Question 16
Dear Dr. N,
I am a 33 year old woman. I have 3 children and don't plan to have anymore. The problem that I have is that I have been having a lot of problems related to my reproductive system, some of them are: Endometriosis, I have growths inside the wall of my uterus, one of my ovaries has some scaring, and I am not sure about the other one's condition, also my uterus is falling down and I am also having trouble with my bladder and with back and leg pain, that I think is related to all of my problems. I have been taking birth control pills to control the bleeding and pain. My doctor has suggested a hysterectomy, and he will probably have to remove one of my ovaries and says he is not sure about the other one. The problem that I am having in deciding about surgery is that I would like to be sure that I could keep one of my ovaries, because I really don't like the hormone replacement therapy, I don't think I am ready for that. I need to know what should I do? I have been reading and getting information, and according to my doctor I don't have any other option, and he says there is no way for him to know about the ovaries until the surgery. Any information you can give me would be greatly appreciated. Thank you
Reply:
Hi,
My impression is that if one or both ovaries are left at the time of hysterectomy for endometriosis, there is a significantly increased rate of reoccurrence of the endometriosis. This often requires a need for further surgery. This may be the rationale for removing the ovaries if that is needed.
I know that you would like to retain your ovaries to avoid the need for hormone therapy treatment and this certainly makes sense and is a best case scenario. If this is not possible because of the extent of your endometriosis, given your age you will need some form of hormone therapy treatment if you are to maintain your health and quality of life. Hopefully, your quality of life would improve, by the absence of pain and bleeding.
How well someone your age feels on a program of hormone therapy treatment / HTT following removal of both ovaries is often dependent on whether they have access to a physician who is knowledgeable about menopause and hormone therapy treatment. While many women seem to do very well on the more well known and prescribed HRT programs, many need a more individualized program if they are to feel well. Physicians who not aware of this often think there is something mentally askew with patients who don't respond to routine therapy. Usually, the problem lies with the physician's limited scope of knowledge and therapeutic options.
This is unfortunate, as many, if not most women who find their quality of life is impaired following a hysterectomy would be able to improve the way they feel if they had access to a physician skilled in menopausal hormone replacement therapy.
If you do retain one or both ovaries and the endometriosis returns, there is a procedure called laser ablation where the endometrial implants can be removed by laser through a scope if they are accessible and not too extensive. however, the potential for reoccurrence still exists.
Please let me know what and how you do.
Dr N