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Opinions Wanted on pelvic pain poss endo Opinions Wanted on pelvic pain poss endo

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Unread 05-01-2003, 08:04 AM
More info;)

I'm glad your Dr acknowledges your pain...seems to be half the battle here for most of us
I did want to post some info on a BSO & possible outcomes..also to let you know we have ((Sisters)) here that still experience pain w/ no Ovaries.....

Surgical Menopause:

HRT: The Whole Story:

The role of ovarian hormones upon brain:

Old Ovaries-still of value?


A risk-benefit analysis of elective bilateral oophorectomy: effect of changes in compliance with estrogen therapy on outcome.

Speroff T, Dawson NV, Speroff L, Haber RJ

Department of Epistemology and Biostatistics, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio.

A bilateral oophorectomy at the time of elective hysterectomy is often performed to prevent ovarian cancer. The assumption that endogenous estrogen can be easily replaced with supplemental medication fosters the decision for routine oophorectomy. Published reports on the use of postmenopausal estrogen indicate that compliance is less than perfect. This fact could affect the overall outcome. Decision analysis techniques with Markov cohort modeling were used to evaluate the policy of elective bilateral oophorectomy. Results from studies judged methodologically sound were combined to determine values representing the influence of estrogen on coronary heart disease, breast cancer, and osteoporosis fracture. The decision tree also explicitly incorporated patient compliance. When compliance with estrogen therapy is assumed to be perfect, oophorectomy yields longer life expectancy than retaining the ovaries. When actual drug-taking behavior is considered, retaining the ovaries results in longer survival. This analysis highlights the importance of including the effects of patient compliance with treatment recommendations when the impact of a health policy decision such as prophylactic surgery is assessed.

Am J Surg 1997 Jun;173(6):495-498

Is incidental prophylactic oophorectomy an acceptable means to reduce the incidence of ovarian cancer?

Rozario D, Brown I, Fung MF, Temple L

Department of Surgery, Ottawa General Hospital, University of Ottawa, Ontario, Canada.

BACKGROUND: According to previous reports, the lifetime risk of developing ovarian carcinoma is 1.4%. This figure varies with age from 6.6 per 100,000 among women aged 35 to 39 years up to 55.1 per 100,000 among women aged 75 to 79 years. Prophylactic oophorectomy remains a modality to decrease the incidence of ovarian cancer. What proportion of women diagnosed with an ovarian malignancy had a preceding laparotomy at which time a prophylactic oophorectomy could have been performed?

METHODS: We reviewed the new ovarian cancer diagnoses seen in patients between August 1988 and August 1993 at the Ottawa Regional Cancer Foundation. Four hundred and four patients were identified. These patients were analyzed for preceding abdominal surgery, age, time to disease progression, time to death, time to death from other causes, and average follow-up. The previous abdominal surgeries were divided into: (1) major gynecological surgery; and (2) general surgery procedures, which were further divided into laparotomy and pelvic surgery (group A surgeries) and general surgery that included other abdominal surgeries (ie, appendectomy, cholecystectomy) where access to the pelvis could be more difficult (group B surgeries).

RESULTS: A total of 270 abdominal surgeries was performed, prior to the diagnosis of ovarian cancer. The group was stratified according to the timing of the surgery ( greater or =40 years, 41 to 45 years, 46 to 50 years, >50 years). Based on these data, and on the grouping of general gynecologic surgeries plus the general surgical procedures of group A, 10.9% of ovarian cancers would have been prevented if prophylactic oophorectomy had been performed in patients who had surgery over 40 years of age; over 45 years this was 6.7%, over 50 years it was 4%. If one adds all major surgeries, including general surgery groups A and B, the results were 26.9% over 40 years of age, 20% over 45, and 16.6% over 50.

