That ovaries question again........

Jen28

Thanks for your message.

Yes my gyn was totally supportive about me keeping everything except the fibroid and top part of the womb, probably because I was so reluctant to have the operation and stalled for about nine months from when he first recommended the op.

At my initial visit with him I got the usual chat about taking everything away and what difference does it make whether you get your hormones from your ovaries or the pharmacy, but after a few more meetings with him after I had really researched everything, he did agree with me that natural is best. He also said that breasts are far more likely to cause women problems than ovaries and cervix!

I read a very interesting article on the net by a doctor in the US who said that ten years ago he was recommending that everyone had everythingl taken out when havinga hyst. He has now completely changed his mind and says that ovaries should be retained if at all possible as they continue producing small amounts of hormones until women are in their eighties!!

I am sure that even these small amounts help to give a gentler menopause rather than just being thrust into it. I have been on Zoladex (or in the US Lupron) shots for the past three months and so have been put into "menopause" aritificially. Although I have several hot flashes per day and night sweats, I have managed to cope without the HRT add back that the gyn gave me to take - I just didn't want yet another drug in my system.

It is a very personal decision, I don't think that the doctors have the right to say that anyone over 45 should have everything removed. It is the same in England - 45 is the age that they think you don't need it anymore.

Good luck.

Love
Mel

((Bev)),
Here is some excellent info on reasons to retain/remove Ovaries..my own personal opinion is that healthy Ovaries/organs should be retained if possible. It is a personal desicion that needs to be researched throughly so all possible outcomes can be looked into as well & discussed beforehand w/ your Dr ....
Problems of ovary removal:

	Quote:
If the ovaries are removed, the woman goes into surgically induced menopause, as the hormone producing organ has been taken out. As a result, she may have problems of flushes and vaginal dryness. These are particularly troublesome when the woman in question is in her twenties or thirties or, worse still, in her teens. The removal of the ovaries and the subsequent loss of hormones could result in bones becoming weaker and an increased risk of heart disease. Women who are less than forty may go in for hormone replacement therapies wherein hormones are artificially introduced to make up for the hormones lost by removing the ovaries. Not all women tolerate this artificial hormone replacement and the risk of breast and gall bladder cancer increases. As far as possible, doctors try to retain at least one ovary so that natural hormone production isn’t badly affected. http://channels.apollolife.com/show.asp?NewAid=4107

A risk-benefit analysis of elective bilateral oophorectomy: effect of changes in compliance with estrogen therapy on outcome.:
Speroff T, Dawson NV, Speroff L, Haber RJ
Department of Epistemology and Biostatistics, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio.

	Quote:
A bilateral oophorectomy at the time of elective hysterectomy is often performed to prevent ovarian cancer. The assumption that endogenous estrogen can be easily replaced with supplemental medication fosters the decision for routine oophorectomy. Published reports on the use of postmenopausal estrogen indicate that compliance is less than perfect. This fact could affect the overall outcome. Decision analysis techniques with Markov cohort modeling were used to evaluate the policy of elective bilateral oophorectomy. Results from studies judged methodologically sound were combined to determine values representing the influence of estrogen on coronary heart disease, breast cancer, and osteoporosis fracture. The decision tree also explicitly incorporated patient compliance. When compliance with estrogen therapy is assumed to be perfect, oophorectomy yields longer life expectancy than retaining the ovaries. When actual drug-taking behavior is considered, retaining the ovaries results in longer survival. This analysis highlights the importance of including the effects of patient compliance with treatment recommendations when the impact of a health policy decision such as prophylactic surgery is assessed. A bilateral oophorectomy at the time of elective hysterectomy is often performed to prevent ovarian cancer. The assumption that endogenous estrogen can be easily replaced with supplemental medication fosters the decision for routine oophorectomy. Published reports on the use of postmenopausal estrogen indicate that compliance is less than perfect. This fact could affect the overall outcome. Decision analysis techniques with Markov cohort modeling were used to evaluate the policy of elective bilateral oophorectomy. Results from studies judged methodologically sound were combined to determine values representing the influence of estrogen on coronary heart disease, breast cancer, and osteoporosis fracture. The decision tree also explicitly incorporated patient compliance. When compliance with estrogen therapy is assumed to be perfect, oophorectomy yields longer life expectancy than retaining the ovaries. When actual drug-taking behavior is considered, retaining the ovaries results in longer survival. This analysis highlights the importance of including the effects of patient compliance with treatment recommendations when the impact of a health policy decision such as prophylactic surgery is assessed.

