Spare the Ovaries! What Women Should Ask Before a Hysterectomy

Far too many women may have their ovaries removed during a hysterectomy.

ByCOMMENTARY<br/>By MARIE SAVARD, M.D.<br>ABC News Medical Contributor
May 22, 2009, 6:16 PM

May 24, 2009&#151; -- Far too many women, even young women, have their perfectly healthy ovaries removed at the time of a hysterectomy.

Doctors long recommended this to prevent ovarian cancer later in life. Although many doctors claim that this practice rarely happens today, the statistics say otherwise.

Of the 600,000 hysterectomies each year for non-cancerous causes, half of all women have their ovaries removed at the same time -- and many of these women have many years to go before menopause.

So, it seems that the practice of removing healthy ovaries at the time of hysterectomy has continued, despite years of evidence suggesting that ovaries are complicated hormone powerhouses, even in the time approaching and during menopause.

Our ovaries influence all aspects of our health and sense of well-being. Unfortunately, too many doctors feel that taking estrogen pills or an estrogen patch will work just fine, and there is really no big loss to having the ovaries removed.

However, taking estrogen as a substitute for young healthy ovaries hardly takes the place of what our healthy ovaries produce.

I remember the stories of many young -- and even not-so-young -- women describing how awful they felt following surgery when their ovaries were removed and how difficult it was to get the right balance of hormones. They all complained of low energy, reduced libido and not feeling quite right.

Even when I came up with a regimen that helped relieve many of their symptoms, they complained that they still were not feeling themselves.

Ovarian cancer is fairly uncommon, accounting for about 3 percent of all cancers and only 1 percent of all deaths in women. But it is difficult to detect and treat, so understandably, many women go along with their doctors and agree to have their healthy ovaries removed. What women don't consider are the potential health risks to having their ovaries removed.

A study published in the May 2009 issue of the journal Obstetrics & Gynecology, from the famous Nurses' Health Study, found what research has long shown us: Surgical removal of perfectly healthy ovaries is associated with a number of health risks, especially for young women.

But the increased risk of death found by the researchers surprised me. The overall risk of death was increased by 40 percent, and the risk of heart attack and stroke increased by 50 percent in women with removal of ovaries before age 50, especially if they didn't take hormones after surgery. In this study, all women, even older women, benefited from keeping their ovaries.

Ovary Removal During Hysterectomy a Disturbing Trend

The findings in this study are a big concern because far too many women elect to have their healthy ovaries removed during a hysterectomy, and many of these women are hesitant to take hormones because of the tremendous media scare against hormones.

Women in their 30s and 40s have a greatly increased risk of heart disease, osteoporosis and even stroke if they have their ovaries removed prematurely. Taking estrogen replacement after surgery will help reduce this risk, but hormones probably don't remove the risk altogether.

The good news, however, is that for women who choose to take estrogen when they have their uterus removed, there is no need to take progesterone as they no longer have a uterine lining at risk for cancer. Synthetic progesterone called progestins, such as Provera, often are prescribed to women with a uterus who are taking estrogen to balance out the estrogen and to prevent a buildup of the uterine lining. Without progesterone to balance out the effects on the lining, unchecked estrogen could eventually lead to uterine cancer.

I think all women need to be informed of their choices and apprised of the risks (there are many) and benefits (there are very few) of such a practice before they go under the knife. Expressing your concerns and wishes to your surgeon in advance will help your surgeon make the best decision for you -- and will more often than not mean you will wake up with your ovaries still intact.

What to Discuss With Your Surgeon Before Hysterectomy

I suggest four things you should ask your doctor before you have a hysterectomy.

1) Can I avoid a hysterectomy? Many women who undergo a hysterectomy could have their medical conditions, such as heavy bleeding and fibroids, treated without surgery. Don't be afraid to ask if you should have a second opinion.

2) Can I have minimally invasive laparoscopy or robotic hysterectomy? The recovery time after minimally invasive surgery is much quicker, and instead of a large incision you end up with a few tiny incisions.

3) Can I keep my ovaries? Always talk over the risks and benefits of keeping your ovaries. Only women with a strong family history of ovarian cancer or women who know they carry the BRCA1 or BRCA2 gene mutations that greatly increase their risk of ovarian and breast cancer should strongly consider having their ovaries removed.

4) Can I begin estrogen in the form of a patch during or immediately after surgery? Women, especially young women, who have their ovaries removed often experience disabling hot flashes soon after surgery. Taking estrogen will help considerably, although finding the right dose of estrogen can take some time. Ask about testosterone cream if estrogen does not completely relieve your symptoms, especially if you experience low libido after the surgery.

What has been your experience after a hysterectomy? What type of surgery did you have? Did you have your ovaries removed? Did you find the right balance of hormones?

As always, I welcome your comments and questions.

Marie Savard, M.D., is an ABC News medical contributor. Her new book, "Ask Dr. Marie: Straight Talk and Reassuring Answers to Your Most Private Questions," will be available in August.

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