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Hi **, Hi **, back to the Castle I go Hi **, Hi **, back to the Castle I go

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Unread 04-26-2003, 06:21 PM
Hi **, Hi **, back to the Castle I go

I am 9 months post op, TVH , kept both ovaries.
Now I have a large (grapefruit sized) cyst on my right ovary. The doctor says it must be removed. I am scheduled for surgery May 6th. I told him to take both ovaries as I am NOT having another surgery....EVER AGAIN!!!!!!!
I have had enough, I'm beginning to feel like that game "Operation!" So far in my life I have had 4 D&C's, 3 cone biopsies, gall bladder removal with complications resulting in 3 ERCP's (stent placement), and a TVH. Now this. I can't stand it.

Has anyone else had to go back later to have a BSO? I don't know what to expect.
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Unread 04-26-2003, 08:05 PM
Hi **, Hi **, back to the Castle I go

Oh ((((DKJ)))) I'm so sorry you've been having such a hard time of it I haven't had to go back for a BSO, but I know that others have gone this route and I'm sure they'll be here very soon, shedding some on the issue.

Just wanted to say that we're here for you and to send some your way.
Unread 04-26-2003, 08:21 PM
Back to the Castle

Sounds like you and I could be paying rent at the Castle. I've met a few people along my road that have had TVh and then had to go back and have the BSO. From what I have been told the BSO was smooth and was a quicker recovery. Just what I've been told. Don't know if there's any doc that would say that. First of all big for everything you've been through. I feel your pain. I had TAH and they took the right ovary but the gyn thought he should leave the left one so I could avoid HRT. (given my past I didn't necessarily agree but resigned myself to the surgery because he was the one with the degree, right?) Here's what I learned...
Nobody knows your body better than you! And if you want both ovaries taken out then stand up for it so you don't have to do it again. I was back in 8 months (almost to the day) to have the left one taken out because I had developed a grapefruit size cyst that had engulfed the ovary. It is of course another surgery for you (they had to do mine laprascopically, I don't know how they will do yours) but it means you get to recover ALL OVER AGAIN! And to me, that was the must frustrating part..

Know that we will all be here you along every step of the way of your recovery!
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Unread 04-26-2003, 11:00 PM
Hi **, Hi **, back to the Castle I go

I am so sorry that you are having such a rough time..

I too fell like the operation game. I am headed for #5 and then #6 shortly there after. I too want it all over and done with. You would think that after the big one it would all be over, but as every sister here knows, it can be a long road.

I had a BSO at the same time I had my hyst so I can not tell you what to expect, but we are all here for you!!

Please keep us posted and you will be in my prayers...
Unread 04-27-2003, 03:21 AM
Hi **, Hi **, back to the Castle I go

I understand how you feel about additional surgery..I've had 2 Post hyst for complications from Adhesions...In Jan 2000 I had a TAH then 12 weeks later I underwent an RSO An U/S revealed a large mass on top of a very enlarged cyst covered Ovary. I had been experiencing increasing pain so due to the unknown origin of the mass, coupled w/the pain I was advised to have it removed. Unfortunately, the pain decided to stick around. Several weeks later I was admitted thru the ER for emergency surgery for Bowel Obstructions caused by adhesions. That surgery landed me a 2 week hospital stay, more complications, along with increased pain. During one of those surgeries the blood supply to my left Ovary was altered so it is non-functioning..I later discover I have a blood clotting disorder so no HRT. My left Ovary has been painful over the yrs...a few Drs wanted to remove it but even tho it is non-functioning it still produces small amounts of those much needed Hormones
Pls DLK, for you, research all you can on Ovarian removal & possible outcomes. I understand the one Ovary being removed but if the other is healthy it can continue to provide you balance..not always an easy task. Our Ovaries provide us w/ many much needed Hormones that contribute to our over all well being. I have seen many, many women who elected to have this done & later to find themselves w/ a whole new set of problems but have also seen women who just take a pill & are fine, I would suggest doing some reading over in Hormone Jungle it has some good info on Surgical Menopause & what to expect...
This isnt always the case & we are all different but you never know until it's too late. There is no turning back, another resaon I suggest research...I'm gonna list some info that discusses these issues, it has been very helpful in some desicions I've been faced with.
When it's your health..knowledge is power..we are our own best Advocates & to do that we must educate ourselves on any surgery, procedures, treatments ect..so that we can research all viable options, weigh the Pro's & Cons of each which can really help in making such life altering decisions..ones that we feel is best for us:

Should I Keep My Ovaries?

