Reader’s Choice : Oophorectomy & Endometriosis

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Plushy ovary available on iheartguts.com

When I was getting ready to get wheeled into the Operating Room back in 2014 for my cystectomy, my Doc tells me that if he gets in there and there’s extensive damage, he may need to perform an oophorectomy (pronounced oh-uh-fuhrek-tuh-mee).  I signed the permission slip/waiver without blinking and off we went.  Luckily, he didn’t have to perform one.  And this turned out to be my Endo diagnostic surgery.  Quite the day.

One of our readers & fellow blogger, SnowDroplets, asked the other day if I could look into the pros & cons of oophorectomies, when to have them, and hormone replacement therapy after the ovary(ies) is removed (especially how it may affect with with Endo).  You know how I love to learn about new things, so here goes!  And thank you, SnowDroplets, for asking this question.  I learned A LOT today.

An oophorectomy is a surgery to remove an ovary.  When one ovary is removed it’s a unilateral oophorectomy; if both ovaries are removed, it’s a bilateral oophorectomy.   And if the Fallopian tubes are removed with the ovaries, it’s called a salpingo-oophorectomy.

“But, Lisa,” you ask, “why would you need one or both ovaries removed?” Good question!  Lots of reasons! And we’ll delve into those reasons today.

Cancer

Ovaries may be removed due to the presence of ovarian cancer…or even just because a woman may have a high risk of developing ovarian or even breast cancer.  If the removal of the ovaries is simply as a precaution, the Fallopian tubes will likely be removed, too, as recent studies have shown that the tubes may also develop Ovarian cancer.

Angelina Jolie underwent a salpingo-oophorectomy because of her already-increased risk of ovarian and breast cancers.  Preventative medicine.

Torsion

Ovarian torsion is when the ovary is twisted so badly that it may obstruct blood flow, causing the ovary to swell, which may cause irreversible damage, abdominal swelling, and pain (it can also twist the Fallopian tube).  Torsion is considered among the Top Five gynecological emergency surgeries. Conservative surgery can unravel and save the twisted ovary; however, many women who suffer from ovarian or tubal torsion opt for oophorectomies instead.

Tumors or Cysts

Benign tumors or cysts on the ovary can simply be cut away (cystectomy); however, sometimes the damage to the tissue may be too extensive or the tumor or cyst may be considered cancerous, and the ovary is removed.

Abscess

An abscess can grow on the ovary or Fallopian tube and it can be very painful.  Imagine a nasty like a nasty little puss-filled zit.  It usually is the result of some vaginal or cervical infection and may go hand-in-hand with Pelvic Inflammatory Disease.  Most ovarian or tubo-ovarian abscesses can be treated with intravenous antibiotics and a hospital stay; however, surgery may need to take place to either 1) drain the abscess, or 2) remove the damaged ovary or tube.

Pelvic Inflammatory Disease

Pelvic Inflammatory Disease is a disease of the pelvis, which can affect the uterus, Fallopian tubes, or ovaries, mostly transmitted through sexual intercourse.  Long-term, untreated Pelvic Inflammatory Disease can cause adhesions to develop, or the infection may cause sepsis, which can be fatal.  PID can also cause abscesses, which may need to be treated with antibiotics, drained, or the infected ovaries removed (as we just learned).

Some studies indicate that women who suffer with chronic PID share an increased risk of developing ovarian cancer.  And, as we learned, some women have oophorectomies to combat their increased risk of cancer.

Some women with PID are advised to get hysterectomies because of the damage the infection has caused to their uterus.  The ovaries may be removed, as well.

Hysterectomy

A hysterectomy is the removal of the uterus, with out without removing the cervix, the Fallopian tubes, and/or the ovaries.  Depending on a woman’s age and medical condition, she may opt to keep her ovaries, or have one, or both, removed during a hysterectomy.  That is a decision that she and her doctor must make together, weighing many factors.

Endometriosis

Some women with severe Endometriosis symptoms may ask for a bilateral oophorectomy, thus ending their periods.  Many also opt to have a hysterectomy.  When I asked my doctor his thoughts on the matter, he said that it will not cure Endometriosis, but it would help with the painful periods…since I wouldn’t have my period anymore.  We’ll cross that hysterectomy bridge if we ever truly have to…but for now I have all my LadyBits.

