“Don’t you dare take out my ovaries! If I wake up without them, there will be hell to pay.”
These were the last words I uttered on March 28th before the anesthesiogist injected the quieting milk of amnesia (aka propofol for you Michael Jackson fans) into my IV, thus sending me off to dreamland and restoring peace to the operating room where I was about to undergo my hysterectomy-slash-vaginal vault reconstruction.
Surgical Pause, not Surgical Menopause
I don’t know if you know this or not, but the entire OR team, including the surgeon, is supposed to stop and perform a “time out” or “surgical pause” prior to beginning any surgical procedure on a you. This little step is supposed to occur while you are still conscious so you can participate in this preemptive measure that ensures you don’t go in for heart surgery and come out with a below-the-knee amputation.
Because I knew this surgical pause was coming, I anticipated the precious moment where’d I’d get to let everyone in the OR know that my ovaries were off limits, and that I was in no way consenting to their removal without my conscious approval.
Female Castration or Preventative Medicine?
While many surgeons continue to routinely encourage healthy women (I am not talking about breast cancer patients or women who carry BRCA1 or BRCA2) undergo prophylactic surgical removal of healthy ovaries during elective hysterectomies–78% of women between the ages of 45 and 64 undergoing routine hysterectomy also have their healthy ovaries removed– the decision whether or not to keep your ovaries requires serious consideration, and very likely a second opinion.
This is one of those times where you do not want to just go along with whatever your surgeon says no matter how much you trust him, or like her. If your surgeon wants to remove your healthy ovaries SEEK A SECOND OPINION!
I know what you are thinking. Preventing cancer sounds good, right? And ovarian cancer is a serious disease that has no reliable screening test and few definitive symptoms. Furthermore, ovarian cancer has a high cure rate if caught early, but the sad truth is that it usually isn’t. So why bother getting a second opinion? Isn’t it better to get rid of them before there is a problem? Are ovaries worth keeping once child-bearing is over?
You’re Not Using Those Things Anymore
In the weeks just before my surgery it came up in conversation with a physician colleague that I was keeping my ovaries. His response?
“Why are you keeping them? You’re not using those things anymore!”
Knowing that this doctor is also done having children, I immediately shot back, “Are you going to get your balls cut off to prevent testicular cancer? You aren’t using them anymore.”
Hands off my Girlie Balls!
There is a very cavalier attitude in our culture in general, and by doctors in particular, towards women’s sexual organs. The thinking seems to be that as long as they don’t close up the hole we’re good to go, right? Wrong. A woman’s sexuality is a lot more complex than just having a hole where the penis goes.
Why is this such a difficult concept for people? I am dead certain that there isn’t a man reading this who wouldn’t be pissed as hell if he went in for a vasectomy and woke up without his balls.
That’s exactly how I felt about the possibility of waking up without my ovaries.
Because, while physicians are focusing on the ovaries’ declining production of estrogen needed for egg production, what they should be paying attention to is testosterone, which the ovaries continue to produce long after menopause. Testosterone for women, just like for men, is the hormone that fuels our sex drive.
But it isn’t just sex. Okay, for me it’s mostly sex, but sex isn’t everything.
Women Who Keep Their Ovaries Live Longer
Despite my last-minute operating room proclamation, I was not really THAT concerned my surgeon would intentionally, or inadvertently, remove my healthy ovaries. He was already up on the current medical literature which now recommends ovarian conservation whenever possible. He’s the one who first said to me, “You will keep your ovaries.” He is the one who told me that, ovarian cancer be damned (studies indicate that only 0.1% to 0.75% of women who retain their ovaries at the time of hysterectomy develop ovarian cancer), healthy women who keep their ovaries live longer than women who have their healthy ovaries prophylactically removed.
Our menopausal ovaries might not be dropping eggs anymore, but they are still producing important hormones for the health of our hearts, our brains, our bones, and, yes, our libidos, well into our 60s, and maybe beyond.
Consider this: While you may be eliminating your risk of ovarian cancer, removing your healthy ovaries increases your risk of all other cancers, not to mention heart disease. And we need to mention heart disease. Because as frightening as ovarian cancer is, we need to recognize that the risks are very low compared to our very real risks of heart disease (15,000 deaths per year from ovarian cancer versus 350,000 deaths from heart disease.)
Sorry. There Isn’t a One-Size-Fits-All Answer
Going into surgery, I knew that my major genetic risks are colorectal cancer and osteoporosis (which I already have). Conservation of my ovaries (and HRT in my future) is my best bet in preventing and treating these diseases. So, for me, the decision was simple, my ovaries stay.
What does this mean for you? This means that you have to weigh your particular risks before making a decision for yourself. This means you need to do research for yourself. And it could mean that you need to seek a second opinion, or even a third, if your surgeon insists on removing your healthy ovaries.
The fact that there isn’t a definitive answer for all women trying to decide whether or not to undergo routine prophylactic removal of healthy ovaries at the time of hysterectomy is frustrating for many women. And it is leaving doctors out there acting like the Lone Ranger recommending surgeries that very well might not be in your best interest. In the case of your ovaries, let the patient beware!