There is no right, or wrong decision. The choice is ultimately a personal one...
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.
Hysterectomy-Leave the Ovaries-Gabe Mirkin, M.D.

Surgical Menopause:

HRT: The Whole Story:

The role of ovarian hormones upon brain:

Old Ovaries-still of value?

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

Hysterectomy: Get the Facts Before You Act:

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? [/i]

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:

What You Don’t Know Can Hurt You: Knowledge Is Power In A Doctor/Patient Relationship:


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


Ovarian Cysts -- What Are They, And What To Do About Them:
http://www.obgyn.net/displayarticle....ey/banter_0708Laparoscopy for ovarian cysts:

FAQ'S-Ovarian cysts:

"Because the removal of the ovaries may have a substantial impact on other health risks and quality of life, further research is needed to determine who is the best candidate " said Dr. O.
There are five (5) common types of ovarian cysts:
  • functional cysts
    polycystic ovaries
    endometrial cysts
    dermoid cysts


Cysts may grow quietly and go unnoticed until they are found on routine examination. However, if they are ruptured (by sexual intercourse, injury or childbirth) and/or become large enough, the following symptoms may occur:
  • Intense abdominal pain (symptom in all types of cysts)
    Menstrual changes such as late periods, bleeding between periods or irregular periods (symptom occurring in corpus luteum cysts and polycystic ovaries)
    Heavy menstrual flow (symptom occurring in polycystic ovaries)
    Infertility (symptom occurring in polycystic ovaries and endometrial cysts)
    Internal bleeding (symptom occurring in endometrial cysts)
    Severe menstrual cramps (symptom occurring in endometrial cysts)
    Pain with sexual intercourse (symptom occurring in endometrial cysts)
    Pain during a bowel movement (symptom occurring in endometrial cysts)
    Weight gain (symptom occurring in polycystic ovaries and endometrial cysts)


Depends on many factors, including the type of cyst, its size, its location, the type of material it contains and the woman's age. For functional cysts a "watch and wait" approach is taken. Functional cysts tend to dissolve over time and treatment is not needed. The doctors do, however, require the woman to return after two menstrual cycles to get a pelvic exam and/or ultrasound again. If the cyst is still present and growing (over 2 inches) the doctor may recommend a laparoscopy to remove the cyst. If the cyst comes and goes, the doctor may prescribe birth control pills. These pills reduce the hormones that promote growth of cysts and prevent formation of large cysts.

What are the treatments for ovarian cysts?
If you have not yet gone through menopause, you may not need any treatment, unless the cyst is very big or causing pain. Sometimes, taking birth control pills will make the cyst smaller. Surgery may be needed if the cyst is causing symptoms or is more than 2 inches across.If surgery is needed, often the cyst can be removed without removing the ovary.

Treatment options include:
Watchful waiting.
Hormone therapy to reduce the size of the cyst.
Cystectomy to remove the cyst.
Oophorectomy to remove the affected ovary.
Hysterectomy. This usually is not necessary unless the cyst is cancerous.

pros and cons of hormone replacement therapy:


Pelvic exam for ovarian cysts:[/url]

Laparoscopy for ovarian cysts:[/url]

Laparotomy for ovarian cysts:[/url]