CONCLUSION: We found that, depending on the age of the patient, prophylactic oophorectomy results in a 4% to 10.9% reduction in the incidence of ovarian carcinoma. This increases to 16.6% to 26.9% if one considers general surgery procedures in which access could be more difficult. Although we are not advocating the frequent use of this procedure, we recommend that surgeons routinely discuss this option before surgery with their postmenopausal female patients over 49 years of age. Given that the decision for prophylactic oophorectomy is multifaceted, we feel that a risk scoring for ovarian cancer and a discussion of the risk and benefit ratio should be undertaken. The ultimate goal is to heighten patient awareness of the risk factors to ensure that an informed decision is made concerning this consistently lethal disease.
Menopause, Estrogen Loss, and Their Treatments:

Surgical Meno resources:

Pain with sexual intercourse deep in pelvis: http://www.wdxcyber.com/ppain.htm#ppainsex

Pain assessment:

Pelvic Pain Assessment Form:

International Pelvic Pain Society:

Gynecologic Causes of Pain - Internal: In Pelvis or Abdomen:

Should I Keep My Ovaries?
The rationale for keeping the ovaries, would be to maintain a source of your own sex hormone production. It is possible that your ovaries may continue to produce adequate amounts of estrogen and testosterone until the time you would have had experienced a natural menopause. The normally functioning postmenopausal ovary also may be capable of producing significant amounts of testosterone for several years following menopause. Testosterone is the hormone is closely associated with energy levels, lean body mass, libido and sexual function. In addition, if testosterone levels are present, some of it may be converted to estrogen by a process called, "aromatization". This may be the reason that naturally menopausal women are known to have less severe menopausal symptoms and fewer negative health consequences. as contrasted to women who have had their a surgical removal of benefit in reducing the severity of menopausal symptoms.

Is there any reason I might want my ovaries removed?

There is always the argument that removing the ovary prevents the possibility of ovarian cancer. A woman has a 1 in 70 chance of developing cancer of the ovary during her lifetime. Due to a lack of symptoms initially, the presence of ovarian cancer is typically not discovered to a late stage and for this reason is often fatal. The peak incidence of ovarian cancer is between the ages of 70-80.

There is a type of ovarian cancer that is hereditary. The mutated genes responsible for most hereditary ovarian cancers have been identified, (BRCA1, BRCA2). There is a blood test available to identify carriers of this gene. Woman who are identified as having the mutated gene should consider the option of ovarian removal and non-carriers can be assured that their risk of ovarian cancer is not increased.

What are the risks of going on HRT?
I believe, assuming that HRT is given in a physiologic manner and in my view means a non-oral route of administration, specifically transdermal or subcutaneous, in doses that result in physiologic blood levels of estradiol and testosterone, the risks would be no greater than having your own source of hormone production. I prefer to prescribe non-oral regimens of estradiol and testosterone, utilizing non-oral routes of administration. This has the advantage of avoiding the "bolus, first pass" liver consequences and enzyme alterations associated with oral administration of hormones. Oral administration of HRT, is the most commonly used route of sex hormone delivery used in the world and it has been proven to be effective and safe for most women. However, my sense is that non-oral routes of administration are potentially even safer and more effective.

Strictly speaking menopause refers to that point in time that normal or physiologic menstrual bleeding stops.


A surgical menopause or hysterectomy refers to a menopause that is induced by a surgical removal of the uterus. If the ovaries are removed at the time of surgery the fall in hormone levels of both estrogen and testosterone is sudden and severe. Testosterone plays an important part in maintaining energy levels, sex drive and in a number of other important functions. If the ovaries are not removed, they may continue to function and produce adequate levels of estrogen and testosterone, until the time that a natural menopause would have occurred. However, as it turns out, in as many as 50% of these cases, the retained ovaries cease to function normally within three years after surgery. It's easy to see why a surgical menopause/hysterectomy has a greater potential to disrupt health and the quality of life.A premature menopause refers to a menopause that occurs prior to age 45.

Additionally, menopause can be induced by chemotherapy, infection, trauma or autoimmune disease.Menopause occurs earlier in smokers and is a result of a smoking related reduction in estrogen levels.


No one "goes through menopause." When a woman becomes menopausal and hormone levels fall, she will remain hormonally deficient for the remaining 1/3 of her life span. This is a normal and expectation.

A surgical menopause or hysterectomy refers to a menopause that is induced by a surgical removal of the uterus. If the ovaries are removed at the time of surgery the fall in hormone levels of both estrogen and testosterone is sudden and severe. Testosterone plays an important part in maintaining energy levels, sex drive and in a number of other important functions. If the ovaries are not removed, they may continue to function and produce adequate levels of estrogen and testosterone, until the time that a natural menopause would have occurred. However, as it turns out, in as many as 50% of these cases, the retained ovaries cease to function normally within three years after surgery. It's easy to see why a surgical menopause/hysterectomy has a greater potential to disrupt health and the quality of life.A premature menopause refers to a menopause that occurs prior to age 45.

