Do I keep Cervix and/or ovaries?

Hi
I am 45 with extensive adenomyosis and have decided that a hysterectomy is only way to relieve my condition. I just went to the surgeon to discuss the fine details of the op and he recommended removing both the ovaries and the cervix.
When I asked him why his responses were:

Ovaries - "I'm 45 and a hysterectomy will bring on earlier menopause, so why keep them. I only have a few years left until menopause anyway. Also, I would never have to worry about ovarian cancer."
I have never had any problems with my ovaries and they are healthy as far as I know. There is no family history of ovarian cancer.

Cervix - "Women always forget the two yearly pap smear, so I won't have to worry about that anymore. Also, the cervix is part of the uterus, so why keep it?. It is common practice to remove the cervix these days. And it does not affect womens sex life."
I always have a pap smear every two years and they have all been normal.

I am so confused. I thought that if they were healthy, they would not be removed. My uterus is enlarged (about a 4mth pregnancy size) and the surgury will be abdominal, so keeping my ovaries and cervix is optional.

The surgeon has an excellent reputation and I do not know of any others personally. I am hesitant to just pick one out of the phone book. I live in Australia and doctors are not allowed to advertise.

Where do I go from here?

If you are uncomfortable with what this dr is telling you do you have a friend or relative that could recommend a second opinion? My doctor was the complete opposite of yours. I had an ablation first which was not successful and when we discussed hyst options he recommended leaving cervix. He said it helps prevent prolapses and for some women it is important for orgasm. We decided once he was in there (I had SAH) he would look at my ovaries and if they were healthy he would leave them as the hormones they produce benefit you in some way or another for life. I kept both my ovaries. Every doctor is different as is all our reasons for having hyst., I was 47 when I had my surgery and age was never a reason for removing anything.

Cindy

aussiecat,

Please find a way to get a second opinion regarding the ovaries and cervix. My GYN advised me to keep my cervix and my right ovary (left ovary removed last year due to an endometrioma). I am very happy with this decision.

From the research I have done, someone is a good candidate to keep their cervix if they have always had normal pap tests. You just need to continue with the pap tests.

As far as the ovaries, surgical menopause is no picnic. It is very different from natural menopause, because natural menopause occurs gradually over time and surgical menopause occurs the minute the ovaries are removed. This is quite a shock to your body...

I don't know how your insurance/medical system works in Australia, but try to seek another opinion. Perhaps friends or relatives can recommend another doctor. You do not seem happy with the advice of your doctor, and after all, it is your body.

Please keep us posted.

aussiecat,

I've just posted a great deal of information about the cause of cervical cancer in the Pre-Op Group, under Peppatty's discussion of "question-ovary and cervix removal"- my last post to that was yesterday, you can click on my name above and view my posts to get to it.

Basically, cervical cancer is caused by a virus, HPV, and what I'd recommend in your decision making is to get a screen for the high risk strains of HPV. But do read the entire tread; it has a lot of good information from other posters as well.

-Torrie

Hi Aussiecat,

I was 46 at the time of my hyst. My ovaries were healthy and my Dr. let me make the decision to keep them or not. I decided I wanted to keep them.

I have read on Hyster Sisters that the ovaries secrete hormones that help with the bones and skin, to name a couple. I felt if I was a candidate to keep my ovaries, why not go thorough ~natural~ menopause?? My mom went through menopause at 51 so I was aiming for that.

Also, what helped me with my decision to keep my ovaries was (3) months of lupron shots before my hyst to shrink my fibroids enough for my LSH. Lupron causes temporary chemical menopause. I had hot flashes and night sweats and I lost interest in sex. To name a few side effects. So...I decided then if chemical menopause was anything like surgical menopause, I wanted natural menopause. My lupron side effects stopped before surgery and I have had none since and I am over one year post-op. My ovaries still work great. How do I know?? I get some monthly breast tenderness and some mild irritability around that time of the month. Just no period.

