Should I have my ovaries out when I have a hysterectomy?

May 2, 2010 1:31 PM

If uterus out, then: ovaries: keep, or toss?

Last week I asked for help getting ready for an appointment with my gynecologist to talk about what can be done about my insanely frequent and bloody periods. Thanks, everybody; that helped me feel educated and ready for what turned out to be a very productive meeting with the doctor.

At this point, pending some tests, it looks like I'll be having a hysterectomy. The doctor mentioned Mirena and endometrial ablation as options, but my periods have been so hellish and exhausting and demoralizing for so long that, barring any strong medical arguments from him, I'm inclined to go for the sure thing.

The question that comes up then, is: do I have my ovaries out at the same time? The doctor gave me some information about making the decision, but I would love to hear other women's experiences with making this decision, and how it ended up feeling to you.

My concern is that obviously I have some whacked-out hormonal stuff going on, and while getting the periods out of the way will help, I may still be at the mercy of my hormones for a long time. I have three young children at home, and the exhaustion and extreme irritability make being the kind of mom I want to be really hard. So a part of me wants to just say, "yep, let's yank 'em and get it over with!"

On a more rational level, I don't have any of the risk factors (like a family history of ovarian cancer) that would make removing them medically prudent. I know that even after menopause residual hormones protect against osteoporosis and some cancers, while increasing the risks of other cancers. I don't know much about what hormone replacement, should I choose to do that after having my ovaries out, would be like.

Right now, I don't need any advice about whether I should have a hysterectomy; I think the doctor and I have that question pretty much under control. But whether to have my ovaries out feels huge and hard to process. I'll have a lot of questions for him at our next meeting, but would really like to hear how you made the decision, what it was like for you afterward, how happy you were with your choice, and all suchlike things.

posted by not that girl to health & fitness (18 answers total)

From what I have read it's best to keep the ovaries; their effects on the body may be less hellish with the uterus removed.

I've had ablation for the same reasons; message me here if you'd like to discuss post-surgical recovery and hormone insanity (or lack thereof).
posted by tilde at 1:42 PM on May 2, 2010

Keep. A lot of women have complained that losing their ovaries destroyed their libido, far worse than an ordinary menopause. Some are helped by testosterone supplements, but others are not.
posted by Ery at 1:42 PM on May 2, 2010 [1 favorite]

I really think at this point you would immensely benefit from joining the community at HysterSisters. The women there were an absolutely invaluable resource to me when I was pondering my options.

You are fixed on your hysterectomy course, as was I, but because of that forum I elected to go with the ablation which in an afternoon eradicated my long-standing bleeding and pain. I did this with the knowledge that I could always go back and do the more extensive surgery if I needed it. The HysterSister forums contained very sobering and eye-opening evidence and testimony that encouraged me to be as conservative as possible, and I'm grateful to this day that I spent lots of time there before finalizing my decision.

I truly wish you the best whatever you decide to do.
posted by melissa may at 1:59 PM on May 2, 2010 [1 favorite]

I should also say that I needed the emotional support too. My circumstances were different than yours: I was in my early 30s, and although I never thought I wanted kids, it was more painful than I ever would have supposed to decide to close the door on that option altogether. This is heavy stuff no matter what your particulars are, and having a caring community always available helps a lot.
posted by melissa may at 2:09 PM on May 2, 2010 [1 favorite]

I kept my ovaries when I had my hysterectomy in 2003. I'm only now (aged 50) starting to go into the menopause. I didn't want to have either a premature menopause or take HRT whilst I was getting over surgery.

I think the general view (in the UK at least) is that ovaries are left if the woman is not menopausal.

If you have any questions at all, please MeMail me, I'll be happy to answer any questions you might have about the operation and recovery afterwards.

I'll say, though, that the decision to have the hysterectomy was the best thing I could have done for my health.
posted by essexjan at 2:20 PM on May 2, 2010

My understanding is that you're better with them in. You might find some good information at Women to Women. Good luck!
posted by kch at 2:26 PM on May 2, 2010

My surgeon said that about half of women who have their ovaries left continue to have PMS symptoms and the other half don't. There was no reason to remove mine so they were left. I had some PMSy-type monthly irritability/insomnia for a few months after surgery and then it faded away. I don't have any menopause symptoms so assume the ovaries are still pumping out hormones and haven't quit working. The end of PMS is icing on the wonderful cake of not having hellish periods. Good luck!
posted by nelvana at 2:48 PM on May 2, 2010

You say that you don't have the risk factors for ovarian cancer, but have you had the genetic testing done? I wouldn't make the decision before I had these results.
posted by meerkatty at 2:57 PM on May 2, 2010

your ovaries, and the hormones that they make (i understand you are still at least premenopausal or perimenopausal, so your ovaries are making some hormones, at least) are protective of your cardiovascular health and your bones. that's why risk of osteoporosis and heart attack increases quite sharply for older women. removing them may require that you take some measures to replace the hormones in other ways that are even more of a PITA than what you're experiencing now, unfortunately. and coudln't you always have them removed later, if it seems like it's really not working out? not to be crude, but you couldn't put them back in. i have an aunt who really misses her, despite having similar complaints to your pre-hysterectomy....
posted by Tandem Affinity at 3:01 PM on May 2, 2010

