Still Not Sure About Ovaries

I had a D & C and biopsy done while I was on vacation in Europe (due to an episode of severe bleeding). I didn't have the pathology report from there translated word-for-word, but the gist seemed to be a diagnosis of complex hyperplasia without atypia. I brought the pathology slides back home and had a pathologist here read them and his report read "severely atypical complex endometrial hyperplasia, focally bordering on grade 1 carcinoma."

A doctor here in the U.S. will do the hysterectomy (with DaVinci). He recommends removal of the ovaries, uterus, and cervix. When I questioned why he recommended removal of the ovaries, he explained it was due to the type of cells that were found and the potential risk of cancer. He said that he was trying to avoid having to do a second surgery later- in the case that a post-surgery pathology report showed cancer.

However, I've been reading that hormones from the ovaries are still produced well after menopause and that these provide important protection from heart disease.

I'm not sure how much I should push for keeping my ovaries. I'm 47. My sister had breast cancer at 44, was treated, and has little risk of recurrence.

What would you ask? Read?

I hate to second-guess what I'm doing. My surgery is scheduled for next week and I've already made arrangements to take time off from work using FMLA.

Thanks in advance for any suggestions.

You will not be able to keep the ovaries. Not with cancer on the table.

While I agree that it sounds like a very strong recommendation to remove the ovaries you should be sure to talk to your doctor about your concerns about heart disease. Does it run in your family even more than the cancer risk? Have the doctor explicitly go over the pros & cons so that you can be content with the decision you make. There may even be other options to help prevent heart disease while still taking the ovaries. Start a list of questions ASAP and get them answered by your doctor as he will know your situation the best.

So sorry you're going through this - hope you can find comfort in making the best decision for your future health.

Is your doctor a gyn-oncologist? If not, it would be a good idea to see one. Best wishes for your surgery. Hugs!

Thanks for the replies.

I'm going to speak to my doctor again on Monday. He is a gyn-oncologist. At this point, one big question I have is:

If uterine cancer is known/found, are the ovaries always removed?

In other words, if a woman went into surgery and had only the uterus removed, but later pathology reports showed uterine cancer, would all/most doctors perform a second surgery to remove the ovaries? Why or why not?

I would be very interested to hear what other women have heard from their doctors regarding this question.

My family history is that my maternal grandmother and my younger sister both had breast cancer. My maternal grandmother died of breast cancer in her late 40s. Two grandparents died from strokes, one from a heart attack, all three at age 70+. Both my parents take medication for high blood pressure, but do not have heart problems, and my mother has not had breast cancer issues. A second sister is in good health.

I am finding this site and the boards very helpful and a comfort.

Thanks very much!

How about (re)posting this question in the gyn cancer forum? The ladies over there would likely also have some good insights (and support) and it might catch their eye better there.

Hi if you have endometriosis it can continue or recur if you keep your ovaries unless they can remove every single implant (almost impossible to guarantee). So that might be another reason for your doctor suggesting removal. But take their advice about the pathology, they will know what your diagnosis is and what is best to do about it. Some research is inconclusive about benefits of ovaries for women near menopause age. There are some benefits early but what I have heard is not so much long term benefit. That is one reason HRT is only recommended for a few years not for the rest of your life. If you get ovaries removed your doctor may want to get all your pathology results in before discussing whether they recommend any HRT for you or what type. You will also hear that for some sisters their ovaries shut down as a result of the hysterectomy either temporarily or permanently and if they stay functional sisters after hyster tend to go into menopause a few years sooner. Even shut down ovaries apparently do still produce small amounts of hormones which can be beneficial for health. Some thoughts for your decision making.

I had a choice about one ovary and my doctor said if I was more worried about menopause keep it, if I was more concerned about cancer remove it. I was more concerned about cancer so had them take both.

Good luck with your surgery.