Is incidental prophylactic oophorectomy an acceptable means to reduce the incidence of ovarian cancer?
Rozario D, Brown I, Fung MF, Temple L
Department of Surgery, Ottawa General Hospital, University of Ottawa, Ontario, Canada.

	Quote:
BACKGROUND: According to previous reports, the lifetime risk of developing ovarian carcinoma is 1.4%. This figure varies with age from 6.6 per 100,000 among women aged 35 to 39 years up to 55.1 per 100,000 among women aged 75 to 79 years. Prophylactic oophorectomy remains a modality to decrease the incidence of ovarian cancer. What proportion of women diagnosed with an ovarian malignancy had a preceding laparotomy at which time a prophylactic oophorectomy could have been performed? METHODS: We reviewed the new ovarian cancer diagnoses seen in patients between August 1988 and August 1993 at the Ottawa Regional Cancer Foundation. Four hundred and four patients were identified. These patients were analyzed for preceding abdominal surgery, age, time to disease progression, time to death, time to death from other causes, and average follow-up. The previous abdominal surgeries were divided into: (1) major gynecological surgery; and (2) general surgery procedures, which were further divided into laparotomy and pelvic surgery (group A surgeries) and general surgery that included other abdominal surgeries (ie, appendectomy, cholecystectomy) where access to the pelvis could be more difficult (group B surgeries). RESULTS: A total of 270 abdominal surgeries was performed, prior to the diagnosis of ovarian cancer. The group was stratified according to the timing of the surgery ( greater or =40 years, 41 to 45 years, 46 to 50 years, >50 years). Based on these data, and on the grouping of general gynecologic surgeries plus the general surgical procedures of group A, 10.9% of ovarian cancers would have been prevented if prophylactic oophorectomy had been performed in patients who had surgery over 40 years of age; over 45 years this was 6.7%, over 50 years it was 4%. If one adds all major surgeries, including general surgery groups A and B, the results were 26.9% over 40 years of age, 20% over 45, and 16.6% over 50. CONCLUSION: We found that, depending on the age of the patient, prophylactic oophorectomy results in a 4% to 10.9% reduction in the incidence of ovarian carcinoma. This increases to 16.6% to 26.9% if one considers general surgery procedures in which access could be more difficult. Although we are not advocating the frequent use of this procedure, we recommend that surgeons routinely discuss this option before surgery with their postmenopausal female patients over 49 years of age. Given that the decision for prophylactic oophorectomy is multifaceted, we feel that a risk scoring for ovarian cancer and a discussion of the risk and benefit ratio should be undertaken. The ultimate goal is to heighten patient awareness of the risk factors to ensure that an informed decision is made concerning this consistently lethal disease.

HRT: The Whole Story:
http://health.discovery.com/centers/...hrt_whole.html

The role of ovarian hormones upon brain:
http://www.bbsonline.org/Preprints/O...bbs.fitch.html

Old Ovaries-still of value?
https://www.hystersisters.com/vb2/sho...threadid=10987

Ovaries:
http://s.ivillage.com/health/lnav/ov...416874,00.html

Menopause, Estrogen Loss, and Their Treatments:
http://www.umm.edu/patiented/doc40.html

The Effects of Hysterectomy on the Subjective & Physiological Sexual Function:
http://homepage.psy.utexas.edu/homep...terectomy.html

What You Don’t Know Can Hurt You: Knowledge Is Power In A Doctor/Patient Relationship:
http://www.obgyn.net/displayarticle....ort/comfort006

Talking To Your Doctor About HRT:
http://www.aeron.com/new_page_21.htm

Should I Keep My Ovaries?
http://drn4u.com/keepovaries.htm

Hysterectomy-Leave the Ovaries-Gabe Mirkin, M.D.
http://www.drmirkin.com/women/W126.htm

