Oophectomy vs hysterectomy

I'm not sure of the spelling on that first word there...sorry...

I was just thinking...If I have endometriosis, it is the hormones stimulating it and causing the trouble, so why don't they just take out the ovaries? Why do they want to take out the whole shebang?

Hi Elise
I had exactly the same question. But I have heard the same from so many different gynaes now, so I guess it is what they do.

My endo specialist did say I could keep the uterus, but she recommended removing it because:

leaving it in complicates the HRT protocol - with a uterus you definitely need progesterone, without it you may not

without the ovaries there is no real 'purpose' for the uterus

you will continue to need a pap smear with the cervix

it leaves a site for future problems - adenomyosis and uterine cancer, fibroids etc which may necessitate later surgery.

It really is your choice though, they can definately take the ovaries and leave the uterus.

So, I decided to have it all out - my aunt has uterine cancer and while she recovered well from this major surgery, the radiation treatments have caused her to suffer so badly.

Good luck with your decision and only do what you feel is good for you.

Oh, I see. If HRT is just progesterone, that might be OK in spite of it affecting my cholesterol. But if the uterus would need estrogen, then I am totally out of luck. It's just the one thing that is really freaking me out is this "vaginal cuff" business. It just seems weird to leave my vagina kind of untethered like that.

Hi Elise,

I had a TAH/BSO about 3 years ago, primarily due to severe stage 4 endo ... so I can relate to your situation. While it might seem that just removing your ovaries will solve the problem, it is more complicated than that. Most women with endo that is severe enough to warrant a hyst have a "web" of endometrial tissue and adhesions inside their pelvis. Often, it's a real task to "find" and remove the ovaries and uterus. Even if only your ovaries were removed, it would be difficult to remove all the endo and adhesions while carefully preserving the uterus ... not impossible, but a difficult surgery.

As for the vaginal cuff ... it does sound pretty "icky" when you first think about it. From my understanding, the uterine ligaments are reattached after the uterus is removed, so your vagina is actually well-anchored in place.

From personal experience, I can tell you that I don't get any sense that my vagina is "untethered." Things feel quite firm and normal inside. I've been extremely lucky, with no surgical complications or long-term issues. I'm actually doing great and really don't have any concerns about my vaginal cuff. Sex is great and I'm just happy not being in pain anymore.

Hope this helps ease your mind a little. Keep us posted on how you are doing and your ultimate decision about surgery.

Beth

I know it probably sounds weird, but I just don't want it wandering around on it's own unsupervised. Good to know it will be properly harnassed. So I guess the other organs will just kind of move into place to fill the void left by everything else. Although I realize all this stuff isn't very big. The sex ed posters I saw growing up misled me by drawing the reproductive organs so large...I always thought my uterus went all the way past my belly button! I was surprised by my 1st ultrasound, when they told me where my fallopian tubes really were.

We really have no idea what's in there yet. It could be like the inside of a pumpkin for all I know. Or maybe it's hardly anything...apparantly pain is not indicative of severity.

I will need alot more time with the doctor discussing everything. Once she determined my current pain was GI, she referred me off to take care of that first, so our discussion was cut short. I was in too much shock to really process everything anyways, because the last Repro-Endo assured me I wouldn't need a hysterectomy at all. The 1st doctor I had gone to recommended TAH, so it's 2 to 1 right now...

Hi again

Just checking you have the HRT thing right.

If you decide to have your ovaries and uterus removed, then you will most likely only need estrogen for HRT.

If you keep the uterus, the HRT must also have progesterone as well as estrogen, otherwise the lining on the uterus will continue to build up under the influence of the estrogen, and this is not good. The progesterone stops this lining building up too much.

Beth is right too - endo tends to muck up everything inside and my doc feels I also have adenomyosis and adhesions.

It is the lack of ovaries that requires estrogen, so it sounds from your post that this is not an option?

I am Diabetic, have messed up cholesterol, my dad died of a heart attack 2 years ago, and my mom had a major stroke 5 years ago. So the doctors refused to continue my birth control pills. They say it will give me a heart attack or stroke in the immediate future.

My Endocrinologist (Diabetes) doesn't want me on progesterone because it further lowers my barely existent HDL ("good") cholesterol. The Repro Endo doesn't want me having estrogen or keeping an ovary because that will keep the endo going.

If I could just have the pill or Depo Provera I could manage with 1 day a month off work and a few Vicodan just fine. But they won't let me take the hormones anymore.

I expected the Dr. to have a peek around inside before making recommendations but she seems to think it's best to just prepare to take it all out. I got the impression she expects to find a big mess. I'm not sure what she'll do if it's all fine in there.

As I mentioned, our conversation was cut short when she realized half my symptoms pointed to a Gastro-intestinal problem, so maybe I am not clear on the plan. The main thing that stuck in my head was the comment "It's probably best to just get in there and clean you right out."

Maybe since diabetes gives you a higher risk of infection, she only wants to go in once?

At this point, I think my decision will rest on one thing. The Lupron made my estrogen drop and the resultant effect was extreme tenderness and inability to have sex anymore. (Not related to lubrication at all). If the hysterectomy will make that tenderness permanent, I'm going to try to just ablate til the cows come home.