AIBU to want a hysterectomy, since both my ovaries will be removed?

[HappenstanceMarmite]

In other words...since I have to go through surgery for a bilateral oopherectomy (because of 9cm cyst which torsioned), then wouldn't it make sense to whip out the whole shooting match? My Gynaecologist won't hear of it even though I have tried to reason with him and explained why I want a hysterectomy.

I am 55, on HRT and have always suffered from quite heavy painful periods. The period I get every month is no lighter/less painful since being on HRT either. I tried the continuous HRT - which means no regular monthly bleed - but it really didn't suit at all

The Gynaecologist has suggested using a Mirena coil in combination with oestrogen therapy to resolve the issue. I've already tried the Mirena and had it removed after a year of almost continuous light bleeding and permanent PMS vs once a month monsoon.

I feel that he is not listening to me. In fact he got irate at our last meeting when I rejected the Mirena and raised his voice slightly when he exclaimed "You're just not getting this are you?!"

So now he has put me down for removal of both ovaries sometime in August/September. It was either that, or just leave the now settled cyst in place, in the hope it would either go of its own accord or stay where it is without event. The initial event - in January- saw me admitted overnight in severe pain when the cyst twisted around the ovary. But I have since had further scans which show it has not grown or changed at all.

Should I seek a second opinion? And would that mean I'd need to pay for the surgery privately rather than via NHS? Am I being ridiculous wanting my troublesome uterus taken at the same time I'm having surgery performed to remove ovaries? I would welcome your thoughts and/or experiences please.

Horrible to have such an aggressive response from the gynae.

If your cyst has gone now the op seems unnecessary - surely? And if it's just one ovary why remove both?

Our ovaries continue to work a bit till we die so even though you are on HRT they are helpful to have.

I'd def get another opinion, but I suppose it depends on what you want. Are you asking for a hyster because of the bleeds with HRT? Is that the main reason?

I've been using HRT for 9 years - have a top notch gynae one of best in UK. My advice would be that some kind of conti HRT might suit you- unless you have tried all of them ( there are 3 kinds of progestogen) there may be some types that suit.
For example, micronised progesterone Utrogestan. Some of us use that as sequi, or you can do 21 days a month or daily.

If you see a private gynae you will pay for that consultation. if they suggest surgery you can go back on the NHS waiting list. Remember you can see any consultant (privately) anywhere - not just your own area. The cost of a hyster privately is around £6K by the way.

Consultations vary but around £200 for the first appt.

Thanks Polly. Useful information 😊

No the cyst has not gone. It is still there, but no bigger. A bit like a ticking time bomb that may, or may not, explode!

I think he would remove both to prevent any potential future cysts forming in the future.

I think I must be sensitive to Progesterone as my experiences with Mirena, the Continuous HRT but also way back in the past I was put onto progesterone in an attempt to reduce heavy loss during periods. I get depressed and very short tempered on it. So I'd rather not start down that road again as I'm only feeling in a good place mentally now.

That's very interesting what you said about having initial private consultantion but being able to revert back to NHS. Is that 100% or only available in certain situations? Would I need a GP referral again or can I just go book it?

Thanks again.

I still think you should a) get a 2nd opinion and b)not dismiss all HRT without trying it.
I expect you were on Norethisterone to reduce blood loss? That is an androgenic sort of progestogen and the side effects are PMS/ bad temper/low mood. I can't force you but all I'd say is keep an open mind. I was on Norethisterone for 5 years - had a few side effects but nothing that was unbearable for the 10 days I used it - but have switched to Utrogestan which is a natural form of progesterone.

(You need to note the difference between synthetic progestogens and natural progesterone.)

You can't use HRT without some type of progestogens (which you will know) unless you have had a hyster. Without your ovaries you will need oestrogen so yes, you would have to choose one type OR have a hyst at the same time. Or go cold turkey with no HRT at all.

You could , under a consultant, try long cycle HRT which is a bleed only once every 2 months.

It's very common to see a consultant for an opinion but tell them that you are not able to pay for surgery privately. If it's someone local and they work in your NHS hospitals they can carry out the surgery on the NHS. If you see someone a long way away, that makes it harder of course.

Whether you need a referral depends on each consultant - some accept self-referrals, some don't. The best approach is to look at is as a consumer- have a dig around to see who is in your area (local private hospitals), phone their PA and ask if they take self referrals or not.

Thank you again Polly. You've clearly had a lot of experience with all of this!

I would be prepared to revisit the HRT if I found a consultant I could work with and who was happy to discuss rather than dictate.

I did have a look around yesterday as I was given the name of a good Gynaecologist. Unfortunately, it turns out that he works alongside my unapproachable arrogant consultant, so that might be an issue! Will keep looking.

If you are SE or SW I can help you with some names if you want to PM. Don't want to discuss people by name here.

I've sent you a PM 😊

What reasons has he given you for not taking it all out?

Storm he said he is "not willing to do major surgery where it is not required". When I pointed out my previous issues with both heavy, painful periods, a stage 2 pre-cancerous cervical cells and now the cyst and that, at my age and history, my reproductive organs are just potential issues waiting to happen, he snorted and dismissed it. He said "we can't go round dragging in every woman over 50 on a "just in case" and give them hysterctomies.

*just in case basis

Can't help at all but how irritating when we don't seem to get a say over our own bodies you've clearly thought about it so I would try for a second opinion

But they'll be in there anyway! This seems insane, I totally sympathise with your frustration!
I definitely feel like theres an attitude with a lot of male surgeons around hysterectomies and sterilisations that boils down to "I cant do this for you because some future man might still want use of it".

But they'll be in there anyway

Precisely!!! And I will have down time to recover from a bilateral oopherectomy (love that word), so why not get it over with FFS! With my history, I'm likely to need further meddling in the future so why he won't countenance it I do not know budget was muttered under his breath

To be fair, removing your ovaries is a much less major op than a hyster. I have known women back at work within a week of ovary removal. Small incision and no real internal damage. With a hyster there is a recovery period of at least 6 weeks (and no driving) as well as possible damage to the bladder, bowel and added risk of prolapse later on.

I'm not defending his attitude at all- appalling- but it's not a minor op.

I'm playing devil's advocate here, but he'd argue that the only reason for a hyster was to avoid bleeds with HRT. He could argue that HRT is not necessary at your age (you aren't having an early menopause) or that you have not explored all HRT options.

Don't think this is me being awkward- just raising these points so you can build your defence if you discuss it again, or with another dr who needs to know how you feel.

Yes those are good points Polly. 😊

Can they remove the uterus by keyhole surgery? I also had to have my ovaries removed due to cysts in March. For other health reasons I also had a hysterectomy and my cervix taken out. It was done by keyhole and I was back at work in 3 1/2 weeks ( and I teach so it's not a sit down job!)

I had a full hysterectomy nearly 2 years ago with keyhole surgery. 6 weeks off work though.

Don't like to think about how they got all my bits out through 3 teeny tiny holes!

Can you get a second opinion? You are def not being ridiculous wanting rid of something that's giving you trouble.

I wouldn't let that man touch me with a 10-foot barge pole! I'd get a second opinion.

Misu, I was told they took mine out through the vagina, did the surgery through the three small incisions but took it out downwards!!

Sorry should have said mizu

Your periods should stop if both ovaries are removed . That should not be a reason to have a hysterectomy.

Or am I being really stupid?

Twodogs not if I'm on sequential HRT, which means a monthly bleed as Progesterone is required when uterus still in situ 😊