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Hysterectomy as surgical treatment of endometriosis: ovaries removed or retained HYSTERECTOMY AS SURGICAL TREATMENT OF ENDOMETRIOSIS: OVARIES REMOVED OR RETAINED
The decision whether or not to have your ovaries removed is an extremely complex and difficult one because at the present time there are no clear answers regarding the pros and cons of removing or retaining the ovaries.
Some gynecologists routinely remove the ovaries in women with endometriosis; others base their decision on the extent and severity of the woman's disease and her age, while still others routinely retain them except under special circumstances.
It is extremely important that you find out what your gynecologist intends to do and that you make your decision perfectly clear as to whether you want your ovaries removed or retained.
If you retain your ovaries you will not undergo a premature menopause but there will be a greater likelihood that your endometriosis will persist or recur. Unfortunately, it is not known how often endometriosis persists or recurs following a total hysterectomy: the few statistics in the medical journals range from around 10% to 85%.
Many gynecologists believe that the ovaries should be retained in the majority of cases as they believe that the risk of recurrence is low and the risks of a premature menopause are considerable.
If your ovaries are removed you will undergo a premature menopause and have less likelihood of having a recurrence of endometriosis because it does not recur if you do not produce oestrogen. It is estimated that as few as 3% to 5% of women will have a recurrence if their ovaries are removed. The unusual cases where endometriosis recurs following a radical hysterectomy are usually due to the fact that a piece of an ovary was left behind because the gynecologist either could not see it or could not remove it safely.
Surgical menopause - menopause due to the surgical removal of the ovaries - is usually more severe than the natural menopause because it occurs instantaneously in a younger woman whose hormone levels are higher. The drop in the hormone levels is both dramatic and sudden and many women will experience significant symptoms as a result.
Most women will experience the early symptoms of the menopause soon after their surgery - often within 24 to 48 hours. The most common early symptoms are hot flushes and night sweats. Some women will also experience tiredness and lethargy and sometimes depression, particularly if their hot flushes and night sweats stop them sleeping.
After a couple of months most women will start to experience some of the other effects of menopause. These include a dry vagina, which may cause painful intercourse, a change in sexual response, decreased libido and decreased breast size.
The main long-term effects associated with surgical menopause are a substantially increased likelihood of developing heart disease and osteoporosis later in life.
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