Additionally, menopause can be induced by chemotherapy, infection, trauma or autoimmune disease.Menopause occurs earlier in smokers and is a result of a smoking related reduction in estrogen levels.


hormone replacement after complete hysterectomy: http://www.medicinenet.com/script/m....amp;qakey=2339


Info on Ovarian pain:










What You Need To Know About Ovarian Cysts: http://home.cyberave.com/~hsquare/pd...rs/wh1ch09.htm

Functional Ovarian Cysts

Ovaries: Should I Have Them Removed? http://www.ivillagehealth.com/expert...46_526,00.html

Ovarian Failure:

Facts About Hormonal Replacement Therapy: http://www.healthy.net/library/books/lark/fc_a_hrt.htm

What IS Early Menopause?

Talking To Your Doctor About HRT

Instruments are now available that enable the gynecologist to remove a cyst through small incisions in the abdomen. This type of procedure, known as laparoscopic surgery, provides the benefits of outpatient surgery and a quick recovery. Using a telescope placed through the navel and small instruments placed near the pubic bone, the gynecologic surgeon can remove either the cyst alone or the entire ovary._An ovarian cyst, which looks like a small balloon filled with water, grows from within the ovary and stretches the normal ovarian tissue over it. Removing the cyst, called a cystectomy, is like taking a clam out of the shell. The thinned out ovarian tissue is cut open, and the cyst is gently peeled away from inside the ovary. The cyst fluid is then removed with a suction device. The cyst now looks like a deflated balloon and can easily be removed through the small laparoscopy incision. If a cyst has destroyed all the normal ovarian tissue, it may be necessary to remove the entire ovary. A number of ways have been developed to allow the removal of the entire ovary with the laparoscope. Using either special sutures or surgical staples, the blood vessels going to the ovary can be tied, and the ovary cut away and removed. In most situations, the operating time for laparoscopic surgery takes no longer than standard surgery. However, the benefit of laparoscopic surgery is that you may leave the hospital the same day and return to normal activity within a week or two._

If surgery has been recommended to you, I think a second opinion is an excellent idea. Very few things in medicine are black or white, and there is a lot of room for differences of opinion. A number of possibilities exist after a second opinion. First, the physician you see for the second opinion may give you the exact same options as your original gynecologist. This may put your mind at ease in that you will feel sure that nothing has been overlooked. Second, the new physician may bring up other options that are available to you or give you more information to think about. Or, the physician giving the second opinion may disagree with what you have been told or even disagree with the diagnosis. For my patients who seek a second opinion, I always ask them to call and talk to me about the results of that consultation. This allows me to answer any new questions and respond to any suggestions the other physician has offered. I never feel offended if a patient wants a second opinion.When a new patient comes to see me for a second opinion, our office asks them to bring all the doctor’s notes from previous medical appointments and any test results that are relevant to the problem. If an ultrasound or MRI has already been performed, I like to look at the films myself so that I can come to my own conclusions about the diagnosis

If you decide that surgery is right for your situation, you will need to choose the doctor to perform your surgery. There are a number of factors that should influence your decision. The first is to choose a doctor who will perform a procedure that fits your particular situation and problem.
In most cases, you should have more than one option from which to choose._
The next concern is the skill of the surgeon.
How many procedures does the doctor perform a month?
How many procedures like the one you are requesting?
How many of these procedures have they performed in women with problems like your?
How many complications has the doctor had and what kind of complications were they?
Studies show that experience makes a surgeon better. Surgeons who perform procedures frequently have lower rates of complications. But surveys show that many gynecologists perform less than one major operation a month.
Choose your surgeon carefully:
It is also important to feel comfortable with your doctor. Do you get an opportunity to ask questions and are they answered? Is the doctor available?_If you decide to have surgery, another visit should be set up with the doctor you have chosen to go over the specific details of the procedure you are to have performed. Again, it is nice to have someone accompany you.

