Oopherectomy vs Hysterectomy?

Hi all! 2 yrs ago had my left ovary removed due to a fibroma. I now have cyst(s) on my right. I'm going to see doc on Wednesday. If the doctor says I need to have the remaining ovary removed, will I have to have a hysterectomy? What would be the benefit/reason to keeping my uterus if I don't have my ovaries? If I don't have my ovaries anymore, I won't get my period, right? Just wanting to have as much info as possible before I go on Wednesday! Thanks!

Hi Lauren I'm sorry you may be facing such a tough decision. To a great extent, the question of whether or not a hysterectomy would be recommended if you have your other ovary removed is one of your personal and family medical history.

First... are you a good candidate to be able to use HRT? If not, you will be dealing with the symptoms of surgical menopause, which can be quite severe for some of us, without the ability to use estrogen. This can be a huge challenge... just browse through the threads in the No-Hormone Desert Oasis forum here to get an idea of what it's like for women who cannot use HRT.

If you are lucky enough to be able to use HRT, then having a uterus can complicate things a little. You see, many of us who have had a hysterectomy with ovary removal do very well on just estrogen, once we find the right dosage. That is not an option (at least not a safe one) for women who still have a uterus, because unopposed estrogen is known to greatly increase your odds of getting some female cancers, most notably uterine cancer. Therefore, women who have a uterus must also use some form of progesterone or progestin (progesterone-like compound) to oppose the estrogen. There are two potential downsides of that... one is that under certain hormone balance conditions, you may still bleed; not necessarily monthly, but whenever the balance favors it. The other downside is that the more effective progestins are also associated with an increased risk of breast cancer if used longer term. This whole dilemma is why women with breast cancer histories who are on Tamoxifen, which acts like estrogen in the uterus, often end up having hysterectomies... otherwise their likelihood of getting uterine cancer is substantial.

OK, so that's basically the argument for removing the uterus along with the ovaries -- and how much weight you give that argument depends in part on whether your family history includes any 'female cancers'. What would be a good reason for leaving the uterus in place? Well... if you haven't had an issue with prolapse yet, then your likelihood of having pelvic organ prolapse would be less if you keep everything where it is now. Also, removal of the uterus is a pretty major surgery, and carries all the risks of any major pelvic surgery. In addition to the anesthesia risks which would be the same with just the ovary removal, there is an increased risk of complications involving the bladder and bowel, which both lie right up next to the uterus. Plus it tends to involve a bigger incision, more stitches or cautery, and a longer healing time. Finally, who knows... we don't know everything there is to know about what the uterus does. Yes, it is the place where our bodies nurture the fetus during pregnancy, but is that all it does? We really don't know. There are prostaglandins that are secreted by the uterus under certain conditions, although those are also secreted by other organs in the body. Prostaglandins are involved in bowel function, and I don't believe we really know all that they do.

In general, I believe it's best to keep healthy organs if we can... you and your DR will need to talk about what the odds are that if you keep your uterus, it can stay healthy and not cause you more problems than if you'd removed it. Not an easy decision, for sure.

Good luck with whatever you decide to do.

s,
-Linda

Linda - Thank you for your very informative reply! I will definitely talk to the doctor about the options, but from what you said, I think I'm leaning towards having the uterus removed if they do have to take the ovary. My sis died from Ovca and Progesterone and me do not go together! Thanks again!

Hi Red,

I recently had my second ovarian surgery for another endometrioma and was faced with the same decision.

I wanted to schedule the ovarian surgery right away around my school schedule and doctor's schedule and decided to "watch and wait" and not to do the hysterectomy. I had my ovarian surgery in January.

I can't say I'm sorry I did that, but I'm very close to deciding to get a hyterectomy now because the bleeding is out of control for me with fibroid and adeno, but I don't want to go off HRT. Although the pain is better without the cyst. Unfortunately, I wasn't at a place in my life to agree to having the uterus taken out. I needed a lot of time to fully research it and "live with" the idea.

Now, I will go back and have another surgery in November or December, I believe, to have the uterus removed. Ideally, I would have had the whole surgery in March or April, but my doctor was away. So, I'll probably have two surgeries in less than a year, but I'm okay with everything. I try not to have regrets.

Linda's insight and information was excellent.

The only thing I might add is that for many women, the uterus is a big source of pleasure when it comes to sexual orgasms. Also, the uterus helps to keep the other organs in their natural place and removing it could cause problems with the stomach, bowels and bladder moving into the empty space. Then there is the decision on whether or not to take the cervix. The same things just said about the uterus also applies to the cervix.

But the MAIN thing I wanted to add is that one should ALWAYS get at LEAST one other opinion before consenting to ANY kind of surgery. No matter how long you've gone to or how comfortable you are with your current doctor. And the second opinion should NOT be from someone your current doctor refers you to. Make sure you see another specialist who is not associated with your doctor either professionally or socially and when you do see them, don't give the other doctor's diagnosis first . . . just say you want some "fresh eyes" on your case.

Good luck and best wishes,

Ladies,
Thank you all for your informative responses! At this point, I don't have to worry about another surgery. The doctor said that my cysts do not require surgery. We are going to try the Ring birth control. He said that the side effects are typically less than with the Pill. We shall see. You all gave me sooo much to think about though, that when I do have to make this decision, I will go into well informed. Thanks again!