The developing follicular cyst is found in the ovary during the first two weeks of the menstrual cycle. This is the egg sac, including the egg, the support cells and the surrounding fluid. Normally these cysts enlarge to about one inch. The egg is then released during ovulation and the cystic fluid drains out of the ovary and thus the cyst goes away. This cycle of events happens almost every month in a woman with normal menstrual cycles. These cysts rarely cause pain unless the ovary is surrounded by adhesions (scar tissue). A hemorrhagic corpus luteum cyst forms when the egg breaks a small blood vessel in the ovary during ovulation. The broken blood vessel can bleed into the ovary and develop a blood clot or what is medically called a hemorrhagic corpus luteum cyst. This type of cyst can get pretty big and has an appearance similar to an endometrioma. A hemorrhagic corpus luteum cyst will appear suddenly and the body will reabsorb it over a month or two. The only way an endometrioma will disappear on a sonogram, other than surgery, is if it ruptures. Once in a while the developing egg is not released resulting in an unruptured follicular cyst. Ovulation does not occur. This condition probably occurs in most women once in a blue moon (the second full moon occurring in the same month). Unruptured follicular cysts occur more often when the ovary is surrounded by adhesions (it is more difficult for the egg to escape from the ovary) and is probably more common the first month after pelvic surgery since the hormone production fluctuates with the stress of surgery. Some women are genetically predisposed to developing this type of cyst. Some physicians believe this is one cause of fertility and is called luteunized unruptured follicular (LUF) syndrome in women who repeated do not release the egg. The majority of the time follicular cysts will eventually resolve on their own.

The most common types of ovarian cysts are called functional cysts, which result from a collection of fluid forming around a developing egg. Every woman who is ovulating will form a small amount of fluid around the developing egg each month. The combination of the egg, the special fluid-producing cells, and the fluid is called a follicle and is normally about the size of a pea. For unknown reasons, the cells that surround the egg occasionally form too much fluid, and this straw colored fluid expands the ovary from within. If the collection of fluid gets to be larger than a normal follicle, about three-quarters of an inch in diameter, a follicular cyst is said to be present. If fluid continues to be formed, the ovary is stretched as if a balloon was being filled up with water. The normally white covering of the ovary becomes thin and smooth and appears as a bluish-grey. Follicular cysts may rarely become as large as 3 or 4 inches. The majority of these cysts, even the large ones, go away after a month or two as the extra fluid dissolves back into the blood stream._

At the time of ovulation, the covering of the ovary tears open in order to release the egg. Within hours, this covering heals, and the cells in the ovary form a structure called the corpus luteum. The corpus luteum produces progesterone, the hormone that prepares the uterine lining cells for the arrival of the fertilized egg. Every menstruating woman, every month, forms a corpus luteum. However, cells can produce fluid within the corpus luteum and form a cyst. While a corpus luteum cyst is usually no larger than a small marble, sometimes so much fluid is produced that a cyst of a few inches results. The good news is that, like follicular cysts, practically all corpus luteum cysts will go away by themselves in a few weeks. Follicular cysts and corpus luteum cysts are collectively referred to as functional cysts._
A number of other types of ovarian cysts can form as a result of the abnormal growth of other cells contained in the ovary.


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. Once a decision has been made, we go over a paper called the “Informed Consent”. Filling out this form, if properly done, encourages a frank discussion of what you should expect from surgery. It allows the doctor and patient to go over the details of the operation to be performed, the specific risks of the procedure, the alternatives to the surgery, and the possible consequences if the surgery is not performed. Basically, this is the time when you will hear all the risks and possible complications during and after your surgery. This is difficult and may feel as if it's the last thing you want to hear, but ultimately it is quite helpful to you. I see this form as part of my job as an educator. I choose to fill out the form by hand in the patient's presence and make it specific for each woman's situation. And, I am available to answer any questions related to the risks of the procedure. Doctors are certainly not trying to erode your confidence at this point, but we are legally and morally bound to tell you about all the things that could happen. Most people's emotional reaction to this form is fear, which is understandable. 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.
Fatigue is a very common consequence of surgery. . A recent study found that 75% of women who had either a myomectomy or a hysterectomy (with an abdominal incision) had significant fatigue lasting up to a few months after surgery. Sixty percent of women noted fatigue for 6 months. Based on studies that show a faster return to normal activity after laparoscopic surgery, it appears that fatigue may be less persistent after laparoscopic surgery.
I'm sorry for the long post but this is a big decision, I wanted to post the info for you..
Good Luck in finding some relief pls keep us posted...(((hugs)))
Unread 04-27-2003, 09:07 AM
Hi **, Hi **, back to the Castle I go

Wow! Thanks to everyone for your support. It makes me feel so much better.
I have thought about this for a long time (have known about the cyst for months) and feel that removal of both ovaries is the right decision for me.
I am at the frustrating point of having to wait those final few days until it is done. Like all LIW's, the anxiety of waiting is a killer for me. I just want it over with already. UGH!

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