So...with your ovaries, I can suggest if they are not "broken" why fix them?? My Dr. told me that ovarian cancer runs in less than 5% of women and ovarian cancer does not run in my family. So...I liked the odds for me. If you decide on surgical menopause, I can suggest really researching it.

My Dr. also suggested I keep my cervix since it was sturdy and I had had normal pap smears for years. My Dr. felt that the cervix helps with sex and future pelvic support. Being one year post-op, I agree with that. My Dr. told me that cervical cancer occurs in approx. 3% of women.

On pap smears...I have read some replies form ladies that ~their ~ Drs recommended a pap smear even if the cervix was removed. From what the ladies posted, cancerous cells can still develop around the area where the cervix was previously located. So, something maybe to ask your Dr.

With the ovaries and the cervix, it is a very personal choice. I agree it is a good idea to get a 2nd or 3rd opinion, if you can.

Best wishes,

Mary

Aussiecat, I think you're right to feel hesitant with your doctor if these are his reasons to remove your ovaries.

What your doctor has neglected to mention is that even after menopause your ovaries continue to secrete hormones, just at lower levels. I just read a new study that reported levels of androgens (which includes testosterone) in women who've gone through natural menopause and those who have had oophorectomy and they found staggeringly disparate levels of androgens - with women who've had oophrectomy having practically none. Studies have shown that though estrogen and progesterone vary during a woman's life, after adolescence, a woman's androgen level remains at the same level for the rest of her life. (here's a link)

Though the role of testosterone is not fully understood in women (they're not finding evidence that it effects libido) it may contribute to healthy bones and muscle development.

I've bounced from gyno to gyno my entire adult life because of changing jobs and insurance coverage. My most recent doctor, the one who performed my surgery, is the only one I did any research on and I'm glad I did. She was a co-worker's ob/gyn and she also had fibroids and delivered her child.

I think the best way to find one is by personal recommendation. Ask other women you know. You also might want to call the hospital you think you'd have surgery at and ask for the head of the ob/gyn department and ask for a recommendation who deals with adeno. Also, your local University that has a medical program may be able to help you find a doctor that specializes in adeno.

Also, have you consulted an interventional radiologist about uterine artery embolization? There has been an effort lately to develop this treatment for adenomyosis. At this time it's only effective for two years for 50% of the women, but if you want to keep your uterus (as you're less than 10 years from menopause), it might be something to try.

Take care and let us know how it goes.

	Quote:
Originally Posted by juniper I think the best way to find one is by personal recommendation. Ask other women you know. You also might want to call the hospital you think you'd have surgery at and ask for the head of the ob/gyn department and ask for a recommendation who deals with adeno. Also, your local University that has a medical program may be able to help you find a doctor that specializes in adeno.

for me..... I have no one to ask.
My hospital says.. I have to make an appointment with my "obgyn". No one wants to give information on the phone near me. My second opinion is on August 9th... which for me seems like "light years" away.

So0o the question I have is.......... "When I have my uterus removed.. keep my cervix and ovaries... is it or will it be like menopause after?

I don't have have alot of pain... it's just the bleeding is taking control of my life.

I still can't understand all the abbrevs here at hystersister. So I'm feel so confused still.

peach~ Tami

	Quote:
Originally Posted by juniper Also, have you consulted an interventional radiologist about uterine artery embolization? There has been an effort lately to develop this treatment for adenomyosis. At this time it's only effective for two years for 50% of the women, but if you want to keep your uterus (as you're less than 10 years from menopause), it might be something to try.

A second opinion is a good idea.

Ideally, you want to agree on a preference beforehand, but leave the doctor the freedom to do a more extensive surgery if something shows up during the operation.

For example, I told my surgeon that my preference was to keep both ovaries and cervix, but she ended up removing the cervix because the fibroids were even in the cervix. In your case, it is possible that the adenomyosis has also infiltrated the cervix, which would be a reason to remove it. So I would think that one question you would want to ask the surgeon is whether there is any test that can be done either before or during the surgery to confirm this or rule it out.