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Should Ovaries Be Removed After Menopause

Risks Of Unintended Procedure

Are Ovaries Removed During a Hysterectomy?

Any surgical procedure has risks. In an analysis of the National Inpatient Sample of all hysterectomies performed for benign indications between 1979 and 2004, women who underwent EO at the time of hysterectomy had an increased risk of organ injury , circulatory or bleeding complications, , and postoperative gastrointestinal complications compared with women undergoing hysterectomy alone. In sum, the benefits of EO at the time of hysterectomy in women with average risk of ovarian cancer may not outweigh the increased risks of cardiac mortality, hip fracture, cognitive impairment, and loss of sexual function. Therefore, women may elect for ovarian conservation at the time of hysterectomy at any age.

Do Postmenopausal Ovarian Cysts Go Away

Most ovarian cysts last a few weeks to a month. Others, however, can last for years. A postmenopausal ovarian cyst may remain undetected for years without any problems. Historically, doctors would recommend postmenopausal women to remove ovarian cysts to prevent any cancer threat if theyre found. Recently, however, studies show that a watchful waiting approach might be a less invasive approach. Allowing a cyst to remain if its not cancerous or isnt causing problems avoids unnecessary adverse effects from surgery.

Should Ovarian Cysts Be Removed After Menopause

Historically, doctors would recommend that postmenopausal women have their ovarian cysts removed when they were discovered to prevent any threat of cancer. However, recent studies suggest that the watchful waiting approach may be a less invasive way to go. Thus, if the cyst is not cancerous or causing problems, allowing it to remain in place may avoid the unnecessary adverse effects of surgery.

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Should You Worry About It

Often times abdominal pain does not indicate a serious condition. Since your ovaries are in the abdominal region, the pain could be coming from something else. Keep in mind that gastrointestinal ailments such as food poisoning, a stomach virus, or irritable bowel syndrome can cause abdominal pain and cramping. They can even pop up after eating certain foods or when under stress.

If you are still in the perimenopausal stage, treat cramps as you would during any period while they taper off. Over-the-counter pain meds such as ibuprofen or acetaminophen can help. A heating pad or hot water bottle can soothe discomfort. Sometimes walking or other exercises can relieve discomfort along with easing stress which can make cramps worse.

Keep in mind that taking estrogen to ease menopausal symptoms and a family history of ovarian or uterine cancer are risk factors for you. Other things to consider are getting your period before age 12, cessation of periods after age 52, and the use of an IUD for birth control. Discuss any of these risk factors with your doctor.

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Getting Over Preconceived Notions About Menopause

Hysterectomy &  Surgical Menopause

The approach of this incredible inner upheaval is occasionally fretting. Right here is some details to set the record directly.

The earlier you have your period, the earlier you experience menopauseWrong. There is no link between the age of very first menstruation and the age at which it quits. Nor is there a link between the age of menopause and also the age of taking the birth control pill . Menopause takes place when the supply of eggs, developed before birth, is practically tired. But out of the initial supply of several million follicles, only 500 are launched during ovulation throughout life. The remainder, 99.9% of the ovarian reserve, dies normally by apoptosis, or set cell death. Removal Of Ovaries After Menopause

The ordinary age of menopause does not transform despite the aging of the populace.True. The average age of menopause is 51, an age that does not differ. When menopause occurs prior to the age of 40, it is called premature ovarian failure. It is after that essential to seek a possible hereditary reason connected to an X chromosome problem. It is imperative to compensate for the hormonal agent deficiency in estrogens by taking hormonal agent substitute therapy until the typical age of menopause. Otherwise, the threat of death from heart disease is much more considerable. Removal Of Ovaries After Menopause

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What Are The Types Of Hormone Therapy

There are two main types of hormone therapy :

  • Estrogen Therapy: Estrogen is taken alone. Doctors most often prescribe a low dose of estrogen to be taken as a pill or patch every day. Estrogen may also be prescribed as a cream, vaginal ring, gel or spray. You should take the lowest dose of estrogen needed to relieve menopause symptoms and/or to prevent osteoporosis.
  • Estrogen Progesterone/Progestin Hormone Therapy : Also called combination therapy, this form of HT combines doses of estrogen and progesterone .