	Quote:
The rationale for keeping the ovaries, would be to maintain a source of your own sex hormone production. It is possible that your ovaries may continue to produce adequate amounts of estrogen and testosterone until the time you would have had experienced a natural menopause. The normally functioning postmenopausal ovary also may be capable of producing significant amounts of testosterone for several years following menopause. Testosterone is the hormone is closely associated with energy levels, lean body mass, libido and sexual function. In addition, if testosterone levels are present, some of it may be converted to estrogen by a process called, "aromatization". This may be the reason that naturally menopausal women are known to have less severe menopausal symptoms and fewer negative health consequences. as contrasted to women who have had their a surgical removal of benefit in reducing the severity of menopausal symptoms. Is there any reason I might want my ovaries removed? There is always the argument that removing the ovary prevents the possibility of ovarian cancer. A woman has a 1 in 70 chance of developing cancer of the ovary during her lifetime. Due to a lack of symptoms initially, the presence of ovarian cancer is typically not discovered to a late stage and for this reason is often fatal. The peak incidence of ovarian cancer is between the ages of 70-80. There is a type of ovarian cancer that is hereditary. The mutated genes responsible for most hereditary ovarian cancers have been identified, (BRCA1, BRCA2). There is a blood test available to identify carriers of this gene. Woman who are identified as having the mutated gene should consider the option of ovarian removal and non-carriers can be assured that their risk of ovarian cancer is not increased. What are the risks of going on HRT? I believe, assuming that HRT is given in a physiologic manner and in my view means a non-oral route of administration, specifically transdermal or subcutaneous, in doses that result in physiologic blood levels of estradiol and testosterone, the risks would be no greater than having your own source of hormone production. I prefer to prescribe non-oral regimens of estradiol and testosterone, utilizing non-oral routes of administration. This has the advantage of avoiding the "bolus, first pass" liver consequences and enzyme alterations associated with oral administration of hormones. Oral administration of HRT, is the most commonly used route of sex hormone delivery used in the world and it has been proven to be effective and safe for most women. However, my sense is that non-oral routes of administration are potentially even safer and more effective. http://drn4u.com/Menopause.htm

http://www.drmirkin.com/women/W126.htm

hormone replacement after complete hysterectomy: http://www.medicinenet.com/script/m...=MNI&qakey=2339

BSO:
http://www.gyndr.com/salpingo-oophorectomy.htm

Ovaries: Should I Have Them Removed? http://www.ivillagehealth.com/expert...46_526,00.html

Ovarian Failure:
http://www.emedicine.com/med/topic1700.htm

What IS Early Menopause?
http://www.earlymenopause.com/whatis.htm

	Quote:
Just remember to be sure and hear the optimism in your doctor's message. This is another opportunity for you to inform and educate yourself. Learning as much as you can will help, not hurt, you. http://www.gynsecondopinion.com/surgery.htm

Is a bilateral oophorectomy needed?

bilateral salpingo-oophorectomy

	Quote:
Oophorectomy is the surgical removal of one or both ovaries. It is also called ovariectomy/Oophorectomy is performed to: remove cancerous ovaries remove the source of estrogen that stimulates some cancers remove a large ovarian cyst excise an abscess treat endometriosis Until the 1980s, women over age 40 having hysterectomies (surgical removal of the uterus) routinely had healthy ovaries and fallopian tubes removed at the same time. This operation is called a bilateral salpingo-oophorectomy. Many physicians reasoned that a woman over 40 was approaching menopause and soon her ovaries would stop secreting estrogen and releasing eggs. Removing the ovaries would eliminate the risk of ovarian cancer and only accelerate menopause by a few years. In the 1990s, the thinking about routine oophorectomy began to change. The risk of ovarian cancer in women who have no family history of the disease is less than 1%. Meanwhile, removing the ovaries increases the risk of cardiovascular disease and accelerates unless a woman takes prescribed hormone replacements. There are situations in which oophorectomy is a medically wise choice for women who have a family history of breast or ovarian cancer. However, women with healthy ovaries who are undergoing hysterectomy for reasons other than cancer should discuss with their doctors the benefits and disadvantages of having their ovaries removed at the time of the hysterectomy. The ovaries, and often the fallopian tubes, are removed.Oophorectomy can sometimes be done with a laparoscopic procedure. The ovaries can also be cut into smaller sections and removed.The advantages of abdominal incision are that the ovaries can be removed even if a woman has many adhesions from previous surgery. The surgeon gets a good view of the abdominal cavity and can check the surrounding tissue for disease. A vertical abdominal incision is mandatory if cancer is suspected. The disadvantages are that bleeding is more likely to be a complication of this type of operation. Complications after an oophorectomy include changes in sex drive, hot flashes, and other symptoms of menopause if both ovaries are removed. Women who have both ovaries removed and who do not take estrogen replacement therapy run an increased risk for cardiovascular disease and osteoporosis. Women with a history of psychological and emotional problems before an oophorectomy are more likely to experience psychological difficulties after the operation. http://www.hendrickhealth.org/healthy/000985.htm

