Ask an Expert: Ovarian cancer risk

Gynecology

Ovarian cancer risk
09/06/2006

Question:

I am 45 and am soon to have a hysterectomy due to fibroid tumors and problems related to them. They are benign and there is no sign of cancer but during my surgery consult my doctor suggested I consider also having my ovaries removed. He was not trying to convince me to do it but gave me a number of things to think about such as not ever having to worry about ovarian cancer and since I am 45 I would be going into menopause sometime in the next 5 years and I could get that over with now. But my family has never had cancer of any kind and I am having such conflicting conversations with friends and family from one end of the spectrum to the other.

My mom and sister get big eyed and frightened when I tell them I am considering the removal and are emphatic that I need my ovaries even when I do go into menopause. I`m not looking for someone to tell me what to do but I am confused at this point. Will going into menopause now be a shock to my system? Are my ovaries needed for anything at this time in my life?

I do trust my doctor but I have to say, I have known women in menopause who are down right crazy and my thought is, if it is so bad do I want to risk ovarian cancer and not do the menopause thing right away...

Answer:

You pose a very common and important question. You will likely enter menopause at 50-51 y/o. After menopause, the ovaries stop making estrogen which leads to the common symptoms of hot flashes and vaginal dryness. The ovary continues to make some other hormones, but we don't fully understand their importance or whether or not a woman has any symptoms once they are no longer made after removing the ovary. Your menopausal symptoms will be more abrupt if the ovaries are removed now rather than the gradual decline of menopause. Estrogen therapy can be given back from now until you would have normally gone through menopause. This poses little risk over natural menopause.
The risk of ovarian cancer after hysterectomy where the ovaries are left behind is much less than a woman who has never had pelvic surgery. This is because once they are seen and found to be normal, they are less to become abnormal in the future. There is the risk of a benign tumor, pain or scarring requiring future surgery. The risk of reoperation because of something abnormal with the ovary that was left behind is about 2-3%.
So the bottom line is are you willing to accept the risk of 2-3% of future surgery for a more natural transition into menopause and the potential benefits of the other hormones, or remove the ovaries and supplement with estrogen until the natural age menopause. There is no absolute right of wrong answer.

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Response by:

Thomas A deHoop, MD
Formerly Associate Professor of Clinical Obstetrics and Gynecology
Director, Medical Student Education
No longer associated