New Study Calls into Question Practice of Removing Ovaries at Time of Hysterectomy
By Christine Cupaiuolo — April 21, 2009
For many years, women who underwent hysterectomies also routinely had their ovaries removed, in order to prevent them from developing ovarian cancer in the future. A new study that will appear in the May 2009 issue of Obstetrics and Gynecology calls this practice into question.
The study, “Ovarian Conservation at the Time of Hysterectomy and Long-Term Health Outcomes in the Nurses’ Health Study,” examines the long-term survival rates of women of women who have had hysterectomies (removal of the uterus) because of non-cancerous reproductive disease. It compares the medical outcomes of women who had their uterus and ovaries removed with women who had only their uterus removed. The study used the database from the Nurses’ Health Study, which included 122,700 registered nurses in 1976 when it began.
The study found that women who had their ovaries removed had a higher risk of death from any cause, primarily from heart disease and lung cancer. Removing the ovaries at any age did not improve life-span for this group of women.
One of the studies lead authors, William Parker, MD, a clinical professor at the UCLA School of Medicine, has written a summary of the study and its findings that was published at Our Bodies Ourselves:
Women often have their healthy ovaries removed when they are having a hysterectomy in order to prevent ovarian cancer from developing in the future. About 50% of women who have a hysterectomy between ages 40-44 have their ovaries removed, and 78% of women between ages 45-64 undergoing a hysterectomy have their ovaries removed. All together, about 300,000 American women have their healthy ovaries removed every year.
If the ovaries are removed before menopause, a sudden decrease in the hormones made by the ovaries, including estrogen, testosterone and androstenedione, results. Even after a woman enters menopause, her ovaries continue to make considerable amounts of testosterone and androstenedione, which are then changed into estrogen by other cells in the body.
Some studies had already show that women who keep their ovaries have a lower risk of heart disease. While ovarian cancer accounts for 14,700 deaths per year in the U.S., heart disease causes 326,900 deaths, and stroke causes 86,900 deaths each year. If a woman is not at high risk for ovarian cancer, then keeping the ovaries might benefit her overall health and survival.
We designed a study to see whether it was better for women who needed a hysterectomy to keep their ovaries or have them removed during the surgery to remove the uterus.
At this point in my life, the entire subjects of hysterectomy and gynecologists enrage me. I recently went through an absolute nightmare that almost ruined my life and my health.
Last September, I had a routine physical. The physician’s assistant told me that my uterus felt “hard.” She suggested I see a OB/GYN. I put this off for quite a while. My trust in OB/GYNs is not overwhelming. Let’s put it this way: during my last delivery, my OB opted to stay in his office almost 30 miles from the hospital, seeing other patients rather than coming to see me. It was a Tuesday morning when I went into labor, so it wasn’t like he was home in bed or spending time with his family. He just couldn’t be bothered. Instead, he sent over an OB whom I had never even seen before in my life. When my baby began suffering distress, it was this stranger who took “care” of us. I had been administered an epidural, yet he didnt’ do a C-section. He had me push the baby out without the help of contractions. I don’t even think I was fully dilated. I did push my son out, purely with my own will. Of course, this caused considerable damage to my anatomy. Two weeks after giving birth, I had become extremely concerned. I could feel something solid and strange just inside my vagina. With a mirror, I could see it. I went to see my “doctor.” Of course, he didn’t bother seeing me; I saw a nurse practitioner. She told me she “didn’t see anything.” I was sent home without treatment. I didn’t bother returning for the six-wk check-up. They didn’t seem interested in listening or taking care of me, anyway. Ever since, I have had almost no bladder control.
Anyway, about a month after the PA told me I should see a GYN, I finally gave in. I had been bleeding every two weeks for two months. Now, this might have been because I took a dose of Plan B emergency contraceptives. However, I also had the bladder-control issue, as well as a number of problems I had endured for my entire sexually-active life (from the age of 14 to my current age of 37). I knew I needed a pap test, as well.
I tried to see my old OB/GYN, even though I didn’t trust him. I made an appointment after explaining that I hadn’t seen him in over 8 years. I showed up about 7-8 minutes before the appointed time. I signed in, and was waved off by the receptionists when I told them that this would be my first visit in 8 years. I sat for 25 minutes in the waiting room until the receptionist called me up and began berating me. She said I was late, because I should have been there 15 minutes before the scheduled appointment to fill out paperwork. Now, no one had ever mentioned this to me. What’s more, I had been sitting for nearly half-hour. Why the hell was I not given this vital paperwork to fill out over that period? She told me I would not be seen that day; I would have to reschedule. I told her she was a bitch and could shove it.
