cervix or ovaries should stay? thoughts please..

Hello and thank you for your imput.

Yesterday at pre op I learned my doctor wants to leave what stays or goes up to me. Since he has so little opinion of it it left me confused. I am in the grey zone he says.

Certainly the uterus and rt ovary go. The left doesn't give me trouble now but then again I have had numerous cysts and they are awful.

I thought I wanted a vaginal hysterectomy until we began talking about prolapse. My grandmother and greatgrandmother had bad prolapses. My past pap wasn't so good. I need to repeat in 3 months. He felt that 5 bad paps in my life wasn't a problem. He wants permission to take the cervix out if it looks bad but by then we will have done the abdominal. Ichaged to abdominal but now maybe I should change back. Or does it matter so much? Maybe I am panicing. Faster healing time seems like a good idea but this is a lifetime surgery so maybe I should cancel activities for 8 weeks and see.

I could use a the voice of experience. Thanks again!

A good article to read that deals with all the major reasons to consider retaining healthy ovaries is: Rational for Ovarian Conservation by Donna Shoupe MD

Please don't view this as "cancel all activities for 8 weeks". Most people with an abdominal hysterectomy are doing reasonably well around 2-3 weeks. I was going out to dinner after 2 weeks, though not back to work full time. I was able to walk and socialize.

I never had a bad PAP but could find no real reason to keep my cervix. There isn't good data proving that keeping it is better. I had mine removed (5 years ago) and my "intimate" life is great.

I decided to keep my ovaries (age 43). Five years ago this reaaly wasn't a "choice" they took them alomst automatically.- all the nurses and doctors thought I was "odd" to keep them. No regrets: no cysts, no problems, no early menopause. I am now 48 and no sign of menopause yet. Yes, I have a risk of ovarian cancer, but it is not all that common. And besides, you can get ovarian cancer even without ovaries. It occurs in the abdominal cavity. Rare, but it happens. Your cysts might occur in the other ovary, but maybe not. You can also have that ovary out later if you really need to. It's an easier operation.

Good luck on whatever you decide!

HI there!

I am sort of back and forth on the whole vag vs. abd thing. I haven't had much discussion with my Dr yet as the last time we talked seriously about it I was going to do a tummy tuck - I have decided against that. So - I'm curious as to the discussion regarding a vag procedure and prolapse?

I am having everything out. Uterus for endo, ovaries becasue I am increased genetic risk for OVCA, and cervix just becasue I'm in there might as well take out the whole ball of wax and go for compelte risk reduction.

Jo

I didn't have a choice between vaginal or abdominal. I had to have abdominal but that was fine with me. I kept my ovaries because there was no reason to remove them. Ovarian cancer is relatively rare and there's no family history. Doc said there's no reason to remove a healthy organ. After all, we don't remove lungs to prevent cancer there either. I didn't want to keep my cervix. I don't need it and I didn't want any chance of any kind of period, mini or otherwise. I can have an orgasm without it. I'm done bleeding forever.

This is a very personal decision and you really need to educate yourself so that you can make up your own mind. Don't base your decision on what is right for other people. Make the right decision for you.

Thanks for your thoughts!

I hadn't considered the mini period concern. This had not occured to me.

Isn't it possible to say remove all diseased parts please and let the rest stay? The doctors know some of whats wrong but aren't they unlikely to know about scar tissue and endo until they get in there?

I am having mini lighting stikes in my center pelvis. Very sharp nerve type pain that goes as quickly as it comes but takes my breath away while it is here. I have them when there is a known cyst so I assume the pain is related.

I will give it a day and then go in with a new surgical order. I am sure the nurse will love this, it is her 3rd time to change it!

Anyone know about cervix and future problems? I have had a few bad paps but thats it.

Thanks for the wisdom of experience and your reseach.

I am two weeks into my recovery. I had my uterus only (loaded with fibroids) removed along with a very large fibroid that was attached to the upper right side. I have a vertical scar. I have had no complications, came home in 2 days, and am still amazed at how good I feel. I would highly recommend keeping your ovary and your cervix. I have no family history of either cancer so was not concerned about future problems. Like I said, I feel great. I have not bled at all although I have heard that I might have a mini period once in a while. I can deal with that!!

On a very personal note: I have not been given permission from my doctor to have sex so I have no idea if my orgasmic ability was affected. I do however have the "urge" and have been able to get "wet" so I'm assuming that everything is OK. Remains to be seen....

Good luck with the surgery. I hope yours goes as well as mine.

	Quote:
Originally posted by tiare Maybe I am panicing. Faster healing time seems like a good idea but this is a lifetime surgery so maybe I should cancel activities for 8 weeks and see.

Tiare,
I didn't have the option of vaginal vs. abdominal because one of my issues was adenomyosis, with a uterus the size of a large sized grapefruit/cantelope,... I did have the choice on my ovaries and cervix, and opted to have them removed,.. like others, to reduce my risk factors. I have quite an extensive family history, and so my personal decision was that I didn't want to leave any extra opportunities for further problems to arise, as far as all of that went. No, it doesn't eliminate everything,.. you can also still get vaginal cancer, but it is another rareity. If you have parts that are still healthy, then it really is just a personal choice. As far as the cervix goes,.. I too, was told that it didn't really matter either way. After the cervix is removed, they just sew it up, which basically creates a faux cervix, if you will. Some women think that this will shorten their vagina, which could effect intercourse. I was assured that this is not true by my GYN, and to date,.. I still trust in that truth because we've never had any problems regarding it, and if anyone would,.. it would be my DH.

