I often have women tell me - “I wish I’d never had my ovaries removed because all my problems started after I had that surgery.” Women with benign disease are sometimes told, “You’ve had all your children. You might as well take everything out so you can’t get ovarian cancer.”
I recall Gina, a 48-year-old patient who saw me after having undergone a total hysterectomy with removal of the ovaries at age 44. She had been a very accomplished businesswoman. She had enjoyed excellent health all her life and had normal regular periods “like clockwork” each month. She had a great metabolism, ate what she wanted and had always weighed around 110 pounds. In her early forties, she started having heavy bleeding and was diagnosed with fibroids. She sought out an ob-gyn who was an expert in fibroids and a professor at a major medical school far away from Gina’s home. The specialist told her she didn’t need a hysterectomy and recommended an endometrial ablation at a facility closer to home.
Gina followed up at a facility near her hometown and the physician there insisted she undergo a complete hysterectomy. She was told she needed to remove her ovaries because her mother had breast cancer in her seventies (after many years of Prempro). She reluctantly agreed to the surgery but now states it was the worst decision she ever made. She was started on oral HRT after the surgery but developed a litany of health problems.
In the first year after surgery, she gained 50 pounds that led to high cholesterol and high blood pressure. She developed poor sleep, fatigue, and problems with mental focus and concentration. She eventually sold her business because she couldn’t function well at work. Her life was totally changed, and she was very remorseful about her decision to remove her ovaries.
I don’t want to frighten women who truly need to have their ovaries removed for medical reasons like cancer. It all goes back to carefully considering the benefit-risk ratio. Undergoing a hysterectomy is major surgery and when you have cancer, severe uterine prolapse or any serious condition that has failed medical therapy, it is warranted. However, if you have a benign condition and medical therapy has not been exhausted, please get a second opinion. Do your homework to study all the available options and the potential consequences of each, so you can intelligently discuss your case with your physician.
With surgical removal of the ovaries and uterus, menopause occurs very suddenly. One day a woman is having menstrual cycles and then the day after surgery, she is in menopause. This can be a shock to the system, especially since she must also recover from major surgery. She has to heal and adjust to what has happened both physically and mentally. For some women who have never had children and even those who have, it is a poignant realization that they won’t be able to bear children ever again. Other women see it as a loss of their femininity. I think it’s important for the patient to know in advance that she is likely to experience these issues after surgery.
Excerpt from "Outliving Your Ovaries" © 2012 by Marina Johnson MD.
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