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Do I need an annual exam after complet hysterectomy? Do I need an annual exam after complet hysterectomy?

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Unread 04-05-2009, 09:43 PM
Do I need an annual exam after complet hysterectomy?

Hi all,
I had my total hysterectomy (incl. ovaries) three years ago at age 42 due to breast cancer to reduce my estrogen level.
On my last PET/CT scan the radiologist noted that my ovaries look normal and there is a small uptake.
WTH...I don't have any ovaries.
Oncologist didn't mention anything of it at my check up so I keep trucking.
Now I have pain in the lower right area and asked the family doc for an exam. I was told I don't need one due to the lack of female parts.

Is that true?
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Unread 04-05-2009, 10:23 PM
Re: Do I need an annual exam after complet hysterectomy?

Hi Mietze

When it doubt, have a check it out. If you still have a vagina, you still have female parts, and it makes sense to have a well-woman exam even though the uterus and ovaries have been removed. You may want to schedule an appointment with a gynecologist rather than your family doctor to be sure. If you have pain, it's important to find out what is causing it so you can start to feel better.

Good luck, and be sure to let us know what you find out!

Unread 04-05-2009, 11:03 PM
Re: Do I need an annual exam after complet hysterectomy?

If I didn't think I had ovaries and someone told me my ovaries were fine, i'd be asking some questions very quickly. :-) And if you still have breasts or a vagina, you still need a yearly check. There are other reasons to check the vagina, including vaginal cancer which a friend of mine died from. And of course, a breast exam if you still hav eyours.
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Unread 04-06-2009, 08:46 AM
Re: Do I need an annual exam after complet hysterectomy?

Mietze, If I understand correctly I believe sometimes ovarian remnants can remain after a hysterectomy. I would make an appointment with your oncologist who I assume is following you for the breast cancer so would have copies of the recent pet/ct scan but if not pls make sure he has these results. If still not satisfied, pls consider an appointment with a gyn/onc. You need some answers.
Good luck and pls keep us apprised.
Unread 04-06-2009, 10:16 AM
Re: Do I need an annual exam after complet hysterectomy?

Oncologist had my PET/CT and didn't say anything.
Family doc denied request to gyn or womens clinic as well as giving me a pelvic exam and telling me I don't need one ever again.
I guess I could go and pay for it myself..........
Unread 04-06-2009, 10:33 AM
Re: Do I need an annual exam after complet hysterectomy?

I believe now's the time to bet aggressive and call the oncologist to at least get his opinion re the pet/ct scan; he might explain why he was not concerned re the test results.? You should tell him re the continued pain and ask his recommendation..
I'm not sure re your insurance but if you're still not satisfied with the oncologist's explanation and the insurance will not pay, you still could consider paying out of pocket for an appointment with a gyn/onc. BTW, I have called a specialist's office when I had a worrisome symptom that my PCP seemed to be ignoring and explained this and test results etc: I was given a nurse to speak with and she advised making the appointment. It turned out to be something that needed treatment.
Good luck and pls keep us informed.
Unread 04-06-2009, 12:07 PM
Re: Do I need an annual exam after complet hysterectomy?

Mietze, I don't know where you live, but I thought most states had a law that says that women can see a gynecologist without a referral from their PCP. I know that any medical insurance that we have had in New York state does not require a referral from a PCP for a HMO. We have had 3 different insurance companies over the past 5 years (options keep changing). If this is not the case where you live then I would consider finding another doctor for your PCP. There is no excuse for a doctor to deny a woman with symptoms a referral.
Unread 04-06-2009, 12:25 PM
Re: Do I need an annual exam after complet hysterectomy?

Further to Happy's comments, I think most gyns would take a new patient without a recommendation but this may or may not be the case with a gyn/onc. When I first got my pre-cancerous dx which led to a hysterectomy, I secured appointments with 2 gyn/oncs without having a doctor's referral; both offices did ask for insurance info and the co. actually allows us to see specialists without any referral from another physician.
If a referral is absolutely necessary, Happy's suggestion to see another PCP is an excellent one. Hope you resolve this soon. and our on your way to the proper doctor.
Unread 04-06-2009, 01:35 PM
Re: Do I need an annual exam after complet hysterectomy?

I had always assumed that annual pelvic exams were continued after hysterectomies. I just checked a 2008 Mayo Clinic web site that stated that whether your uterus and cervix were removed for cancerous or non-cancerous conditions, regular pelvic exams are recommened. Some doctors and studies consider that Pap smears are not necessary after hysterectomies not involving cancer.

Maybe your family doctor, with limited experience in gynecology, doesn't realize that an annual pelvic exam includes much more than getting a Pap smear. Did this doctor have any concern at all about the pain, or does he want you to ignore it?

When you asked the family doctor about getting an exam, were you asking him to do one or for him to refer you to a gynecologist? Way back when I was in an HMO, my PCP suggested that he do my annual exam. Even back then, the insurance plan allowed women an annual woman's exam by a gynecologist without referral from a PCP.

Can you contact someone at your insurance company about your right to have an annual exam without approval of the family doctor? Would it make any difference in his willingness to refer you if you showed him information from reputable cancer web sites that annual exams are recommended after hysterectomies?

As someone noted above, you could ask the oncologist who was involved with your breast cancer treatment to recommend a gynecologist for you.

Did anyone question why the radiologist who read your pet scan noted ovaries when you didn't have them? That's another question to ask your oncologist.
Unread 04-20-2009, 11:42 PM
Re: Do I need an annual exam after complet hysterectomy?

Yes, you definitely still need annual exams and Pap tests as well.

My own PCP told me that I didn't need a Pap test after my hysterectomy back in 2002, so I went three years without one. A new PCP talked me into having one and I was found to have HPV and moderate/severe dysplasia, which advanced to carcinoma in situ, cancer which has not spread yet. After having laser surgery, then being monitored with Paps every three to six months for the past two years, I've finally be cleared to resume yearly Pap tests. And I most definitely will be doing so, as HPV has a nasty way of rearing it's ugly head years later.

Please, do yourself a favor and get the exam and Pap tests yearly. It could save your life.



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