Removal Of The Ovaries

The National Institute for Health and Care Excellence recommends that a woman’s ovaries should only be removed if there’s a significant risk of associated disease, such as ovarian cancer.

If you have a family history of ovarian or breast cancer, removing your ovaries may be recommended to prevent you getting cancer in the future.

Your surgeon can discuss the pros and cons of removing your ovaries with you. If your ovaries are removed, your fallopian tubes will also be removed.

If you have already gone through the menopause or you’re close to it, removing your ovaries may be recommended regardless of the reason for having a hysterectomy.

This is to protect against the possibility of ovarian cancer developing.

Some surgeons feel it’s best to leave healthy ovaries in place if the risk of ovarian cancer is small for example, if there’s no family history of the condition.

This is because the ovaries produce several female hormones that can help protect against health problems such as weak bones . They also play a part in feelings of sexual desire and pleasure.

If you’d prefer to keep your ovaries, make sure you have made this clear to your surgeon before your operation.

You may still be asked to give consent to treatment for having your ovaries removed if an abnormality is found during the operation.

Think carefully about this and discuss any fears or concerns you have with your surgeon.

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Why Do Women Have Hysterectomies

Hysterectomies are most often done for the following reasons:

  • Uterine fibroids common, benign tumors that grow in the muscle of the uterus. More hysterectomies are done because of fibroids than any other problem of the uterus. Sometimes fibroids cause heavy bleeding or pain.
  • Endometriosis another benign condition that affects the uterus. It is the second leading reason for hysterectomies. It occurs when endometrial tissue begins to grow on the outside of the uterus and on nearby organs. This condition may cause painful menstrual periods, abnormal vaginal bleeding and loss of fertility.
  • Uterine prolapse a benign condition in which the uterus moves from its usual place down into the vagina. Uterine prolapse is due to weak and stretched pelvic ligaments and tissues, and can lead to urinary problems, pelvic pressure or difficulty with bowl movements. Childbirth, obesity and loss of estrogen after menopause may contribute to this problem.
  • Cancer the reason for about 10 percent of all hysterectomies. Endometrial cancer, uterine sarcoma, cervical cancer, and cancer of the ovaries or fallopian tubes often require hysterectomy. Depending on the type and extent of cancer, other kinds of treatment such as radiation or hormonal therapy may be used as well.
  • Hyperplasia thought to come from too much estrogen and occurs when the lining of the uterus becomes too thick and causes abnormal bleeding.

Reducing The Risk Of Ovarian Cancer In Women At Increased Risk

Postmenopausal Ovarian Cysts

Family history may confer a significant increased risk of epithelial ovarian cancer . When family history of ovarian and/or breast and bowel cancer suggests a significant risk of carrying a genetic mutation, patients should be referred to a Clinical Genetic Service for assessment and confirmation of their risk status and discussion of screening for specific gene mutations. Management of women known to be gene mutations carriers includes counselling, surveillance and consideration of risk-reducing surgery including prophylactic mastectomy, hysterectomy and/or BSO depending on the gene mutation identified. Advances in diagnostic genetic techniques mean that increasing numbers of women are being identified as being at increased risk for ovarian cancer due to gene mutations. Two types of ovarian cancer susceptibility genes have been identified: the BRCA1 and 2 and the mismatch repair genes associated with HNPCC. Carriers of germ-line mutations in the BRCA1 gene carry a lifetime risk ovarian cancer of 3646% and 1027% in those carrying the BRCA2 gene mutation . The HNPCC mutation confers 912% increased risk of ovarian cancer and an increased risk for endometrial cancer up to 40% .

Proposed flow diagram to guide clinical decision-making regarding bilateral oophorectomy at the time of hysterectomy for benign disease. *BRCA1/2 or HNPCC gene mutation or strong family history.