Supracervical hysterectomy - should I keep my cervix?

	Quote:
Before surgeons learned how to safely remove the cervix (which is really the lower portion of the uterus), it was left in place during a hysterectomy._ In the 1950's improvements in surgical technique and the desire to prevent cervical cancer resulted in the adoption of the routine removal of the cervix with the rest of the uterus at the time of hysterectomy._ Currently there is a resurgence of interest in leaving the cervix at the time of hysterectomy._ The short version:_ there are many arguments in favor of leaving the cervix, but very little data to support or to disprove these arguments._ I do have the impression is that recovery from surgery is faster when the cervix is left in._ What are some of the arguments? There is less risk of vaginal vault prolapse with subtotal hysterectomy (the vagina falling out)._ It is argued that the supports of the vagina are damaged by removal of the cervix. Counterpoint:_ Uterine prolapse (the uterus falling out) is a common indication for hysterectomy._ The supporting structures are frequently damaged by childbirth, and can be repaired during hysterectomy. Fact:_ There are no good studies comparing vaginal prolapse with and without removing the cervix._ Lot's of arguing, but no_ data. Statement: Orgasm is better with the cervix left in._ In 1983 Kilkku published a study showing more frequent orgasms after supracervical hysterectomy than after total hysterectomy._ It is argued that the nerves in the cervix are important for orgasm. Counterpoint: _ Much of this argument comes from Kilkku's 1983 study._ The flaws in this study were numerous._ This was a retrospective study in which there was not even a baseline assessment of the subjects. _ It is impossible to draw any meaningful conclusions from this study._ Fact: In order to study this, it would be necessary to evaluate a group of woman planning hysterectomy, randomly leave the cervix in half of them, and then re-asses orgasm at a given time after surgery._ Once again, strong opinions, little information. Statement: If the cervix is normal then leave it in._ Counterpoint: It is easier to leave in the cervix if the uterus is removed through the abdomen, but the reverse is true for a vaginal hysterectomy. _ Although we have good screening methods for cervical cancer, adenocarcinoma (cancer of the glands_ inside of the cervix) is increasing in frequency, and can be fatal. _ In addition, there are now reports of having to go back and remove the cervix after a supracervical hysterectomy because of bleeding or other problems._ Fact: _ There is a small but definite risk of cancer in a remaining cervix, and of needing to have surgery to remove the cervix at a later time if it causes problems._ The arguments about pelvic support and sexual functions have not been tested, so their validity is unknown._ Hopefully there will be good prospective studies to better determine whether or not it is best to remove the cervix. http://www.gynalternatives.com/hysterectomy.htm

The uterus is joined at the cervix to the vagina and by the fallopian or uterine tubes to the ovaries:(pics)
http://www.mercksource.com/pp/us/cns...Sz002915zPzhtm

