elawady's specific claim?
Supports the claim with an age condition; contradicts its size
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Cannot prove causation
No study in this group is marked as key.
Regional context
Germany / EU
Most cited cohorts are Scandinavian (Denmark, Sweden) and directly European; RCTs from the UK and Finland are directly transferable. Guidelines in Europe also emphasize defined indications (not verified here in detail).
Egypt
No Egypt-specific data on rates or outcomes of tonsillectomy, cholecystectomy, hysterectomy, splenectomy or thyroid surgery were identified in this review.
What applies in my country?
General scientific assessment
Mostly true Supported for women under about 50: removing healthy ovaries at hysterectomy is linked to higher mortality, but not after 50, and the 'one in nine' figure is misquoted and over-generalised.
This statement concerns biological or medical relationships. The scientific assessment above applies regardless of the country; country-specific food data do not change it.
References
- Long-term mortality associated with oophorectomy compared with ovarian conservation in the nurses' health study.. Parker WH et al.. Obstet Gynecol 2013 · PMID 23635669 · DOI 10.1097/AOG.0b013e3182864350
- Accelerated Accumulation of Multimorbidity After Bilateral Oophorectomy: A Population-Based Cohort Study.. Rocca WA et al.. Mayo Clin Proc 2016 · PMID 27693001 · DOI 10.1016/j.mayocp.2016.08.002
- Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention (ACOG Committee Opinion No. 774; reaffirmed 2024). American College of Obstetricians and Gynecologists (ACOG). ACOG Committee Opinion 2019
- Bilateral oophorectomy is not associated with increased mortality: the California Teachers Study.. Duan L et al.. Fertil Steril 2012 · PMID 22088205 · DOI 10.1016/j.fertnstert.2011.10.004
- Long-term outcomes of hysterectomy with bilateral salpingo-oophorectomy: a systematic review and meta-analysis.. Hassan H et al.. Am J Obstet Gynecol 2024 · PMID 37364803 · DOI 10.1016/j.ajog.2023.06.043
- Association of bilateral salpingo-oophorectomy with all cause and cause specific mortality: population based cohort study.. Cusimano MC et al.. BMJ 2021 · PMID 34880044 · DOI 10.1136/bmj-2021-067528