Associates in Obstetrics & Gynecology in Colorado Springs
Hysterectomy is the removal of the uterus and cervix but not necessarily the removal of the ovaries. With the advancement of new technology, a hysterectomy is becoming easier to perform and faster to recover from. This surgery usually takes 45 to 60 minutes to perform. After a hysterectomy, you may never require another pap smear in the future, as long as you have never had a history of abnormal pap smears. There are several methods that I use to perform a hysterectomy. I will describe each type of surgery and the main considerations for choosing the appropriate procedure for you. All hysterectomies have risks and benefits.
Major Operative Risks include:
- Operative injury to surrounding organs such as the bladder, ureters (kidney tubes), intestines, and blood vessels
- Bleeding that may on occasion require transfusion
- Anesthetic risks
Long term satisfaction with a hysterectomy is very high. Most studies show that 90% to 95% of women will be happy with their choice of a hysterectomy. Sexual functioning for the vast majority of women is unchanged or improved. Women still experience orgasm and their partners are unable to notice a difference during intercourse. However, some long term issues can occur. For a very small amount of women, they experience difficulty with sexual intercourse causing pain. Some women also experience abdominal pain from scar tissue related to the healing process. Fortunately, this only occurs in a very small fraction of women (<5%).
To Remove The Ovaries Or Not To Remove The Ovaries
The most common question women ask when considering a hysterectomy is, “Should I remove my ovaries?” There are advantages and disadvantages to either decision. Ultimately, it is the patient that will need to make her own decision after considering all the factors that may be important to her. The surgery performed to remove both ovaries and the fallopian tubes is called Bilateral Salpingo-oophorectomy (BSO).
The Case for Keeping the Ovaries
Ovaries are the organs that produce hormones for women. These hormones include estrogen, progesterone, and testosterone. Once a woman becomes menopausal, at an average age of 52 years old, her ovaries no longer produce estrogen and progesterone, but does make a small amount of testosterone. If only one ovary is removed, the remaining ovary will increase production of hormones to match the amount produced by two ovaries. So, if one ovary is removed, no real changes in hormone levels will occur. Hormones produced by the ovaries help keep bones strong, prevent heart disease, and prevent menopausal symptoms. On the other hand, if a woman keeps her ovaries, there is a risk for ovarian cancer or ovarian diseases that may require surgery in the future.
The Case for Removing the Ovaries
Ovarian removal at the time of hysterectomy can be accomplished very easily. There is only a very small difference in the surgery for a GYN surgeon to remove the ovaries. Surgical risk may be slightly increased but the cost difference to you or your insurance company is little to none.
There are some reasons why I may encourage ovarian removal for a patient:
- Endometriosis is a female pelvic disease associated with pelvic pain, intestinal cramping, and other less common symptoms. Endometriosis can only be cured with ovarian removal or menopause and can only definitively be diagnosed with visualization of lesions in the pelvis at the time of surgery. If a woman with endometriosis opts to retain her ovaries at the time of hysterectomy, there is approximately a 50-50 chance she will need future surgery to remove her ovaries due to pain, ovarian cysts, or scar tissue. If a woman opts to remove her ovaries in light of endometriosis, there is only a 4% risk of surgery in the future for continued pain.
- Family history of ovarian cancer is a situation in which ovarian removal may increase the life span of certain women. There are certain genetic risk factors that can be determined in families that markedly increase risk for death due to ovarian cancer. In this situation, when a woman has completed childbearing or reached the age of 35 years old, ovarian removal with hysterectomy may be warranted.
- Pain associated with recurrent ovarian cysts may be a reason for some women to desire ovarian removal.
- Premenstrual syndrome may cause significant disability for some women and may warrant ovarian removal with hysterectomy.
- Ovarian tumors if found at the time of surgery, will usually warrant ovarian removal if they cannot be removed off of the ovary.
- Hormonal or menstrual migraines can be treated with ovarian removal. Some tests may be necessary prior to hysterectomy to determine if ovarian removal will assist with migraines.
- Post-menopausal or near menopausal women may desire ovarian removal to markedly reduce the risk of ovarian cancer in the future
If a woman is less than 50 years old and elects to have her ovaries removed, I do highly encourage the use of estrogen/hormones until she is into her mid-fifties. Estrogen replacement in this group of women will decrease risk for heart disease, improve sexual functioning, strengthen bones, help maintain weight control, keep hair and skin younger appearing, and does not appear to increase risk for breast cancer. In studies, a woman who opts to use estrogen after hysterectomy and ovarian removal appear to live longer and do better than women who opt not to use hormones after hysterectomy and ovarian removal in this age group.