Just remember to be sure and hear the optimism in your doctor's message. This is another opportunity for you to inform and educate yourself. Learning as much as you can will help, not hurt, you.
Is a bilateral oophorectomy needed?

bilateral salpingo-oophorectomy

Oophorectomy is the surgical removal of one or both ovaries. It is also called ovariectomy/Oophorectomy is performed to:[list]
remove cancerous ovaries
remove the source of estrogen that stimulates some cancers
remove a large ovarian cyst
excise an abscess
treat endometriosis[list]

Until the 1980s, women over age 40 having hysterectomies (surgical removal of the uterus) routinely had healthy ovaries and fallopian tubes removed at the same time. This operation is called a bilateral salpingo-oophorectomy.
Many physicians reasoned that a woman over 40 was approaching menopause and soon her ovaries would stop secreting estrogen and releasing eggs. Removing the ovaries would eliminate the risk of ovarian cancer and only accelerate menopause by a few years.
In the 1990s, the thinking about routine oophorectomy began to change. The risk of ovarian cancer in women who have no family history of the disease is less than 1%. Meanwhile, removing the ovaries increases the risk of cardiovascular disease and accelerates unless a woman takes prescribed hormone replacements.


There are situations in which oophorectomy is a medically wise choice for women who have a family history of breast or ovarian cancer. However, women with healthy ovaries who are undergoing hysterectomy for reasons other than cancer should discuss with their doctors the benefits and disadvantages of having their ovaries removed at the time of the hysterectomy.
Oophorectomy is done under general anesthesia. It is performed through the same type of incision, either vertical or horizontal, as an abdominal hysterectomy. Horizontal incisions leave a less noticeable scar, but vertical incisions give the surgeon a better view of the abdominal cavity.After the incision is made, the abdominal muscles are pulled apart, not cut, so that the surgeon can see the ovaries. Then the ovaries, and often the fallopian tubes, are removed.Oophorectomy can sometimes be done with a laparoscopic procedure. With this surgery, a tube containing a tiny lens and light source is inserted through a small incision in the navel. A camera can be attached that allows the surgeon to see the abdominal cavity on a video monitor. When the ovaries are detached, they are removed though a small incision at the top of the vagina. The ovaries can also be cut into smaller sections and removed.The advantages of abdominal incision are that the ovaries can be removed even if a woman has many adhesions from previous surgery. The surgeon gets a good view of the abdominal cavity and can check the surrounding tissue for disease. A vertical abdominal incision is mandatory if cancer is suspected. The disadvantages are that bleeding is more likely to be a complication of this type of operation. The operation is more painful than a laparoscopic operation and the recovery period is longer. A woman can expect to be in the hospital two to five days and will need three to six weeks to return to normal activities


Before surgery, the doctor will order blood and urine tests, and any additional tests such as ultrasound or x rays to help the surgeon visualize the woman's condition. The woman may also meet with the anesthesiologist to evaluate any special conditions that might affect the administration of anesthesia. A colon preparation may be done, if extensive surgery is anticipated.On the evening before the operation, the woman should eat a light dinner, then take nothing by mouth, including water or other liquids, after midnight.


After surgery a woman will feel discomfort. The degree of discomfort varies and is generally greatest with abdominal incisions, because the abdominal muscles must be stretched out of the way so that the surgeon can reach the ovaries.When both ovaries are removed, women who do not have cancer are started on hormone replacement therapyto ease the symptoms of menopause that occur because estrogen produced by the ovaries is no longer present. If even part of one ovary remains, it will produce enough estrogen that a woman will continue to menstruate, unless her uterus was removed in a hysterectomy.

Antibiotics are given to reduce the risk of post-surgery infection.Return to normal activities takes anywhere from two to six weeks, depending on the type of surgery. When women have cancer, chemotherapy or radiation are often given in addition to surgery. Some women have emotional trauma following an oophorectomy, and can benefit from counseling and support groups

Oophorectomy is a relatively safe operation, although, like all major surgery, it does carry some risks. These include unanticipated reaction to anesthesia, internal bleeding, blood clots, accidental damage to other organs, and post-surgery infection.Complications after an oophorectomy include changes in sex drive, hot flashes, and other symptoms of menopause if both ovaries are removed. Women who have both ovaries removed and who do not take estrogen replacement therapy run an increased risk for cardiovascular disease and osteoporosis. Women with a history of psychological and emotional problems before an oophorectomy are more likely to experience psychological difficulties after the operation.
Good Luck in your decision ((Michelle)) Pls keep us posted & know your ((Sisters)) are here to support you...((((hugs))))

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Unread 05-01-2003, 03:31 PM
Opinions Wanted on pelvic pain poss endo

Thanks, Sheri!

Looks like I have some reading to do

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