Hysterectomy in one week (4/1) - need advice - remove ovaries or not

Hi, I am new here. My abdominal total hysterectomy is scheduled for April 1.
I have a uterine fibroid the size of a 6 month old fetus. It's much bigger than the head of a full term baby.
I am very high risk for ovarian cancer and the doc recommended taking everything out.
I am still peri menopausal although I am over 50. There is a strong history of heart attacks, strokes and dementia in my family as well.
I signed all the paper for surgery but I am freaking out. My main fear is the link to cognitive decline due to surgical menopause. I asked many questions about prevention but it seems like no one has definitive answers. I keep hearing that an estrogen patch will help with hot flashes, that's about what they can promise me. I read a few papers on PubMed, and everything "requires more research".
I am considering making a last minute change and keeping my ovaries AMA. I am afraid taking them out would have an immediate impact on my nervous system, bones, weight etc., Maybe I can wait a few years until my ovaries stop functioning and the hormonal change would not be that big. I don't want to suffer a certain impact on my health now for a possible risk in the future. Besides, dementia is worth than death at this point in my life.
I also have interstitial cystitis and recurrent UTIs, and I hear that both conditions might get worse after surgery.
The surgeon is an oncologist. None of the doctors there is an expert on HRT.
My thought is...I can't hit the "undo" button... I don't want to make an irreversible mistake.

The problem is I am not completely sure keeping them is not a big mistake either. The oncologist is convince it would be a mistake, but he is biased. The Urogynecologist also thinks it would be a mistake (but she gets to keep hers... What would she really do in my place?)

I was wondering if anyone had their ovaries taken out and maybe had a more helpful expert who knew more about HRT and prevention of surgical menopause.

Any advice would be highly appreciated!

Hi Sane Cat Lady : to HysterSisters!

This is such a difficult decision to make, and there does seem to be no easy answers to this, especially given your family history of ovarian cancer. Here are two articles that may provide information to you:
Should I Keep My Ovaries if I Am Near Menopause?
Should I Have an Oophorectomy (Removal of the Ovaries) with My Hysterectomy?

Talk to your doctor, and let him know your concerns. Maybe you can ascertain one risk over the other, given your family medical history.

I had a TAH BSO at age 46 - everything went and no choice for me. Surgical menopause was MISERABLE for me. My GP put me on HRT and it gave me my life back. She also stated that it was better for my health to be on HRT than not on HRT.

You have to make the right decision for you - whatever that is.

Hi marestail,
Thank you so much for your reply. After my initial panic response I am realizing surgical menopause is much more manageable than cancer. I think I will not take any chances. I will listen to my doctors and get everything out. If there is no cancer and my doctors allow it I will try HRT.
Thanks again!
SCL

I was already four years past menopause when I had my ovaries removed (along with everything else). My hysterectomy was for endometrial cancer, which is usually fed by estrogen, so no ovaries and no HRT either for me.

I have a family history of dementia that strikes in the mid-70s. Maybe mine will strike a bit sooner? I guess I'll find out.

Bone density is also a concern for me. My cancer recurred nine months after surgery, so I ended up having chemo and radiation, including external pelvic radiation. The radiation plus the lack of estrogen has led to some osteopenia in my hips. I try to get plenty of weight-bearing exercise and eat sufficient dietary calcium. I also take calcium and vitamin D supplements and cross my fingers.

My bottom line was that having treated the cancer, I'm still alive to do what I can about my bones and my sanity.

Also, my cancer was endometrial cancer. I've had three different docs tell me that I "shouldn't have gotten endometrial cancer" because with my body type, I should have been low risk. Myself, I'm just as glad to have gotten *endometrial* cancer because it's symptomatic in the early stages and spreads slowly. The cancer I actually had risk factors for? Was ovarian cancer, which is sneaky, silent, scary stuff.

I didn't mind seeing those ovaries go at all.

PS Love your handle, as I'm a more-or-less sane cat lady myself. :-)

Thank you, SurprisedInNB. I am beginning to feel more confident about the total hysterectomy. I hope I will be able to take estrogen. I had no idea endometrial cancer and body types were connected! The oncologist had concerns about my endometrial thickness. I am usually tall and thin, but right now I look 6 months pregnant.

"Tall and thin" describes me too. I was told that the main risk factor for endometrial cancer is being overweight, since fat cells secrete estrogen. Apparently mine was just bad luck!