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Causes Of Uterine Fibroids Appearance

Currently, scientists are forced to admit defeat the causes of myomatous nodes are unknown. There are two main theories, but none of them has strong evidence:

  • Embryonic theory suggests that abnormalities occur during fetal development. The smooth muscle cells of the uterus of the embryo do not finish their development for a long time, until the 38th week of pregnancy, and are in an unstable state , due to which there is a higher risk occurrence of defects in them.
  • Based on the traumatic theory, a defect in the cells of the myometrium occurs due to repeatedly repeated menstrual cycles, inflammatory processes, abortions, curettage of the uterus, the inaccurate performance of obstetric manual methods during childbirth, and a small number of pregnancies.

The uterine fibroids after menopause nods always arise from a single cell. Due to damage, this cell begins to divide and forms a node.

Uterine fibroids are a disease that no woman is safe. Since the causes of the occurrence are unknown, effective methods of prevention do not exist, except for regular visits to the gynecologist twice a year. The doctor may pay attention to nonspecific signs and schedule an examination.

What You Need To Know About Surgical Menopause

This is part of an ongoing series featuring interviews with physicians on topics related to hereditary cancer. This is a summary of a discussion with Ann L. Steiner, MD, anobstetrician-gynecologist and clinical professor at Penn Medicine. The Symptoms of Surgical MenopauseMenopause is the absence of estrogen. When women stop making estrogen, this can result in several key symptoms. On average, natural menopause occurs around 51 years of age, when periods cease. Menopausal symptoms may begin before the final menstrual period when the loss of estrogen begins gradually. But if a 35 year old woman with regular, monthly periods has her ovaries removed, she is likely to be much more symptomatic then if she had gradually gone into menopause.

Surgical menopause can affect hot flashes and mood, and can increase the rate at which a woman loses bone and may develop osteoporosis. Theres a concern that younger women who go into menopause might be at an increased risk of heart disease later in life. It could also affect cognitive function. If women dont have a history of a cancer that would contraindicate the use of estrogen, such as breast cancer, we discuss giving estrogen, both for symptoms and for potential prevention of these problems.

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How Long Does It Take To Recover From A Hysterectomy

The length of your hospital stay and recovery will depend on the type of hysterectomy you had abdominal, vaginal or laparoscopic. Most women stay in the hospital for one to two days, though some may stay up to four days. It takes longer to recover from an abdominal hysterectomy, with complete recovery usually taking four to eight weeks. Most women can return to normal activity in one to two weeks following a vaginal or laparoscopic hysterectomy.

Symptoms Of Ovarian Cysts After Menopause

Hysterectomy

Though ovarian cysts dont always cause symptoms and can disappear on their own, there are some symptoms that may indicate their presence.

The most common symptoms of ovarian cysts after menopause, especially those large in size, include:

  • Pain in the lower abdomen or pelvis
  • Bloating or heaviness of the abdomen

Other symptoms that might indicate a ruptured cysts and call for an immediate medical attention include:

  • Pain with nausea and vomiting
  • Fever, weakness, and dizziness
  • Rapid breathing

Although ovarian cysts are usually benign, visit your doctor regularly to get symptoms checked out, especially in postmenopause.

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Confirming That The Menopause Has Taken Place

Its not always easy to confirm that the menopause has actually happened. Of course, irregular periods and the occasional hot flush are a sign that changes are taking place, but identifying the time of the actual menopause is not so simple, especially if you are taking the Pill or have started Hormone Replacement Therapy for the relief of peri-menopausal symptoms.

The question may seem irrelevant, but it is helpful to know the date of your last period, not only so that you can respond to symptoms in the most appropriate way, but also for contraceptive purposes. A truly menopausal woman will be infertile and will have no need of contraception. However, most doctors advise menopausal women under 50 to continue with their contraception for two years after their last period and for one year if they are over 50.

Most doctors will evaluate a womans menopausal status according to her symptoms , pattern of periods, and medical record. It is possible to take a blood test to measure levels of a reproductive hormone known as FSH. However, while elevated FSH levels may be a sign of the menopause, the test is not always accurate and results cant be guaranteed. Measurement of FSH is not required to diagnose perimenopause or menopause in women aged over 45 years.

