ovarian cancer

does anyone know if your risk of ovarian cancer increases after a hysterectomy? I have searched the web (which I am really not that talented) but have not found anything. My doc wants to remove my ovary b/c of that risk, but I dont want sudden menopause.
thx
chele.

Chele,
Here's what one doctor has to say. This is from [A Gynecologist's Second Opinion]. There is a good website about this book with lots of info:

"If you need a hysterectomy, should you also have your ovaries removed?
I have changed my view about this controversial subject since the first edition of this book was published. At that time, I suggested that women who were having a hysterectomy performed for appropriate reasons also consider having their ovaries removed after the age of about forty-five. My thinking at the time was that the ovaries would continue producing hormones for only a few years thereafter, and this advantage would be overshadowed by the benefit of removing the ovaries and eliminating the 1 percent chance of developing ovarian cancer in your lifetime. However, a number of issues have come to my attention since then, and I now believe that the ovaries should almost never be removed at the time of hysterectomy.

First, the risk of ovarian cancer goes down if the ovaries remain after hysterectomy. The reason for this is not clear, but it may be that the path for potential carcinogens from the vagina to the ovaries is interrupted when the uterus is removed. Thus, the risk of a woman developing ovarian cancer after hysterectomy is probably closer to 1 in 300 rather than 1 in 80 for women who have not had a hysterectomy. The benefit of removing ovaries for ovarian cancer prevention has been overstated in the medical literature and is, therefore, misunderstood by most physicians.

Significantly, the ovaries produce hormones long after menopause. Estrogen continues to be produced in small amounts, about 25 percent of normal pre-menopausal levels. Blood levels of estrogen in some post-menopausal women are equivalent to the levels attained by low-dose estrogen patches used for estrogen replacement in menopause. The circulating level of estrogen produced by the patch has been shown to be sufficient to prevent bone loss in clinical studies. Studies also show less bone loss in women who have ovaries than in women who have had their ovaries removed. Studies show that women who have had their ovaries removed (and have not taken replacement estrogen) have higher rates of heart disease than women the same age who still have their ovaries.

Testosterone is usually thought of as solely a male hormone. However, it and other androgen (male) hormones are produced by the ovaries from the time of the first menstrual period. These androgens continue to be produced by the ovaries after menopause. Testosterone has many direct and indirect benefits to your body. Some of the testosterone is converted into estrogen by your body, and it circulates in the bloodstream to all of your tissues where it has a direct effect on many organs. It helps to build bone and thus reduces osteoporosis. Its steroid features prevent muscle loss that often occurs with aging. Testosterone directly affects the brain and increases libido. Sexual feelings, desire, and arousal are all related to androgen levels. Testosterone also affects brain function and mood. Women with hormones from their own ovaries have a lower rate of depression than women who have had them removed, even if estrogen replacement therapy (ERT) is taken.

Some physicians have argued that women can replace estrogens and androgens with medications. However, less than 30 percent of women who have a hysterectomy and removal of their ovaries will actually take hormones. Therefore, 70 percent of women will not have the benefit of their own hormones. Some women do not take ERT because they feel fine and do not understand the benefits of taking estrogen for their bones. Some women are concerned about the still controversial issues surrounding estrogen and breast cancer, although it appears that the effect of estrogen on the risk of breast cancer may be small. Some cannot afford the medication. For whatever reason, most women would be better off with their own supply of estrogen and testosterone from their ovaries.

Another problem with estrogen replacement therapy (ERT) is the dilemma that some doctors and women have as they try to find the right doses. Some women note that despite trying multiple regimens of ERT, they still do not feel right. Because hormone production and metabolism is a complex issue, it should not be a surprise that we are not able to mimic normal hormone levels in all women. For all the above reasons, I have recently started recommending that most women choose to keep their ovaries at the time of hysterectomy for uterine problems, regardless of their age.

However, there are a few situations where women may wish to have their ovaries removed at the time of hysterectomy. If the ovaries are affected by endometriosis or a woman has severe endometriosis and pelvic pain, studies show that removing the ovaries is associated with better long-term relief of pain than if the ovaries are not removed. Severe adhesions, or scar tissue, around the ovaries may also cause continued pelvic pain.

As noted in Chapter 10, some women are at increased risk for developing ovarian cancer. If you feel your family history suggests an increased risk for ovarian cancer, you should see a genetic counselor to help evaluate your risk. The counselor may suggest you have BRCA (breast/ovarian cancer) gene testing to determine if you have inherited the gene that increases your risk. If you have an increased risk, you should strongly consider having your ovaries removed. In this case, the benefits of removing your ovaries and preventing ovarian cancer should far outweigh the benefits of keeping your own ovarian hormones.

Some women are very uneasy about leaving their ovaries in because of the fear of ovarian cancer. They may have seen a friend or relative die of this terrible disease. As a result, some women may choose to have their ovaries removed at the time of hysterectomy. But for each woman, the risks should be weighed carefully against the benefits of having her own hormones from her own ovaries after menopause. Women tend to make very different decisions based on their particular circumstances, their feelings about estrogen replacement therapy, and their risk and fear of ovarian cancer. However, it is always best to make these decisions based on accurate and current medical information. This decision is yours to make and should be discussed in detail with your doctor. As always, if there are unanswered questions or concern, get a second opinion. "

Dear Chele,
Having had breast cancer and now pre-cancer in uterus due to the anti-cancer drug tamoxifen (go figure), my DRs all have cancer on the brain when it comes to me (and rightfully so, i admit it is good for them to be vigilant, but such a drag as i'd like to forget it all ONE day.) But, not one of a team of 5 has said anything about greater chance of cancer due to a hysterectomy itself. I understand it is due to your profile of things that lead up to the hysterectomy, and then also family history. For me, having no family history of any of these things (go figure again) DR is taking ovaries b/c they are serving no purpose, as chemo induced menopause almost 4 years ago, & MY cancer history. I think the web is good for info that brings you to good questions for your DR (and of course for great support at HS), but for technical info i'd always run it past the DRs, as the origin of some "facts" is not always reliable, and logical inference applied to any facts is not always accurate, as well. My best experience is finding DRs who, no matter how ridiculous and frequent you may bother them, they will answer your questions w/respect. Good luck

Thank you Denise and Minnowpaws. I have no history or family history of any cancer at all. (that I know of). My left ovary and tube were removed due to adehisions and my ovary was stuck under my colon and in a rigid state. (docs words). I am having the hyst due to adeno. Thanks so much for the info. And Denise if I was in your shoes I dont think I would be questioning it at all. Good luck to you!
chele.