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Should I have my ovaries removed when I have a hysterectomy?

Your Information

Your choices are:

Have your uterus removed, but keep your ovaries (hysterectomy only).
Have both your uterus and your ovaries removed (hysterectomy with oophorectomy).
The decision whether to have your ovaries removed when you have a hysterectomy takes into account your personal feelings and the medical facts.

Hysterectomy

Topic Overview
From Healthwise
What is a hysterectomy?

A hysterectomy is surgery to take out a woman’s uterus, the organ in a woman’s belly where a baby grows during pregnancy. After a hysterectomy, you will not be able to get pregnant.

Other organs might also be removed if you have severe problems such as endometriosis or cancer. These organs include the cervix (the lower part of the uterus that opens into the vagina), the ovaries (glands on both sides of the uterus that release eggs for pregnancy), and the fallopian tubes (the passageway between the uterus and the ovaries).

Whether or not the ovaries are removed will depend on your age and risk for certain types of cancer. For example, removing the ovaries lowers the risk of ovarian cancer and some types of breast cancer. But, if you have your ovaries removed before the age of menopause, you will go into early menopause, and you may be more likely to get heart disease or osteoporosis. Be sure to discuss all the benefits and risks of removing your ovaries with your doctor.

See an illustration of the female reproductive system.

What problems does this surgery treat?
Most often, hysterectomy is done to treat problems with the uterus, such as pain and heavy bleeding caused by endometriosis or fibroid tumors. The surgery may also be needed if there is cancer in the uterus, cervix, or ovaries. Some women may have the surgery during childbirth to save their lives if there is heavy bleeding that cannot be stopped.

Before you choose to have a hysterectomy, consider all of your treatment options. In many cases, this surgery is a last resort after trying other treatments for the problem.

How is the surgery done?
There are many different ways to do hysterectomy surgery. The type of surgery you have depends on three main things: the reason for the surgery, the size of the uterus and its position in the belly, and your overall health. The most common types are:

Abdominal hysterectomy. In this type, the doctor makes a cut in the belly, either across the bikini line or straight up and down. The doctor takes out the uterus and the cervix. This type is most often done when cancer might be present or when severe endometriosis, a lot of scar tissue (adhesions), or a very large uterus makes the uterus hard to remove.
Vaginal hysterectomy. With this type, the doctor takes out the uterus through the vagina. He or she makes a small cut in the vagina instead of the belly. Your doctor will not use this method when there is a chance that cancer may be in the uterus, cervix, or ovaries. Doctors use this type of surgery only in cases where the uterus is small and easy to remove.
Laparoscopically assisted vaginal hysterectomy (LAVH). To do this surgery, the doctor puts a lighted tube (laparoscope) through small cuts in your belly. The doctor can see your organs with the scope and can insert surgical tools to cut the tissue that holds your uterus in place. Then he or she can remove the uterus through your vagina.
Laparoscopic supracervical hysterectomy (LSH). With LSH, the doctor inserts the scope and tools through small cuts in your belly. He or she takes out the uterus in small pieces and leaves the cervix in place. This surgery is done only if you don’t have cervical cancer.1,
Total laparoscopic hysterectomy (TLH). In this type, the doctor inserts a scope and tools through several small cuts in the belly. The doctor takes out the uterus and the cervix in small pieces through one of the cuts.
How long will it take to recover from surgery?
Feeling better after surgery takes time. Most women are in the hospital 1 or 2 days after the surgery. Some women stay in the hospital up to 4 days.

When you get home, make sure you move around, but also be sure you don’t do too much. You can walk around the house and up and down stairs, but take it slow. During the first 2 weeks, it’s important to get plenty of rest. Even after you start to feel stronger, you should not lift heavy things (anything over 20 pounds). Also, you should not have sex until your doctor says it’s okay. It usually takes 4 to 8 weeks to get back to a normal routine.

Satisfaction After Fibroid Embolization Similar to Hysterectomy

WEDNESDAY, Feb. 27 (HealthDay News) — Women with fibroids face a myriad of choices for treatment, each with its own benefits and drawbacks, which can make it difficult to choose the right procedure.

Now, a new study helps define the choice between at least two options — uterine artery embolization (UAE) and hysterectomy. After two years of follow-up, the study, published in the March issue of Radiology, found that women who had UAE reported an equal quality of life compared to women who’d had a hysterectomy.

“Both UAE and hysterectomy improved health-related quality of life,” wrote the Dutch researchers, who added that they believe UAE is a good alternative to hysterectomy.

“UAE does offer a decreased hospital stay, quicker recovery and less morbidity,” added Dr. William Romano, an interventional radiologist at Beaumont Hospital in Royal Oak, Mich.

As many as one in four women have fibroids that cause symptoms, such as heavy menstrual bleeding, pelvic pain and reproductive problems, according to the National Institute of Child Health and Human Development.

Common treatment options include hysterectomy, myomectomy (surgical removal of individual fibroids), UAE, and endometrial ablation, a procedure in which the endometrial lining of the uterus is destroyed. In UAE, two catheters are placed in the uterine arteries, and small particles are injected that block the flow of blood supply to the fibroids. Women who wish to retain their fertility cannot choose hysterectomy, UAE or endometrial ablation.

For the study, 177 women with fibroids and troubling symptoms who had originally planned to have hysterectomies agreed to participate in a randomized trial comparing UAE to hysterectomy.

The researchers then followed the women’s health for two years and assessed health-related quality of life at six different times. Twenty percent of the women in the UAE group went on to have hysterectomy, which offers a permanent end to symptoms, because the uterus is removed.

Six weeks after treatment, people in the UAE group had higher satisfaction scores for physical function than those who underwent hysterectomy.

Quality-of-life scores improved significantly for people in both groups six months after treatment. The only difference at six months was in a measure called the defecation distress inventory that related to bowel symptoms, and these scores improved in the first six months for the UAE group but not for the hysterectomy group.

After two years, more than 90 percent of the women in each group reported being satisfied with their treatment, according to the study.

“UAE is an excellent addition to women’s options,” said Dr. Erika Banks, director of the Fibroid Center at Montefiore Medical Center in New York City. However, she added that 24 months is the longest follow-up available on UAE, and the procedure can cause premature ovarian failure and hasten menopause.

“There are many options, and women with fibroids should see a gynecologist who specializes in all of the options and who works with a radiologist. Not every single option is right for every woman. With your doctor, weigh the risks and benefits of each option, considering your own situation,” Banks advised.

“Fibroids significantly impact on women’s mental and physical health, and any treatment can improve their overall outlook. In this study, patients with fibroids had a significant improvement in quality of life with either treatment. Having a choice and the proper knowledge to make the decision can lead to a better outcome overall,” Romano said.