This is also the case in those rare instances of premature ovarian Insufficiency, when the hormonal system fails at an early age and the ovaries lose their normal function.

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Putting The Risks And Benefits Of Hrt In Perspective

If you’re just glancing at list above, some of the risks of HRT might seem to overwhelm the benefits. Could a reduction in vaginal dryness possibly be worth an increased risk of cancer?

But look at the details. The risks of HRT — while real — are quite small for an individual person. For example, the 2002 Women’s Health Initiative study found that ERT increased the risk of strokes by 39%. That sounds frighteningly high. But the actual number of people affected is very small. Out of 10,000 women who are not taking ERT, 32 have strokes each year. Out of 10,000 who are taking ERT, 44 have strokes each year. That’s an increase of just 12 people out of 10,000.

On the other hand, when it comes to controlling the symptoms of surgical menopause, a huge number of women feel the benefits. One out of four menopausal women has severe hot flashes. Treatment with hormone therapy cuts down the number of hot flashes per week by 75%. So if a woman had 24 hot flashes per week, HRT would drop that number to six. That could make a big difference in the quality of their day-to-day life.

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Avoidance Of Further Gynaecological Surgical Interventions Related To Retained Ovaries

Prophylactic removal of healthy ovaries at the time of hysterectomy for benign conditions may be performed to avoid the potential development of subsequent benign ovarian pathology such as cysts, hydrosalpinx or entrapment/adhesions, which may be symptomatic and require surgical intervention. Although ovarian cysts visible on ultrasound are relatively common following hysterectomy, affecting up to 50% , relatively few women require subsequent surgery for adnexal pathology . Retrospective studies suggest that the risk of further surgery is greater in those who have abdominal compared with vaginal hysterectomy with ovarian retention . This is likely to reflect the original indication for surgery rather than the procedure itself. Recent ACOG guidelines advise that women with endometriosis, pelvic inflammatory disease and chronic pelvic pain are at higher risk of reoperation therefore, the risk of subsequent ovarian surgery if the ovaries are retained should be weighed against the benefit of ovarian retention in these patients .

If My Cervix Was Removed In My Hysterectomy Do I Still Need To Have Pap Tests

Oophorectomy – HysterSisters Ask the Doctor

If you have had a total hysterectomy in which the cervix was removed along with the uterus, you will not usually require Pap testing. An exception is if your hysterectomy was done because of cervical cancer or its precursors. Ask your health care provider if you need to have periodic Pap tests. It is important for all women who have had a hysterectomy to have regular gynecologic exams as part of their health care.

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What Is A Hysterectomy

Hysterectomy is surgical removal of the uterus and sometimes the cervix and supporting tissues. It is the most common non-pregnancy-related major surgery performed on women in the United States, with one in three women having a hysterectomy by age 60. If you have not reached menopause, a hysterectomy will stop your monthly bleeding . You also will not be able to get pregnant. If the ovaries are removed in a woman before she reaches menopause, the loss of female hormones will cause her to suddenly enter menopause .

You Can Keep Your Ovaries Even If You Don’t Have A Uterus

Should you need your uterus removed due to concerns like fibroids or endometriosis, your ovaries can definitely stay put. In fact, considering the risks of losing your estrogen, you probably want them to stay. Yes, Siedhoff says, a hysterectomy is a natural time to bring up ovary removal, and the two were frequently done simultaneously in premenopausal women in years past. “Now most women elect to keep their healthy ovaries for the benefit of the hormones,” he says.

However, if you do have a hysterectomy, you need to monitor those hormone levels afterward, Sarrel says. He published a study that found 6 months after surgery, 25% of women’s ovaries had stopped functioning due to lack of blood flow. Three years after surgery, that was the case among 40% of the women. The other 60% were totally fine, he says. “You can assume ovaries are going to continue to function, but we need to make sure they are producing regular amounts of estrogen,” he says. A surefire sign that they’re not, he says, would be the beginnings of menopause-related symptoms like hot flashes, sleep problems, and feeling depressed. “All you need to do is replace estrogen, and that’s the end of the symptoms.”

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