	Quote:
If you leave in the lower part of the uterus, the cervix, that's the place where cervical cancer will exist. What you are doing, to prevent that patient from having cancer of the cervix later on, is taking out the dangerous part of the cervix where the cancer will appear, and in addition you take out the endocervical zone - is that correct?" "Correct, and from the six kinds of hysterectomy that are offered now, I would just do the supracervical hysterectomy - leaving the cervix and coring out the cervix. So the danger has gone down tremendously by detection of premalignant lesions of the cervix by the pap smear, which is done worldwide. But still, your question is correct because if you leave the cervix in, the patient can still develop cancer. If you have a healthy organ, which is the cervix, and only the uterus has the myoma, then we take only the uterus. If we have malignancies in the uterus, we will take out the whole uterus and use a LAVH. But now we are discussing benign indications and if this cervix is healthy, why should we take it out? It is an organ that is centric in the pelvic floor - there are vessels, there are nerves around it. It has connections to the bladder, to the rectum, and you are destroying all this if you take out the cervix. So our concept is to leave the cervix in, in patients that want it, and emphasize the idea that it's minor surgery - and it is minor surgery, compared to taking the whole uterus out. We leave it in, and we also do careful pap smears as before, but if the patient has the transformation zone out, her risk of severe cancer is minimal because all the squamal cells are taken out and only the cylindrical cells are left in. Only 0.6% of all cervical cancers are developing from cylindrical epithelia." http://www.obgyn.net/displaytranscri...r_hysterectomy

Is it necessary to remove the ovaries along with hysterectomy?

	Quote:
Usually not. In most cases the decision about removing normal ovaries can be made by the patient in consultation with her physician. In younger women, we do not remove normal ovaries unless there is a medical reason to do so. In women in their late forties or older, we usually do remove the ovaries with abdominal hysterectomy. This plan is based on the fact that a younger woman will have many years to benefit from the hormones her ovaries will produce if they are not removed. An older woman approaching menopause has only a short time to benefit before the ovaries normally stop functioning. There is a small risk of cancer arising later in the ovaries, hence if there is little benefit to be gained by leaving them in, most gynecologists suggest their removalA woman who has a strong family history of ovarian or breast cancer may benefit from ovarian removal at a younger age. A woman whose ovaries are involved with a disease process, for example, with endometriosis or chronic infection, will need the ovaries removed in order to be cured of the problem. In such instances, ovaries should be removed even for young women. The ovaries make hormones that have important functions throughout the body: most importantly estrogen, progesterone, some androgens (male type hormones) and inhibin. Women who have both ovaries removed prior to menopause will have sudden onset of menopausal symptoms: hot flashes, and perhaps increased dryness of the vagina and some slowing of lubrication with sexual excitement. Some will report loss of sexual interest. Loss of the sex hormones before the normal age of menopause is associated with increased risk for heart attack. For all of these reasons, if it is necessary to remove the ovaries before menopause, women are usually offered replacement of estrogen and sometimes replacement of androgen as well. This can take the form of a pill to take every day or small patches containing hormone that are worn on the skin. http://www.bestdoctors.com/en/condit...omy_013001.htm

Last but not least

	Quote:
Questions for Patients ask their Physicians: Are there treatments available that do not include hysterectomy? Will you help me understand the advantages and disadvantages of these treatments instead of hysterectomy? Should my ovaries be removed if I have the hysterectomy? Will a vaginal hysterectomy solve my problem, or do I need the abdominal operation? How long will I need to be in the hospital? How long before I can return to full activity? If my ovaries will need to be removed, will you prescribe replacement hormones? Do you regularly perform this kind of hysterectomy? At which hospital will I have the surgery? Are you currently board certified in Obstetrics and Gynecology? Is blood transfusion likely? If so, can I donate my own blood before surgery? What kinds of problems or complications might occur with this operation? You should ask these questions to assure yourself that the doctor takes a meticulous, thorough approach to diagnosis and treatment, and that he or she is accessible and flexible http://www.bestdoctors.com/en/condit...y_013001_q.htm

Good Luck in your research & decision...pls keep us posted...(((hugs)))

Sheri

Thanks for all of the information, but I have already decided.

My op is this Tuesday and I am keeping cervix and ovaries!!

Love
Mel

Bev: First of all, is your name Bev or Mel? I read your signature with a "Mel" and then a "Bev" under that. If I've been calling you by the wrong name, I apologize.

Catherine, Sheri, Joselle, Bev: Again, thanks so much for everyone's efforts to help me make an informed decision.

Bev: I am totally behind you in your decision. I can see that you've done your research and have gotten the blessing of your doctor. This is no time to waver - good luck to you on your surgery on 5/13...we'll all be praying for you; please keep us informed of how you are doing.

Girls, you have all given me much research to look into. I've already done a quick reading of all your postings but I will now go back and really do my research. Thanks millions!

