Keywords: hysterectomy abdominal vaginal laparoscopic laparoscopy uterus removal ovary ovaries fallopian tube abnormal bleeding menstruation uterine tumor tumors cancer fibroids leiomyomata endometriosis infection cyst cysts adenomyosis prolapse tissue weakness bladder rectum vagina prolapse pelvic surgery gynecology medical emergency menopause estrogen complications morbidity mortality

One of the great controversies in gynecology is whether normal ovaries should be removed at the time of hysterectomy. The main reason to remove normal ovaries is the prevention of ovarian cancer. The probability of developing ovarian cancer in a lifetime is approximately 1 in 70. The disease is almost uniformly fatal except for early stage disease which unfortunate is not common. The main reasons not to remove normal ovaries are that it will cause acute menopause in the pre-menopausal woman and that the ovary, at all stages of a woman life, produces many poorly understood hormones which may help someone feel better and which cannot always be replaced. Most gynecologists would not recommend the routine removal of ovaries in women under the age 40-45 and would recommend their removal after menopause. Removal of healthy ovaries at any age requires an adequate informed consent.

If the ovaries are removed prior to menopause, the woman will go into acute menopause. She will probably require a much higher dose of estrogen replacement than a woman who enters menopause naturally because her body is accustomed to more estrogen. A common error on the part of gynecologists is to start a relatively young woman whose ovaries have been surgically removed on too low a dose of estrogen. Many gynecologists will start estrogen replacement therapy on young women who have had their ovaries removed before they leave the hospital.

Some pre-menopausal women whose ovaries have been surgically removed will not feel "right" even after their estrogen replacement is adequate (as measured by FSH and estradiol blood assays.) Often, small doses of testosterone may be added to the treatment program if she does not feel right within several months after surgery. These are available in many forms including tablets, pellets or topical gels. It may be very important to measure hormone levels (FSH, Estradiol, and Testosterone) occasionally to ensure that the hormone replacement therapy is adequate.

Dr. Andrew Dott  teaches advances hysteroscopic and laparoscopic surgical techniques, is on the speaker's panels for several American pharmaceutical companies and is a professional lecturer.  He is available to travel and give seminars on the topics covered in this website both nationally and internationally.