So, not knowing how to find a reliable GYN, I just chose one that was listed on my insurance website. I made an appointment and went to see him. I explained all my symptoms, stressing that most of them were decades old. He did a pelvic exam, during which he roughly shoved a finger in my rectum (which had NEVER been part of any pelvic exam I’d ever had before). After the pelvic, he left so I could dress. He returned and told me I had fibroid tumors. I either had to take drugs to induce menopause or have a complete abdominal hysterectomy, he told me. I stupidly trusted him. About a month later, I returned on a Friday afternoon to schedule the surgery. He told me about the risks of the actual surgery. He said nothing about what might happen afterwards.
I went home and began to think about it. I started getting scared. I turned to the Internet. I was especially concerned about sex after such a surgery. I learned a number of things that this quack had never mentioned. I was horrified and terrified. One woman wrote that her vagina was left so short and narrow that it took two years before her husband could fully penetrate her. In the meantime, she endured pain while they tried to have normal sex. I was reminded of the role of the uterus in female orgasm. I knew that the cervix was involved, but had forgotten the the rest of the womb was, as well. After reading about uterine contractions during orgasm, it made sense: THAT was what I felt that made orgasm with my husband so much more pleasurable than orgasm from masturbation.
I learned that the ovaries were not the only organs that released female hormones; the uterus had a role in that, too. I learned that many women found that their ovaries died within two years of a hysterectomy, leaving them in very early menopause. If this happened to me, I’d be in menopause before the age of 40.
It wasn’t just the risks and lifestyle changes, though. I also learned that this hateful butcher had hidden other treatments for fibroids, treatments that were FAR less drastic than a total hysterectomy. One was UAE.
I called the doctor on Monday and told him that I had learned about UAE and wanted to pursue it. He knew exactly to whom I should be referred, proving that he had known all along and chosen to hide the info from me. He sent me to an interventional radiologist at the University of Arizona’s University Medical Center. The IR was shocked that I had been given a diagnosis without so much as an ultrasound. He ordered an MRI.
I was scheduled for an MRI the next week. Meanwhile, I did more research. This time, I learned about yet another treatment: myomectomy. This required only the removal of the actual tumors. I had wondered the entire time why the tumors couldn’t be removed; why did my entire uterus have to go? (I’ve begun to think there are two answers to this: it makes the GYN a huge amount of money, and most GYNs don’t value the female organs once childbearing is no longer of interest to the woman.) Worse, I learned that there were two doctors in the SAME PRACTICE as my quack who performed myomectomies using robotics (the da Vinci method) and both were professors at the U! So, yet another procedure he HAD to have known about, yet concealed from me. I made an appointment with one of these doctors.
That afternoon, I got a call from the doctor’s office. I was asleep, so I missed the call. It was Easter weekend, so I had other things on my mind. I wasn’t going to see this no-good SOB again, anyway, so I didn’t feel.he need to talk to him. The following Monday, his nurse called. She asked if he would be doing my surgery. I told her I was NOT having surgery and he would NOT EVER be touching me again. I told her exactly why, as well. She was pleasant about it. She went on to say that the MRI results had revealed that my problem was not uterine fibroids, after all. Instead, I had ovarian cysts, a far less serious condition. So, this piece of trash was going to hack out my uterus WITHOUT ANY TESTING TO VERIFY HIS DIAGNOSIS, and he would have left me mutilated but with the problem still in my body. This made me even more angry, and I told her so. He had her try to call back that afternoon. Again, I was asleep. I had nothing to say to him or his staff, anyway. As far as I’m concerned, that piece of crap shouldn’t have a medical license. Who knows how many women he’s violated and mutilated?
During my research, I learned that at least 76% of hysterectomies in the U.S. are done unnecessarily. I’m not sure how many of them meet my level of “unnecessarily,” but it’s still an astonishing number. OB/GYNs think they can control women’s bodies. When we are done having kids, they see no problem in hacking out our organs, even destroying our ability to have and enjoy sex. Can you imagine them doing the same to a man? I can’t believe that a single doctor would tell a man he was going to remove his testicles and half his penis due to some disease the doctor hadn’t tested for. They certainly wouldn’t hide the significant post-surgery risks to his life and lifestyle. They would tell him the effects on his sex life. They would tell him, “Sex may be painful or impossible. Even if you can have it, you may never have an orgasm again, or it may be considerably less pleasurable if you can have one.”
As I perused one hysterectomy site after another, I read the “advice” given to women. They were told to slather on the bottled lube so their husbands could penetrate them. Okay. That may make sex possible. It may make it comfortable. I can’t imagine that it would make it pleasurable. Women naturally lubricate because they are turned on, because they WANT it. The “advisors” simply told them how to be of service to men. I guess it was too late to warn them that they were likely giving up their own pleasure for all time.
In short, NEVER trust an OB/GYN. Don’t even go on a “second opinion.” Get at least a dozen, from different specialties. Talk to others with the same issues to get recommendations. And never let some SOB mutilate you simply because you don’t want any more kids.