Hi Mel
In December I had my TAH and kept my ovaries. I told my Dr. that if they looked good and were still working - to please leave them.

And Jen - was 50 at time of surgery - no signs of menopause yet. Just had my 51st birthday this week. I am still glad I made that decision to keep them. However, I do have to tell you that within the last few weeks I have started experiencing hot flashes and other menopause symptoms. I was fine after surgery. I am at that age and this could be the time it was going to happen anyway. But since it has come on so quickly, I think maybe the surgery had some effect on my ovaries and hormones. But it still is not like surgical menopause - because what I am experiencing is not that bad.

Hi Sandy; Happy belated birthday to you. Did your dr suspect cancer in your fibroids before surgery? You mentioned "precancer" so does that mean you need any additional treatment? Obviously you didn't need to go back in to remove your ovaries?

Since you're experiencing menopausal symptoms 4-5 months after hyst, I wonder if the surgery quickened your menopause or your're going thru menopause you would've gone through anyway had you not gone thru hyst. What age did your mom go through menopause?

Right now that is my biggest fear - that they might go in and find cancer in my large fibroid(s). In the last couple of years my dr always presented the small chance of the fibroids turning cancerous but he also said that since my fibroids really didn't increase in size over the years too greatly, that it was up to me: whether I feared the hyst or cancer more. I chose to wait and monitor.

An ultrasound taken recently showed that my uterus increased 26% over the past year. I now know I have to do something about my fibroids.

I appreciate any more thoughts you can share with me. I will be going in for 2nd opinions on 5/14 and 5/22. I am truly nervous.

Mel: I'm thinking of you and wish you good luck!

Jen
I had fibroids since early 40's and they continued to grow. Last year I started having a lot of problems - period that lasted 6 weeks. I thought it was due to changing hormones due to perimenopause, but seems it was due to my uterus that had gotten very large from fast growing fibroids. (I think my uterus measured about a 6 month pregnancy size.) I knew I had to finally come to terms with having a hyst. I was hoping my fibroids would shrink once I went though menopause. But Dr. told me my uterus was too big - and I really could not wait for menopause. He also told me that my uterus was too large to do much shrinking. He was not concerned about cancerous fibroids - becasue that is really rare. When they removed the uterus they found lots of fibroids. One of them was pre-cancerous - not cancerous. It was just beginning to get wierd cells. It may never have developed into cancer, but I am sure glad it is out now.

My ovaries have never given me problems. The Dr. said they looked fine. He did tell me there was no point keeping them at my age. But after a lot of reading, research and sleepness nights, I decided to keep them - IF they appeared healthy and he (the Dr.) felt they were not diseased.

My first thought was to take them out so that I would never have to worry about ovarian cancer. I am adopted so I don not know what my family health history is. But on the other hand, I thought if heart problems ran in my family, maybe whatever little bit of hormones my ovaries squeeze out over the next few years might protect me from heart problems. It was a 50/50 gamble. Since I don't have any idea of my family genes - I decided I am not going to remove every healthy organ from my body just on the chance that maybe someone in my family had ovarian cancer, or breast cancer or colon cancer or whatever.

And I don't have any background on my mother's age at menopause etc. so I am just taking things as they come. I think probably the surgery may have started the menopause thing. But then, the symptoms are not that bad.

I am having a frequent warm flushes - no night sweats and I am not as lubricated as I once was. But I sure don't have anxiety, depression, crying jags, memory problems, sleeping problems. I am not cranky or moody and I still think I like sex. So maybe the menopause thing is coming on - but it certainly isn't like what I heard surgical menopause is like.

I wanted someone to tell me whether to keep my ovaries or not, but I found that I had to make that decision myself. And I feel that I made the right one for me.

Keep me posted on what you decide. And Mel, good luck to you.

Hi Sandy: I noticed you have the same birthday as my daughter. Do you know that in the Japanese culture, 5/5 is Boys' Day...I think they now call it Children's Day (But I still think it should be Boys' Day because there is a Girls' Day on 3/3). And you were born the same year as me.

Yes, you had a more difficult decision to make since you didn't know your family health history. Sounds like you made the right decision for you. Thank you so much for sharing your thoughts and story with me. Take care!