There are reasonable considerations for keeping your ovaries when a hysterectomy is indicated. This is certainly true prior to age 45 and in some cases even after. This may not be possible when the ovaries are diseased, or if there are conditions such as extensive endometriosis, or a malignancy of pelvic organs.
The rationale for keeping the ovaries is that they may to continue to produce estradiol, the naturally occurring female hormone until the age a natural menopause would have occurred. This is usually thought of as being between the ages of 48-52.
In addition, following a natural menopause even if the ovaries no longer produce significant amounts of estrogen, they are capable of producing significant amounts of testosterone, the hormone most closely associated with sex drive, energy levels and maintenance of lean body tissue. When present, some of the testosterone may also be converted to estrogen in tissues of the body, by a process called aromatization. While the levels that result are small, they are nonetheless significant, and at least in a hypothetical sense provide some benefit.
Accordingly, it makes sense to keep your ovaries if possible as it may preclude the need for HRT at least until the time of your expected menopause.
"I had a hysterectomy and kept my ovaries. I have menopausal symptoms, hot flashes, fatigue and no sex drive. I went to my Dr and he says I don’t need HRT, because I still have my ovaries. Can this be true?"
Hypothetically, if you’re premenopausal and still have your ovaries following a hysterectomy, one would expect continued production of ovarian sex hormones. Unfortunately, it has been well documented that this is often not the case. A number of medical studies have documented that ovarian failure occurs frequently in retained ovaries following a hysterectomy.
This frequently presents a dilemma for the woman who is of premenopausal age, has had a hysterectomy, still has her ovaries and has menopausal symptoms.
- First, as she still has her ovaries and expects them to produce adequate amounts of hormone; are the symptoms related to declining hormone levels or do they represent another health-related problem?
- Second, if she realizes that the symptoms are menopausal and she goes to her physician for help, she may be told that since she still has ovaries that this is not possible. I receive frequent e-mail from symptomatic women whose physicians fail to recognize that ovarian dysfunction is the problem and refuse to provide HRT.
- Third, even if the cause of the symptoms is recognized as being related to declining hormone levels, the possibility exists that the more routinely prescribed regimens of HRT will not relieve the symptoms.
"So, what do I do about this?"
The first strategy is to make reasonably certain that the symptoms are related to ovarian failure. Symptoms such as hot flashes, sweats and vaginal dryness are usually related to lowered estrogen levels. Hyperthyroidism, a condition of an excess of thyroid hormone will cause feelings of warmth and sweats can be tested for and excluded as a cause of the symptoms. A diminished libido is associated with ovarian failure, but can be related to other health problems, relationship issues or situational factors. Symptoms of irritability, or fatigue can be of menopausal origin, or related to other factors as well.
"What if I’m sure that the symptoms are menopausal?"
It may be possible to document that ovarian failure has occurred by having your Dr perform blood tests. If the levels of estradiol and testosterone are low and the FSH, (Follicle Stimulating Hormone), are elevated there is little question that ovarian failure has occurred. FSH, is the hormone secreted by the pituitary gland that signals the ovary to make more estrogen. If the ovary is failing in its ability to do this, the pituitary produces higher levels of FSH in an effort to "whip" the ovary into producing adequate levels of estrogen.
Unfortunately, this strategy although useful is not perfect. If the ovaries are "struggling" to produce adequate hormones levels, the test results may be in the normal range and symptoms may still be present.
"Okay, then what do I do?"
If the blood tests are normal and the symptoms are suggestive of being of menopausal origin, a trial of HRT is indicated if desired. If the symptoms resolve, you have the answer.
"What if the hormones don’t relieve the symptoms?"
There are 2 possibilities.
Either a more effective program of HRT is indicated, or the symptoms are not of menopausal origin.
"How do I find a more effective HRT program?"
See the section of the web page; What do I do when my hormones don’t work? (Coming soon.)
"What do I do if my doctor tells me that I don’t need hormones because I still have my ovaries and refuses to even provide a trial of therapy?"
You will need to emphasize that you are fully aware that ovarian failure can and does occur in retained ovaries following a hysterectomy and that he/she needs to read the readily available literature that documents this phenomenon.
If it is your desire, you need to insist that you be provided with a reasonable program of HRT.
The alternative is to find a physician who is more knowledgeable regarding these issues.
Dr Nosanchuk is currently in practice in Southeastern Michigan and is accepting new patients. His office is located in Bingham Farms, Michigan, a suburb of the Detroit Metropolitan Area. Dr N specializes in the care and treatment of menopausal women and has a special interest providing treatment to women whose lives have been altered by their menopause, hysterectomy, or both.
To make a doctor appointment, contact Sherri at
1-248-644-7200 from 10AM - 6PM M-F EST.
This web site is for educational purposes only. It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician/patient relationship.
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