Old Ovaries-still of value?

I am almost 56. I have been diagnosed with probable Adenomyosis. I have had a history of fibroids and polyps. Blood tests show that I have been stuck in the middle of menopause for 3 years, have been dealing with the change for 5 years..

I am pretty well convinced that I need to part ways with my uterus. But I am not sure about a complete hysterectomy. My GYN says I should keep the ovaries if they are healthy. She says she will not know that until she can actually see them. Some suggest having everything removed so there is not reason to suspect uterine, ovarian or cervical cancer in the future. Others tell me I need the hormones the ovaries produce.

My questions are: How much hormone will be produced by my ovaries at this stage in my life? Would it be less complicated to supplement hormones when the ovaries are not there to contribute an unknown amount of undetermined hormones?

It's hard to predict, for any specific woman, how much of her ovarian hormone production will continue how long. Menopause (as it sounds like you are discovering) isn't like throwing a switch. Your hormone production just tapers off in fits and starts, and at some point, it's below the level that supports ovulation and you stop cycling. How much goes on after that, no one has looked into closely. Some women (we've all heard about them) carry on just fine, never notice symptoms, and live to a hearty healthy old age without any supplementation. I imagine that their ovaries and adrenals and body fat all manage to keep these women adequately supplied. Others crash and burn, dry up and blow away without hormones; we can only guess that they manage to produce far less. I'm not aware of any way to predict an individual's destiny, although you can derive clues from older women in your family.

But the important thing that you keep along with your ovaries is some resiliancy. The ovarian feedback mechanisms can do things we just can't duplicate with steady state hormone replacement. And we don't even know that we have all the bases covered, even when we check estrogen, progesterone, and testosterone. For many in surgical meno, finding a route and dose that are right are difficult and still seem to leave holes in the coverage our ovaries gave us. It's just not that perfect yet. Natural menopause (which is what you have when you keep your ovaries, regardless of your uterine status) is a generally easier situation to manage...and to experience.

In any case, hormonal dosing is not an exact science. We can test levels--but both saliva tests and blood tests have their flaws. And even when we know a number, how that number translates into adequacy of hormonal supply differs from one woman to the next. A circulating level that would have one of us feeling good might slay another. All hormone fine tuning, whether ovaries are present or not, is ultimately based on listening to your body and determining when you feel your best (and then longterm monitoring of things like bone density and blood lipids and mammograms). It's all the same process, just at different doses. Since you are already perimenopausal, testing your pre-op levels won't even give us a clue what your needs will continue to be, since you are already at some level of imbalance.

In the absence of ovarian pathology or strong family risk factors, I would second your doctor's opinion: if they are healthy, it may be healthier for you to keep them.