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[Avalon85]

I'm due my hysterectomy in 2 weeks.  I have Atypical hyperplasia so have pre-cancerous cells which may, or may not eventually turn to cancer.  As I'm postmenopausal, the recommendation is a full hysterectomy plus ovaries and Fallopian tubes.  I'm on HRT - oestrogen and Utragestan.  My gynaecologist is a bit 'no nonsense' and has said at my age it is 'doubtful' the ovaries are doing much.  But I have researched lots to the contrary. 

I have no familial risks to ovarian cancer.  I have low BMI, don't smoke or drink, and as a yoga teacher, I'm really active and fit.  My instincts are saying keep the ovaries.  The surgeon said I can tell him on the day what I've decided.  They 'normally recommend' removal to save them having to go in again in future should anything develop.  Its being suggested as a preventative measure.

I also have osteopenia and what little hormones they are secreting will be helping towards preventing this escalating further. I think the consensus is just take them out and we can give you more medication etc as necessary.  They can have the fallopian tubes (I only have one anyway after an ectopic pregnancy in my 30s) and the uterus.  I just feel I should leave my ovaries where they are.  Has anyone else been through this? I'm so conflicted.  My heart is saying keep but there isn't anyone to really use as a sounding board.

[CLKD]

My breast consultant was of the 'remove it all save going in again' attitude.  This is your body and if U want to keep your ovaries, make it completely plain that this is what *you* want as long as there is no sign of disease.  Read the Consent Form.

Let the Consultant's secretary know sooner rather than later so that you don't feel pressured into going against your gut instinct?  An e-mail to her? 

Even when removed sometimes if the stem is left ovaries may continue to ooze a little hormone 

It might be worthwhile asking a dedicated menopause specialist what U may require after radical surgery. 

Who will be looking after you?  Do cook and freeze in good time, also buy button through nighties to save lifting up over the head scenario. U may be stiff and sore and 'there may be enough wind to fly a kite' ;-)  . 

[Gnatty]

Hello, I am just off out but  nearly four years ago I chose at the age of 55 to have my ovaries removed when I had my hysterectomy. I was already on hrt. The worse thing that happened to me was after the operation reading too much online about what a horrendous mistake I had made and I went into a fast downward spiral and needed 12 months of antidepressants. I honestly think I would probably have been ok if I hadn't scared myself witless by googling. It was only when I spoke to a marvellous menopause doctor who had also had her ovaries out that my mind settled and I was able to carry on with my life again. I now mostly feel really well and I discovered exercise and I enjoy my life. Occasionally I tweak my hormones....For me I think in the end I chose to have them removed as I just didn't want the worry of them. I know how silly that sounds! You will always find those against and those for, at the end of the day it's your decision. xx

[CLKD]

Nothing is 'silly'!  It's how the mind works, should I/not ........ whether it's buying a pint of milk or regarding surgery.

[bombsh3ll]

I would get them taken out - I agree with your gynaecologist that they are just a potential source of malignancy and other problems and unlikely to be serving any meaningful function.

It is not necessarily a bigger operation, it is often easier and quicker to remove everything en bloc rather than dissect it out.

I would however make sure you have access to therapeutic doses of estrogen and testosterone before signing the consent form.

If you do not have access to androgen replacement, then even the pitiful amount coming from a postmenopausal ovary is worth keeping, so this would change my decision.

Is it possible to get a blood test for endogenous testosterone between now and then? That might help you see if you actually have anything worth keeping.

[Hurdity]

Hi Avalon

I completely disagree and would absolutely decide to keep them, and not of the opinion to take things out in case they cause problems in the future. Yes they do still secrete some hormones, as I understand and especially testosterone - and blood tests for T are notoriously unreliable - since the test normal used is designed for men and higher levels so is not sensitive enough at the levels women experience.

You haven't said how old you are and I can't see from the few posts you've made but I would still keep them at any age - if it were me and I'm in my 70's. You can't put them back!

By the way sorry to hear you have to have a hysterectomy - and I presume judging by your post that your womb lining must have thickened and that you will have had bleeding? I do note you had some bleeding in 2023 I think and hopefully you had this checked out?

At least after your hysterectomy then you won't have to worry about progesterone any more especially if the cervix is removed as well.

I hope you feel able to make the decision that's right for you...

All the best for your op...

Hurdity x

[joziel]

Like Hurdity says, keep them.

They continue to produce hormones after menopause. They 'do stuff' - and research is still ongoing to find out exactly what that is, but it is becoming more and more apparent. They are not totally inert things after menopause.