As far as canceling all activities for 8 weeks,.. strenuous ones, yes, I'd agree with that decision, but light ones, not likely. Odds are good, you'll be up for some activity, and light activites are good for you, once your doctor clears you for it. Most women do start feeling better after about the 2nd or 3rd week, however, you can still injure yourself months later, so please use discretion in the severity of your activities. It can be EXTREMELY easy to overdo, and a few weeks post-op, many women are feeling 'buggy' to get active,... even weeks after, simply getting a little over-zealous on catching up the housework can set you back a pinch. You know the old saying, one step forward, two steps back,... it eventually turns into two steps forward, one step back, and over time, you're back on both feet again,.. fully. Honestly, you can feel great pretty quickly, but in order to maintain that,.... Easy does it. Discuss things you're thinking about doing with your doctor, too,... as I said, even months later, you can injure yourself. FYI: You are not fully healed from a hysterectomy for ONE YEAR.

If you have any questions about my perspectives, please feel free to PM me.
Best of luck, and I hope I've provided you some positive insight!

Hi tiare!

First of all, I wanted to point out (if you hadn't already realized it), that the following is not a valid analogy, because a human being needs at least one lung to live, whereas they do not require either ovaries or cervix to experience life:

	Quote:
Originally posted by swank After all, we don't remove lungs to prevent cancer there either.

When a patient has the option (based on their unique medical circumstance) to remove or retain their cervix and ovaries, it may certainly be a tough decision, particularly if their doctor does not offer any advice one way or the other. And the more reading you might do on this site will result in finding that some women are happy with either decision, and some women are not...results seem to run the gamut.

If we had a crystal ball that would tell us for certain whether our cervix or ovaries would "go bad" in upoming years, the decision would be much easier. In my opinion, in cases like yours, you might need to "go with your gut instinct" in terms of deciding the best route to take.

Many s and Best Wishes,

taire--

What kind of bad Paps have you had? Have you been tested for HPV (the virus that can lead to cervical cancer)? I'm a little surprised to hear that your doc would say that 5 bad Paps shouldn't concern you.

Carmen is right. You will find soooo many conflicting opinions here, as it's a controversial topic. The doctors don't even agree with each other! In my opinion, there hasn't been enough research conducted to make blanket statements. It really seems that our bodies have their individual ways of responding to these surgeries. I wish we had that crystal ball!

Regarding the mini periods, I wanted to share what happened to me. I was having really long periods and was cramping around my cycle for about a year. An ultrasound showed a complex ovarian cyst that the doc said had to be removed. He said the whole ovary had to come out. I'd had fibroids for years that had never bothered me. But when he looked at my uterus he said that they were twisting my uterus and pushing it back. He suggested a hyst as well as the oophorectomy.

So we did an LSH--where the only incisions are laparoscopic and they detach your uterus from your cervix, grind it up, and suck it out through a tube. Lovely, huh? Turns out that he had misdiagnosed my cyst--it was a simple cyst that had ruptured before surgery.

I did *not* have a history of a healthy cervix. Just one year previous to the surgery I had carcinoma in situ on my cervix, which is pre-invasive cancer. This doc pushed keeping the cervix anyway--if we did this type of surgery it would be minimally invasive and he would be able to use "the robot," which is a lot of fun for him. He said that problems with the cervix are easy to detect and easy to treat. I wasn't really that comfortable with it because I'd gone from 20+ years of normal Paps to the worse Pap result you could get before invasive cancer, all in one year. But, I did *not* follow my gut.

I ended up having mini periods that lasted up to 12 days. I continued to cramp around my cycle. I went back to the doc who had treated me during my pregnacies--it was a ways to travel but very worth it. I'd developed another simple cyst and so we tried BCP to stop the mini periods and keep new cysts from forming. But my pain increased--it was like having bad menstrual cramps all the time. So we decided to take out my cervix.

This doc was very upset that the first doc had left my cervix given my history. He never leaves the cervix unless the patient feels strongly about it because the chance of mini period is 10-15% (if you have at least one ovary). There is no clear dividing line between cervix and uterus--it's all one organ--so the surgeon does their best to detach far enough down so that there is no tissue left from the uterus that could respond to the monthly hormones. They can't always get that right! They usually cauterize the top of the cervix during surgery, but that is no guarantee. And then when women do get mini periods, some docs will cauterize the bottom of the cervix. My doc says that that doesn't work because you can't burn tissue on the bottom to stop bleeding that's coming from the top.

So, I had my cervix removed. It took him 3 hours to get it out! I also had a bladder repair and some endometriosis (that the first doc decided to leave in) zapped. The blood had been pooling over my cervix for 6 months and the space was filled to capacity, which is what was causing the pain. So, I ended up having 2 surgeries in 6 months. And after the second one I overdid it and ended up hemorrhaging and being taken to the ER via ambulance.

That said, the kind of mini period I was having is not the usual kind of mini period. My case was extreme. I think that my hormones are not working correctly (that's my next project!) and that the small amount of tissue that was left was being told to shed for way too long. Just a theory....

I take it your doc does not do laparoscopic surgery? Is that why if you wanted to keep your cervix he would have to convert to an abdominal hyst? Are there other docs in your area that do do lap surgery? It *is* possible to keep your cervix without having abdominal surgery. The procedure is called LSH: Laparoscopic Supracervical Hyterectomy.

It's always a good idea to get a second opinion (and a 3rd and 4th). Since you're doc is leaving everything up to you and that leaves *you* confused, maybe you should get at least one more opinion. I'm sorry if I've confused you even more. I just wanted to let you know what happened to me when I did not follow my gut.

I'm sure you'll hear lots more on this topic. Take your time making your decision. Also know that things just happen sometimes and there are no guarantees for a perfect outcome from whatever surgery you choose. I like to go with the doc who seems the smartest, listens well and takes the time to really go over the options. Then I go with what he or she says.

Good luck with this decision and your surgery!



Margot