Studies have indicated that Endometriosis sufferers who undergo a hysterectomy and bilateral oophorectomy have a decreased risk of recurrence.  One study had 29 women undergo a hysterectomy, but left their ovaries – 18 of those women had recurrence of Endo.  That same study had 109 women who had hysterectomies with bilateral oophorectomies, but only 11 of them had recurrence.  A second study showed similar findings with a different bunch of ladies.  And yet another study found that it didn’t make a difference if you kept your ovaries or not with a hysterectomy; that the rate of recurrence was the same.

My personal belief is that a hysterectomy isn’t a cure for Endometriosis.  I know it has helped a lot of women with their symptoms, but I also know a lot of women who continue to suffer years after their hysterectomy.  Excision is the key.  And even then it may recur.

That being said, Endometriosis is believed to be an estrogen-fed disease.  Ovaries produce estrogen, but so do a lot of other functions  in our body (adrenal glands, fatty tissue, and certain foods & supplements mimic estrogen) – cut out the ovaries and our bodies are able to still produce estrogen. Just know that fact…


Surgical Options

If you’ve had surgery for Endometriosis, you’ll be familiar with these choices of surgical techniques for removing the ovaries:

Laparotomy: manual surgical procedure using a large incision across the abdomen; usually a longer recovery time with more risks of complications.  May require a hospital stay.

Laparoscopy: manual surgical procedure using smaller incisions, tiny camera, tiny surgical instruments; usually a faster/easier recovery.  May be outpatient (in and out the same day).

Robotic laparoscopy: same as a laparoscopy, but this time it’s robot-assisted! Queue the Terminator!


Pros & Cons

The biggest pro to an oophorectomy : hopefully you’ll be solving whatever issue caused you to have the procedure done in the first place!

If you have only one ovary removed (and still have your uterus), you’ll continue to have your period and are still able to conceive naturally (well, if your body will allow you to).  Even if you have both ovaries removed and still have your uterus, you can still make babies, but with help from SCIENCE!!  Consider freezing your eggs for future IVF treatments before the bilateral oophorectomy, although some doctors just won’t do it under the theory that freezing eggs isn’t a viable option.

Women who undergo a bilateral oophorectomy are plunged into immediate menopause.  The severe lack of hormones that may also cause depression, mood swings, and sex drive, or even lead to heart disease, osteoporosis, or dementia.

Studies indicate that women under the age of 40 who undergo a bilateral oophorectomy are 7 times more likely to develop heart disease.  They’re also at a higher risk of stroke, Parkinson’s Disease, anxiety, or depression.  The younger the age of the woman at the time of surgery, the greater the risks of developing these conditions.

Another study indicated that a woman’s risk of developing dementia or cognitive impairment is increased by 50% if they undergo an oophorectomy.  Further research is needed, and quickly.

As with all science and studies, though, the data is ever-changing.  Reanalysis of past studies are always being conducted and contradicting prior findings.  These pros & cons may seem dark and scary…but know that not all women suffer from these side effects or increased risks.  Our bodies are our own.  Individual.  Don’t let these scare you from treatment you may need.  Please talk to your doctor.


Hormone Replacement Therapy

To combat some of those cons, some physicians recommend hormone replacement therapy (also called HRT).

Some studies have indicated that women with Endometriosis (and no ovaries) may benefit from a continuous combined HRT (estrogen + progestogen) or the use of Tibolone.  Rather than just straight estrogen, these therapies may not stimulate the recurrence of Endometriosis.

Not only can hormone replacement therapy be detrimental to those with Endometriosis, but it once more increases the chance of cancer in women who take HRT.  Research shows that women over the age of 45 who had undergone a hysterectomy with bilateral oophorectomy and are taking HRT have an increased chance of developing breast cancer.

Some side effects to hormone replacement therapy can be irregular bleeding, nausea, breast tenderness, leg cramps, depression, and irritability.


When do you know if you should consider an oophorectomy?

Well, you’ll likely not know until your physician says something.  He or she may bring it up in a consultation after reviewing your symptoms and imaging studies.  Or it may be, like me, a possibility during a surgical procedure.

