WHAT WOMEN SHOULD ASK BEFORE GOING UNDER THE KNIFE FOR A HYSTERECTOMY

Far too many women, even young women, have their perfectly healthy ovaries removed at the time of a hysterectomy. Doctors have long recommended this to prevent ovarian cancer later in life. Although many doctors claim that this practice rarely happens today, the statistics say other wise. Of the 600,000 hysterectomies each year for non-cancerous causes, half of all women have their ovaries removed at the same time – and many of these women have many years to go before menopause.

So it seems that the practice of removing healthy ovaries at the time of hysterectomy has continued despite years of evidence suggesting that ovaries are complicated hormone powerhouses even in the time approaching and during menopause. Our ovaries influence all aspects of our health and sense of wellbeing. Unfortunately too many doctors feel that taking estrogen pills or an estrogen patch will work just fine and there is really no big loss to having the ovaries removed. However taking estrogen as a substitute for young healthy ovaries hardly takes the place of what our healthy ovaries produce.

I remember the stories of many young and even not so young women describing how awful they felt following surgery when their ovaries were removed and how difficult it was to get the right balance of hormones. They all complained of low energy, reduced libido, and not feeling quite right. Even when I came up with a regimen that helped relieve many of their symptoms, they complained that they still were not feeling themselves.

Ovarian cancer is fairly uncommon, accounting for about 3% of all cancers and 1% of all deaths in women. But it is difficult to detect and treat, so understandably many women go along with their doctors and agree to have their healthy ovaries removed. What women don’t consider are the potential health risks to having their ovaries removed.

A study published in the May 2009 issue of the Journal Obstetrics & Gynecology from the famous Nurses Health Study found what research has long shown us – surgical removal of perfectly healthy ovaries is associated with a number of health risks – especially for young women. But the increased risk of death found by the researchers surprised me.  The overall risk of death was increased by 40% and the risk of heart attack and stroke increased by 50% in women with removal of ovaries before age 50, especially if they didn’t take hormones after surgery. In this study, all women, even older women, benefited from keeping their ovaries.

The findings in this study are a big concern because far too many women elect to have their healthy ovaries removed at the time of hysterectomy, and many of these women are hesitant to take hormones because of the tremendous media scare against hormones.  

Women in their 30’s and 40’s have a greatly increased risk of heart disease, osteoporosis, and even stroke if they have their ovaries removed prematurely. Taking estrogen replacement after surgery will help reduce this risk, but hormones probably doesn’t remove the risk altogether. The good news however is that for women who chose to take estrogen when they have their uterus removed, there is no need to take progesterone as they no longer have a uterine lining at risk for cancer. Synthetic progesterone called progestins such as Provera are often prescribed to women with a uterus who are taking estrogen to balance out the estrogen and to prevent a build up of the uterine lining. Without progesterone to balance out the effects on the lining, unopposed estrogen could eventually lead to uterine cancer.  

I think all women need to be informed of their choices – and apprised of the risks (there are many) and benefits (there are very few) of such a practice before they go under the knife. Expressing your concerns and wishes to your surgeon in advance will help your surgeon make the best decision for you – and will more often than not mean you will wake up with your ovaries still intact.


I suggest four things you should ask your doctor before you have a hysterectomy. 
 

1) CAN I AVOID A HYSTERECTOMY? Many women that undergo hysterectomy could have their medical conditions, such as heavy bleeding and fibroids, treated without surgery. Don’t be afraid to ask if you should have a second opinion. 

 2) CAN I HAVE MINIMALLY INVASIVE LAPAROSCOPY OR ROBOTIC HYSTERECTOMY? The recovery time after minimally invasive surgery is much quicker, and instead of a large incision you end up with a few tiny incisions. 

3) CAN I KEEP MY OVARIES? Always talk over the risks and benefits of keeping your ovaries. Only women with a strong family history of ovarian cancer or women who know they carry the BRCA1 or BRCA2 gene mutations that greatly increase their risk of ovarian and breast cancer should strongly consider having their ovaries removed.

4) CAN I BEGIN ESTROGEN IN THE FORM OF A PATCH DURING OR IMMEDIATELY AFTER SURGERY? Women, especially young women, who have their ovaries removed often experience disabling hot flashes soon after surgery. Taking estrogen will help considerably, although finding the right dose of estrogen can take some time. Ask about testosterone cream if estrogen does not completely relieve your symptoms, especially if you experience low libido after the surgery. 

