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1 year post op/drooping ovaries/adhesions 1 year post op/drooping ovaries/adhesions

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Unread 05-01-2003, 06:31 PM
1 year post op/drooping ovaries/adhesions

Hello, it's been a long time since I've been here!! I've been doing so well. So happy it's over.....at least that's what I thought...I had a total hysterectomy last year. The Doctor insisted I keep my ovaries. I have never had any problems with them...that is until now. Maybe someone can help make me feel better. Here's the story...for a few months I've been having pain in my left side when I have to urinate, it I hold it too long it really hurts. After I go I'm fine...I told this to the Dr. he suggested an ultrasound. he told me my ovaries had dropped onto the pelvic floor(or onto my bladder)they may be stuck there. They are stuck together. I also have a walnut sized cyst on one of them along with a fluid filled "sac" of adhesions. Has anyone else ever had ovaries that drooped like this. I will probably have another surgery, which is like having had two hysterectomies. I'm so upset. Dr. says maybe in 6 weeks this cyst will have shrunk. But still is it going to be okay with my ovaries down so low? I just need opinions..help, I don't want to go through anesthesia again.

Thanks for listening!!!(I forgot how to put cute little animated inserts in my posts, oops)
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Unread 05-01-2003, 08:00 PM
My right ovary "fell" too..

That's what the doc told me at my last 3mo checkup.
He said that when they tacked up the ovaries to get the uterus out, that somehow the right one "fell" and is just kinda bouncing around on the top of the vagina, and that could possibly be the source of my right sided pain. However, he also mention that he felt something on that side as well, and sent me for an ultrasound. He said I could either deal with it like this and just keep taking my motrin 800mg pills or I could have it tacked up again, or even removed. Haven't decided on anything yet. Just wanted you to know that apparently it DOES happen that way sometimes, and you aren't alone. Hope you feel better really soon

Stef TVH for adenocarcinoma of cervix
Unread 05-02-2003, 08:31 AM
1 Year Post-op

Well, the good thing is if you do have to have surgery again, surely it will be laparoscopic? That'll be less invasive and also much less anesthesia. Hang it there - - I have to say posts like these make me soooooo glad they took my ovaries at the time. Good luck.
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Unread 05-02-2003, 06:01 PM
1 year post op/drooping ovaries/adhesions

Big ((hugs)), I'm sorry your going thru so very much I am 3.5 yrs Post TAH...at 12 weeks post an U/S revealed a large mass(of unknown origin), multiple blood filled cysts on an enlarged Ovary. My Gyn, not knowing what the mass was & thinking it was the cause of my worsening right sided pain, scheduled me for an RSO.
The mass turned out to be Adhesions adhering my Ovary to my vaginal cuff..unfortunately the pain never left
After a Hysterectomy our Ovaries kinda float around, surgery causes Adhesions to form, which can cause them to *stick* where there not supposed too..
Ovarian Hormones are very important to a Womans over-all health. They are discovering more & more just how important they are. Pls research & educate yourself on the possible outcomes of Ovarian removal(BSO) which is an entire different surgery than a Hysterectomy=removal of the Uterus & cervix. This is your body ((Suz)) & you must be your own best Health Advocate Remember knowledge is power..the more you know the better an Advocate you can be:

Menopause, Estrogen Loss, and Their Treatments:

Surgical Meno resources:

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...=MNI&qakey=2339


Info on Ovarian pain:


What You Need To Know About Ovarian Cysts: http://home.cyberave.com/~hsquare/pd...rs/wh1ch09.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.
http://<br /> <br /> <b>Is a bilat...D=hw178560</a>

Laparoscopy for ovarian cysts:[/url]

Laparotomy for ovarian cysts:

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.
Adhesions on cuff:

Incapacitating pelvic pain:


rebounding pain:

Life with HRT: Monitoring your health:

Additional Resources for Patients and Patient Advocates:

Ovary - mixed cystic and solid:

Ovary - (mostly) cystic:

Pain Inventory Form:

Hormonal Replacement Therapy Regimens:

When deciding if or not to retain Ovaries, some things to consider~
Surgical Menopause:

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.
Good Luck w/ your research & decision....pls keep us posted...(((hugs)))

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