Keep them. My ovaries shut down when I was roughly 24 years old. The symptoms of that suck, to put it lightly. Libido problems, dryness, not to mention I have to worry about things like osteroporosis and certain cancers beforehand, and am on the same HRT as my mom while about half her age. At the very least, know going into it what the loss of your ovaries will do to your body -- that's not something it's fun to be surprised by.
posted by pixiecrinkle at 3:18 PM on May 2, 2010

nelvana, it's very heartening to hear that you stopped having PMS after your hysterectomy. I think I've been afraid everything would keep being exactly the same (which is intolerable) except with no bleeding.
posted by not that girl at 3:29 PM on May 2, 2010

It's a big decision, far more so than some male docs recognize. The conservative (literally) medical approach is to do the least invasive surgery, i.e., leave the ovaries. IANAD
posted by theora55 at 3:30 PM on May 2, 2010

They (the doctors) really really really want to leave as much of the plumbing in as they can, even if this means returning for later surgeries. A friend with pretty ghastly endometriosis had a hysterectomy and just a hysterectomy, even though she swore up and down that one ovary needed to go, too. That wasn't successful, so this Friday I'm taking her in to get her left ovary removed. They will be leaving the right one. She might have to have some kind of mild hormone replacement therapy.

Reading up on this, the ovaries do cycle through a variety of hormones in a way that we cannot yet perfectly mimic with medicine. Taking everything can leave you at an increased risk for other mortality factors. My friend is struggling with the urge to just go "scorched earth" to solve the chronic pain (and who can blame her?) but at the same time, realizes that this is a decision with some long-term impacts.

Look into ablation. It's one of the first, smallest things you can do, surgically. Join one of the aforementioned support groups and find out with other women have done. And, of course, there are some non-surgical aids with a few studies to back them up, that might help in the interim.
posted by adipocere at 3:56 PM on May 2, 2010

Nthing looking into Ablation much more than you have thus far. Surgery sucks. Surgery carries a risk of infection and a small but present risk of death. You will have restrictions on your activities, you will hurt in a godawful way and you will have an unsightly scar.

My mom had ablation for the very same symptoms you described and has been incredibly happy with the results. It's been probably seven years and she doesn't have any bleeding and feels wonderful. And, best of all, no surgery, so I didn't have to sit in a waiting room biting my fingernails off with worry.

Please don't make medical decisions based on some loosely defined layman's version of "sure thing". If your doctor thinks it will work, please trust him or find one you do trust.
posted by nursegracer at 4:36 PM on May 2, 2010 [1 favorite]

See also: HERS Foundation. Please call them. And be careful and specific with any waivers you sign prior to surgery if you want to be certain to keep your ovaries regardless of discretionary calls a surgeon might make during the procedure.
posted by quarterframer at 4:47 PM on May 2, 2010

My mom and sister both had the surgery (mom took out ovaries, sister left in) and the recovery, apparently, sucks donkey balls. (they both had fibroid problems/hormonal swings).

My mom died fairly young (67) of congestive heart failure, and I have to wonder if having ovaries removed didn't contribute, since she was not overweight or a smoker. But of course, who knows.

When/if my time comes to get some of the plumbing out, I intend to do as little as I can get away with, for that reason. C/section recovery was supposed to be easy and wasn't; not really interested in any more abdominal surgery if I can avoid it.

/anecdotes
posted by emjaybee at 5:08 PM on May 2, 2010

To balance out nursegracer's point of view, I have no scar and had no pain. Really.

Before my surgery, I took hormones to try to alleviate the sypmtoms. Then I had surgery to remove a polyp that was to alleviate symptoms. Then they wanted to do the ablation but by that time, I just wanted the 100% fix. I had it done on Thursday afternoon and went home Saturday morning. And really, I didn't even need a Tylenol for pain because there wasn't any. I took it easy for three weeks and went back to work because I felt fine.

Since that time, I've taken up hiking and have seemingly endless energy. I've lost a bit of weight and become fit. I was anemic before and spent years not even realizing how tired and rundown I felt. Oh yes I almost forgot ... I can plan to do anything at any time - what a bonus.
posted by nelvana at 6:02 PM on May 2, 2010

I was frightened in advance by what I had been told by older women, and while I am sure they were true to their own experiences, modern care is much better than it used to be. Pain management is much more sensible nowadays. Really no need to fear it, and although I didn't have quite such as easy time as nelvana, like her I can barely believe how much better I feel. Good luck with it.
posted by communicator at 3:54 AM on May 3, 2010