Asked by Melissa, St. Louis, Missouri
I have had painful periods for the past couple of years and have also had ovarian cysts. I had a couple of larger cysts removed about five years ago and was told I had endometriosis at that time. I continue to have pain and now have been told I have a 7 cm cyst on the right ovary. My doctor recommends removing both ovaries and the uterus. I'm just researching the pros and cons. Was wondering if there are any major issues I should be concerned about if I had the uterus and both ovaries removed. I am 42 and do not plan to have children. Given the history of pain and previous cysts, is it a good idea to go ahead and remove everything? Thanks for your time. Melissa
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
This is a decision that no one can make except you. Arm yourself with as much information as you can, as you are doing.
You did not say, but being 42, but I suspect you are still menstruating. Most women in North America and Europe reach menopause about the age of 50.
Hysterectomy (removal of the uterus) with bilateral salpingo-oophorectomy (removal of both ovaries and tubes) leads to surgically induced menopause. With menopause, the major concerns or complaints are the symptoms we often hear about, especially hot flashes, night sweats, osteoporosis and vaginal dryness. Women also sometimes complain of decreased libido, mood swings, irritability, fatigue and memory loss. No one can estimate who will have bad menopausal symptoms needing treatment and who will have tolerable ones that do not need treatment.
Many physicians are of the opinion that women who have a surgical menopause oftentimes have more severe symptoms than women who go through a natural menopause. These symptoms can be relieved by estrogen replacement, which can be given by daily pill, a patch or a ring inserted into the vagina. Note that a postmenopausal woman with a uterus who is treated with estrogen should be treated with low-dose estrogen and another hormone, called a progestin. The progestin prevents uterine cancer. A woman who has had a hysterectomy can be treated with low-dose estrogen without progesterone. This is important because the Women's Health Initiative, a study by the National Institutes of Health, showed that women treated with estrogen with progesterone have a dramatically decreased risk of uterine cancer but a slightly increased risk of breast cancer.
Some women treat menopausal hot flashes with black cohosh, found in health food stores, or even with soy products. Occasionally, bad menopausal symptoms are treated with medicines such as venlafaxine (trade name Effexor), which is also commonly used as an antidepressant and anti-anxiety medication.
The osteoporosis can be prevented through weight-bearing exercise such as walking or stair climbing. Diets higher in calcium and vitamin D also appear effective. Some women can just increase calcium intake with milk or calcium carbonate tablets such as Tums. Some women will need treatment or a preventive strategy using bisphosphonates such as pamidronate (Aredia), ibandronate (Boniva), alendronate (Fosamax) or zoledronic acid (Reclast).
Vaginal dryness, if a problem, can be treated with various creams.
If at all possible, this is a question you should discuss with at least two physicians before deciding. Most all insurance will pay for a second opinion. Another treatment to be considered is leuprolide injections, which will cause a temporary medical menopause. And a woman with few risks of vascular disease might consider oral contraceptives as a treatment.
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