If the oo-word does enter into your realm of possibilities, please have long discussions with your doctor about your individual medical history, the risks, and the benefits.  See if only one ovary needs to be removed, or if they must take them both.  If you’re getting a hysterectomy, please know that they don’t always have to remove your ovaries; again, talk to your doctor.

Write down your questions before your appointment.  Bring them with you and ask them all…and write down the answers.  Sometimes it helps to have a friend or loved one accompany you; they may remember some information you didn’t.

And most importantly, breathe.  It will be okay.


Resources:

Baylor, Scott & White Health

Dr. Scott Salisbury

Facing Our Risk of Cancer Empowered

Healthy Women

HERS Foundation

International Business Times – (March 25, 2015; Article) What is Salpingo-Oophorectomy? Angelina Jolie Had Surgery to Reduce Ovarian Cancer Risk, But Procedure Not Recommended for All Women

Lifescript

Mayo Clinic

Modern Medicine Network – (July 1, 2011; Article) Bilateral Oophorectomy: Solving the Risk/Benefit Equation – Choosing Candidates, Monitoring Outcomes

OBGYN.net – (Feb. 17, 2014; Article) Oophorectomy Increases Risk of Osteoporosis and Cardiovascular Disease

Obstetrics & Gynecology – (April 2013; Article) Long-Term Mortality Associated with Oophorectomy Compared with Ovarian Conservation in Nurses’ Health Study

Our Bodies Ourselves

RadioGraphics – (2008; Article) Pearls and Pitfalls in Diagnosis of Ovarian Torsion

RadioGraphics – (2004; Article) Unusual Causes of Tubo-Ovarian Abscess: CT and MR Imaging Findings

Susan G. KomenPost Oophorectomy Estrogen May be Safe for Younger, Not Older, Women

The New England Journal of Medicine – (May 23, 2002; Article) Risk-Reducing Salpingo-Oophorectomy in Women with a BRCA1 or BRCA2 Mutation

US National Library of Medicine – (Oct. 2006; Abstract) Hormone Replacement Therapy in Women with Past History of Endometriosis

US National Library of Medicine – (Jan. 2009; Article) Long-Term Effects of Bilateral Oophorectomy on Brain Aging: Unanswered Questions from the Mayo Clinic Cohort Study of Oophorectomy and Aging

US National Library of Medicine – (Aug. 1996; Abstract) Pelvic Inflammatory Disease and Risk of Ovarian Cancer

US National Library of Medicine – (Oct. 1986; Article) Tubo-Ovarian Abscess: Pathogenesis and Management

Wiley Online Library – (2012; Article) An Update on the Diagnosis and Management of Ovarian Torsion

WiseGeek

Women’s Health Concern

 

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

5 thoughts on “Reader’s Choice : Oophorectomy & Endometriosis

  1. Another well done post, Lisa! I admire your dedication to helping others with endo. You are my blogging rock star.

    I just wanted to add real quick that a UNIlateral oopherectomy will also have no bearing on endometriosis. As in, having g half your ovaries won’t “halve” your severity of endo, nor will it even lower your risk of developing endo in the future. I was dx with stage iv endo many years after my unilateral oopherectomy. Also, many doctors are reluctant to freeze eggs following an ooph’ because, as more than one doctor has told me, “Eggs don’t freeze well.” So if someone out there is going into this surgery with the idea that she can just freeze her eggs for later use, that is not always an option. I wish it was. Maybe someday the science in this area will be better. 🙂

    Liked by 1 person

  2. Lisa, you are amazing! Thank you!! In my case, they are recommending bilateral oophorectomy to deal with severe recurrent endo and large endometriomas that keep forming on both my ovaries. I’m not sure what happens to the tubes. I’m assuming they go too. I guess I’ll keep my uterus for now? Such a bummer. I don’t even know. I’ll also have excision of as much endo as they can find while they’re in there. Robot laparoscopy. The alternative is to have the same surgery I did in 2012 and try to save one or both ovaries, but the doc says my chances would be high to be right back in the same place a few years from now. I looked into all my egg options and there’s really no chance. They say my eggs are toast. No retrieving, no freezing, no nuthin. I have so many questions and so much research still to do before deciding. You gave me lots of material to consider! Many scary things. Still, thank you so much!

    Liked by 1 person

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