The MenopauseRx Hysterectomy Guide

The Ovary Question

Once a hysterectomy is decided upon, one of the most important questions to ponder is 'what to do about the ovaries'? It is important to realize that a hysterectomy does not mean that the ovaries need to be –or– will be removed at the time of surgery. However, when the ovaries are removed, the term 'surgical menopause' is used, since the major source of female hormones is removed and menopause symptoms can develop.

In general, there are two main issues to consider prior to deciding whether to remove the ovaries or not. 

1. If the ovaries are left in place:
1. What is the chance they will need to be removed later... therefore, needing another surgical procedure.
2. What is the chance the ovaries will become abnormal or cancerous later in life? If they are removed, will this entirely reduce my risk of ovarian cancer?
2. If the ovaries are removed:
1. What is the risk of a 'surgical menopause'? Will this affect my health in later years? For instance, osteoporosis and bone fractures are a risk if the ovaries are removed in young women.
2. What about the menopause symptoms? How bad will the hot flashes, night sweats, mood changes and other menopause symptoms be?
3. Can anything be used to help treat menopause symptoms?

Often, the reason for the hysterectomy leads to a recommendation regarding the ovary issue. For instance, if a hysterectomy is done for severe endometriosis, many gynecologists will recommend removing the ovaries to prevent further pain and complications from endometriosis post-operatively. Ovarian cysts frequently necessitate removing one or both ovaries at the time of hysterectomy.

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A common counseling point is the age of the patient undergoing hysterectomy. For instance, a hysterectomy done in a female who has gone through menopause will frequently decide to have the ovaries removed to minimize her risk of ovarian problems later. Her concerns of a 'surgical menopause' and associated symptoms are less since she has already gone through menopause.

Conversely, a hysterectomy being done on a younger female will frequently decide to keep one or both ovaries (assuming they are not diseased) to avoid the potential for a significant menopause symptoms associated with a 'surgical menopause'. Fortunately, if the ovaries are removed, there are excellent choices to help treat menopause symptoms.

Because your ovaries are your body's main source of estrogen, the removal of both your uterus and ovaries will cause menopause to occur immediately. The symptoms associated with surgical menopause are the same as those from natural menopause, but can be more intense due to the sharp, immediate decline in estrogen levels.

Symptoms Associated with Surgical Menopause Include:

• Hot flashes: A sudden wave of heat. Up to 90% of American women who undergo surgical menopause experience hot flashes.
• Night Sweats: Hot flashes that occur at night are accompanied by heavy sweating.
• Vaginal Dryness: Itching, burning, dryness and thinning of the vaginal walls and shortening of the vagina.

Managing your Symptoms:

Before your surgery, your doctor may write a prescription for some form of estrogen therapy (ET) to manage the symptoms associated with surgical menopause. There are many types of ET, but the most commonly used ones are pills and transdermal patches. ET can be started almost immediately after surgery. Many doctors will order an estrogen patch for the patient to start in the recovery room.

The Survival Kit contains free educational materials and coupons for products to relieve menopause symptoms, including hysterectomy information.

Ask your doctor about ET with Vivelle-Dot – the #1 prescribed transdermal estrogen patch. It helps to control moderate to severe hot flashes, night sweats and vaginal dryness associated with menopause. It also helps reducec the risk of postmenopausal osteoporosis.

The main point is that a female needs to think about these issues well before her hysterectomy date and have a thorough discussion with her surgeon about the 'ovary question'.