Hysterectomy - 5 reasons to hang on to your ovaries

About 600 hysterectomies are performed in the U.S every year and about half or these are accompanied by removal of apparently normal ovaries. The reasoning behind this is that it reduces the occurrence of ovarian cancer, i.e. if your ovaries aren't there, then they can't become cancerous. Ovarian cancer is not common - about 1 in 400 American women will develop ovarian cancer by the age of 50. The main problem with ovarian cancer is that it is usually detected in the late stages when treatment becomes virtually useless. Unfortunately, removing the ovaries before the age of 65 also carries some major health risks. If you're having a hysterectomy for a benign (non-cancerous) condition, here are 5 reasons to keep your ovaries:

1. You will have less chance of developing ovarian cancer. Does that sound confusing? Let me explain. When you have a hysterectomy, the surgeon looks at the ovaries to make sure that they're healthy before the abdomen is closed up. Any abnormal looking ovaries are usually removed at this point. A more likely explanation according to some studies that have been done suggests that:
   • removal of the uterus closes the route through which cancer-causing agents like talc, uterine tissue and the human papilloma virus would have reached the ovaries,
   • destruction of some tissues of the reproductive system cause release of substances which in turn cause the production of antibodies which protect you from developing ovarian cancer.
   This reduced risk of developing ovarian cancer lasts for 10-20 years after the hysterectomy.
2. After menopause, the ovaries continue producing the hormones androstenedione and testosterone until the age of 80. These hormones are converted to estrone, the main form of estrogen found in the body after menopause. Removal of the ovaries even after menopause can cause sudden onset or worsening of menopause symptoms like hot flashes, sleep disturbances and depression.
3. You'll be less likely to have a hip fracture. Estrogens and androgens slow down the rate at which bone is broken down in the body. Removing the postmenopausal ovary removes a major source of androgens which are converted to estrogen. One study has shown that women who had their ovaries removed after menopause had a 54% higher risk of having a fracture due to osteoporosis than postmenopausal women who still had their ovaries.
4. You will have less chance of developing heart disease. The absence of the sex hormones that are produced after menopause further increase your risk of developing heart disease. This could be bad news especially if you have other risk factors for heart disease.
5. Medication may not be the solution.It has been argued that estrogen replacement therapy and other forms of medication can help with some of these conditions like menopausal symptoms and osteoporosis after the ovaries have been removed. These therapies have their own risks and some women go off the medication because of distressing side effects.

With women living longer now (average of 78 years), quality of life becomes very important in any decision you take about your health. I haven't written this to scare you into keeping your ovaries. I think it's important to have a balanced view so that you can make informed decisions. Do some reading, talk to your doctor, ask him/her questions and expect answers in simple language you can understand. At the end of all this, make the decision that best suits your personal circumstances.