[Gnatty]

Except that after hysterectomy a lot of them decide to stop working anyway...

[Wrensong]

Hi Avalon85, I'm sorry to know you are faced with this decision, but you will have peace of mind from the hysterectomy given the hyperplasia is atypical.

My instincts are saying keep the ovaries

I think you're sensible to pay attention to them.

I had to have both ovaries removed postmenopause, several years before going on to have total hysterectomy (uterus & cervix).  I started HRT 3 years postmenopause, a couple of years prior to BSO & symptoms were on the whole easier to manage with ovaries intact than since.  That said, I do have other chronic conditions in the mix muddying the picture. 

You've read up so you'll probably know that our ovaries are said to go on producing significant amounts of androgens for us well into old age, with widespread benefits for our systemic health & for that reason I'd say you're wise to think carefully about whether to retain them.  Trying to compensate for this loss with supplemental testosterone has not been straightforward for me, with symptoms including systemic dryness, particularly pre-existing dry eye - now deemed severe - markedly worsening post-BSO.   There is research suggesting that loss of androgens may be implicated in dry eye/Sjogren's & if you have not come across it I'd say it's worth looking into, as well as familiarising yourself with the other actions of endogenous androgens if you haven't already - GU health being considered another important area.   Like you I have osteopenia & androgens are also thought to contribute to bone health.

Several of my friends have had hysterectomy without BSO & whether on HRT or not, they seem to have fared better in subsequent years than I have!  On the whole I tend to agree with Hurdity & Joziel on this issue.  It's not a simple decision though, as with BSO there is peace of mind in knowing you will not have to contend with future possible ovarian disease.  I think Gnatty's point is also valid, as it's said that when left intact, ovarian function can decline after removal of the uterus, but to what degree & whether this always happens, I don't know.

I think I'd continue to read around as widely as you can from reliable sources if you feel there is more you could usefully learn & hopefully more members will come along with their experiences to help you decide.

W x
P.S. sorry, repeatedly edited as more & more came to mind!  Will try to stop now!!

[Wrensong]

Couple of interesting papers here covering pros & cons of ovarian conservation, including those relating to women already postmenopause at time of hysterectomy. . .

https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.34970

https://pmc.ncbi.nlm.nih.gov/articles/PMC3514564/

[CLKD]

How often has the Consultant seen ovarian problems for ladies who opted to keep an important part of our bodies? And how much later following hysterectomy.  % of necessary removal following hysterectomy  for example against those that had them removed?

[bombsh3ll]

This article is super interesting and a really good point about salpingectomy as this is where ovarian cancer often starts.

I think as well as considering the likelihood of a particular outcome in this case ovarian cancer which for the general population is low, the gravity of said outcome is also an influencing factor, as is our personal exposure and proximity to it.

My aunt passed from it (I am a non carrier within a BRCA family) so this of course affects the way I would choose. Your gynaecologist also will have seen many women with ovarian cancer, which is often diagnosed late and has a poor prognosis, and this will no doubt have shaped their perspective on it too.

You have to gather as much information as you can and take whatever you personally feel is the path of least regret.

[Wrensong]

Bombsh3ll, I'm sorry to know about your Aunt & yes naturally our own personal experiences influence our life choices, so your perspective makes perfect sense.  At the time my BSO was recommended it was a result of red flag changes to a 2nd cyst to have caused gynaes some concern, with suspicion of malignancy.  It arose at a time of acute stress for me due to v recent diagnosis of another serious condition for which I was awaiting further treatment & I was not in the best frame of mind to deal with this untimely additional worry.  The BSO was advised as urgent, so there was no time to research as fully as I would have in other circs.  My then (young) gynae felt given my 5-yrs postmenopause status there should be no long term adverse consequences from the oophorectomies, though future HRT looked to be out of the question.  Her priority - & I was grateful to her for this - was to get me through that episode of care quickly, as the possibility of OC was a more serious prospect than any other consideration at that time.  So yes to what you say here too

Your gynaecologist also will have seen many women with ovarian cancer, which is often diagnosed late and has a poor prognosis, and this will no doubt have shaped their perspective on it too.

So the decision to go ahead was made within minutes of her strong advice that this was best course of action, though I'd had no idea on entering the consultation room that surgery would be proposed. 

I felt very lucky the ovarian histology turned out to be benign & don't regret the decision, but also that the loss of ovaries has probably contributed to the complexity of managing my overall health.

[CLKD]

Many years ago I arrived at MM via the ovacome website - might be worth while posing the question there?

[CLKD]

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