What has been your experience after a hysterectomy? What type of surgery did you have? Did you have your ovaries removed? Did you find the right balance of hormones?

As always, I welcome your comments and questions.

Dr. Marie  

Marie Savard, M.D. is ABC News Medical Contributor. Her new book, Ask Dr. Marie: Straight Talk and Reassuring Answers to Your Most Private Questions, will be available in August.


Go to the Ask Dr. Marie Home Page | Dr. Marie's Home Page

4 Responses to “WHAT WOMEN SHOULD ASK BEFORE GOING UNDER THE KNIFE FOR A HYSTERECTOMY”

  1. Jana Says:

    What if you are 49 and have a fluid filled noncancerous cyst growing in your one remaining ovary (other taken out 10 years ago because of other non-cancerous cysts)? Do you keep it?

  2. Joan Jenkins Says:

    I just wanted to share my story. (I’m sorry it is so long but I have been wanting to share it for a while).

    My best friend and I went to the same gynecologist for years when we were both diagnosed within the same year with a large 18 week fibroid. The diagnosis and treatment he told both of us was identical.

    Hysterectomy.

    My friend decided to go ahead and have the proceedure and followed his recommendation to remove her uterus, ovaries and cervix. He suggested the same for me after my annual exam. I was in shock because although I had some some heavy bleeding at times, it was nothing that I could not manage and otherwise I felt very healthy. I was concerned about the size. It was a very hard uncomfortable mass under my belly-button. I looked six months pregnant. I asked if it was possible to perform laporoscopic surgery or a myomectomy and he said that it was too large and that he felt he would need to perform a traditional total hysterectomy with a vertical incision. He also said that I would never have to deal with having periods anymore. (something that never bothered me) He told me it might shrink once I go though menopause but he said, that since I was in my early fourties, and I did not have plans to have any children that I might as well consider having the proceedure. I was both shocked and scared. I felt a deep spiritual connection with those parts of my body and I wanted to go through the change with them and keep them like my mother and grandmother before me. I didn’t want to loose that part of me for the sake of not having periods or children. Heck, I still have my tonsils and I’m 51 now. I didn’t get his logic, if I had, I might consider taking out my tonsils, gall bladder and my appendix just to be sure I never have any problems! I decided to search for alternatives and another doctor for a second opinion. I did some research and booked an appointment with a surgeon in the gynocologic specialty and oncology division Magee Women’s Hospital in Pittsburgh. He specialized in laporoscopic myomectomy and minimally invasive surgery. After my examination and a review of the utltrasounds, he suggested a laporoscopic myomectomy. He said that all of the other structures and tissues were heathly and he said that I was a good candiate for the proceedure to remove the fibroid. I explained that another doctor had told me that it was too large to consider an alternative to a hysterectomy. He assured me that he had performed a proceedure on this size of fibroid in other patients with similar histories. He gave me names of several other surgeons that I might want to consult with that perform traditional myomectomy and hysterectomy and laporoscopic proceedues to help me form a final method of care that I felt was right for me taking into consideration my fears and concerns.

    I decided to have the laporoscopic myomectomy. To this day I am grateful for the decision that I made; and to have found a surgeon who understood and adressed my fears and concerns. As it turns out, my friend now wishes that she hadn’t made such a quick decision. She is on traditonal HRT and fears going off of it. I told her that she did what she and her doctor felt were best for her and that I did what I thought was best for me based on inforamation from the doctors that I had consulted.

    It’s hard to know what the right answers are when there are so many great many doctors and specialists with similar and conflicting views, opinions and bias. We all must consider both their professional opinion of our treatment and care and our knolwedge of our own unique bodies when making decisions that can affect our quality of life throughout our lives.

    I feel beter having had a hand in my treatment and care because ultimatley it is my body and my responsibilty to respect it, listen to it and do the best I can to preserve my heath, my vitality and at the same time nuture that quiet voice inside of me that is my soul.

    There are many choices in life but the most important one is how you choose to take care of yourself, mind, body and spirit.

  3. HALIM Says:

    HALIM

    Although your article about estrogen menopause sounds interesting but i’m not sure if i could agree with you in 100%.

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