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Gynecology

Hysterectomy

06/25/2008

Question:

I am 52 and planning on having a hysterectomy because of a 10x10 cm fibroid and an enlarged uterus. My Dr. tells me that although my ovaries aren`t involved, he strongly suggests I also have them out. He says they are no longer producing estrogen, because of my age, and leaving them in only gives me a 10% chance of cancer in the future. Should I consider having my ovaries removed during my hysterectomy?

Answer:

Deciding to remove the ovaries at the time of hysterectomy does take some thought. In the past, doctors were very paternalistic in this regards and encouraged most women around 40-45 to routinely remove the ovaries to reduce the incidence of cancer or other problems related to the ovary. The general thought was that the ovaries are either no longer making estrogen, or will soon no longer be making estrogen so why not remove them. "They aren't going you any good anyway", was the thought.

We now know that the ovaries do provide some additional hormones, but not only do we not know the importance of these hormones, we also know the levels after removal are about the same as natural menopause. There is about a 2-3% risk of the need for reoperation due to problems with the ovaries if they are preserved. This isn't just for cancer, but also for an ovarian cyst, pain and scarring.

The risk of cancer is reduced after hysterectomy, but this depends on that particular woman's risk for ovarian cancer based on her past medical history and family history. In a premenopausal woman, the risk reduction of ovarian cancer must be weighed against the risk of the consequences of premature estrogen loss. For a postmenopausal woman, there is no risk of premature estrogen loss since they are already at a state of estrogen deficiency.

Lastly, even if the decision to preserve the ovaries is made, it may not be technically possible depending on the anatomy. Also, if the ovaries are not found to be normal, then both ovaries must be removed.

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Response by:

Thomas  A deHoop, MD Thomas A deHoop, MD
Formerly Associate Professor of Clinical Obstetrics and Gynecology
Director, Medical Student Education
No longer associated