Removal of just ovaries - pros & cons

[KatyMac]

I haven't googled yet!

I have (apparently a 5cm cyst on my left ovary and a fair amount of scarring from an ectopic 15yrs ago)

Good idea to remove them both? After/Side effects?

Menopause which can then cause brittle bones, hair loss, dry vagina etc. Why not just remove the cyst?

Dunno - menopause is in my immediate future anyway as I'm 50 I guess

Yes but it’d happen immediately rather than slowly like it’s meant to. And at your age brittle bones is a very real fear. Mum got severe osteoporosis within just a couple years of menopause.

They mentioned HRT but I was a bit distracted - that'll be why I guess

www.nhs.uk/conditions/hysterectomy/considerations/#removal-of-the-ovaries-salpingo-oophorectomy

www.nhs.uk/conditions/hysterectomy/considerations/#surgical-menopause

I'd read those if you haven't already OP, and talk things through with medical professionals rather than allowing yourself to be swayed by alarmist posts on MN. Have they suggested removing both, and if so, why?

I had an ultrasound and the found a 5cm cyst and a 3cm mass in my uterus
The MRI has suggested the mass is a fibroid and no further action is necessary
"The cyst while not concerning means we would prefer to remove your ovaries, is that OK"

So I asked questions I thought of at the time (why not a hysterectomy, will it affect my prolapse or TVT, how long is recovery, when would it happen) then they said are you happy to go ahead - I said yes and I have come home to work out if there were other questions I should have asked (goodness knows how i ask them now)

MN is pretty reliable and combined with google I may work it out

I had already planned on seeing my GP next week to chat as they have said they won't do my gallstones and my ovaries too close together & I want which ever will make me feel better first (unless there is a reason to do the other first)

Starting to sort out questions (I guess I ask the GP)

I'm wondering why both ovaries if it's only the left one?

Will they remove my tubes?

I'm concerned which surgeyr I should have first (mind you, I may not get the choice, but I'd curse if I got the appt for both at the same time) - which is more important?

Why are they doing nothing with the fibroid?

Who do I need to be referred to for my lump - that is a non-gynae issue?

WHat sort of HRT are they considering?

seems rather drastic to me. The rule for cysts 5cms and under is 'watch and wait' for women your age.

I guess this could be a money and time saving option - to save them doing scans in future.

I had a 3.5cms cyst in my 50s and there was no suggestion at all of removal. I've also had / got a small fibroid ( about 2cms).

Ovaries continue to make smalls amount of estrogen forever and also testosterone in tiny amounts.

you would need HRT immediately and possibly for ever - estrogen and progesterone as you will have a womb. Not sure what you mean by 'what type'? They won't be talking brand names at this stage but you can choose what you want- pills, patch, gel- that's a whole topic in itself!

I'd like to know why major surgery when none of it bothering you- or is it?

ps that is a small fibroid. half of women have a fibroid or more. Really common. They are only removed if they are causing real issues. The less surgery you have the better- there are always risks and the cyst and fibroid are not large. They seem to be playng safe with ovary removal but there are some rather old school dr out there who think of nothing but ripping it all out.

My understanding is that ovaries are an important part of our endocrine system. Eg. I believe that removing them can increase the chances of death by heart disease, which may be an issue for you if this is in your family. Personally, I would be looking to keep them if at all possible.

Well I'm quite poorly - not sure any of it is Gynae related
Gallstones, IBS, Fibromyalgia, CFS, Hyper mobility, partial prolapse, TVT & associated random frequency and urgency

But I went to the GP with a getting larger lump on my upper right abdomen/tummy - my lump aches and so does my lower ribs, back and lower tummy

But because I was having bleeding between periods, after sex, no appetite, redistrubution of weight Knicker size 14>10, skirt/waist 10

@sandandsea Ovaries post menopause are different,(they don't produce much estrogen) so removing them just puts someone into a surgical menopause. Women's levels of CVD rises post menopause to equal men's. HRT reduces the risk.

@KatyMac I honestly don't think your issues are gynae related with the size of that cyst and fibroid- I had both and never knew (until a routine MOT type scan found them.)

Sounds as if you have many of classic peri meno symptoms which are often misdiagnosed as fibro, and your urgency, weight gain etc are typical too. But you need that lump checking out. You mentioned this before- why on earth has no one said what it is? They must surely know. Maybe you need HRT for your peri meno symptoms anyway.

FM is over 10 yrs old - CFS for 25 - but I think they are pretty much the same

The left ovary is the side I had my ectopic on - I also have a unicornate uterus (found on the ultrasound) possibly due to scarring - but this appears now to be a fibroid

The urgency/frequency seem (to me to be connected to my IBS) are since the TVT

My lump has so far been: a hernia, a lump of fat, odema, because of the cyst (on the other side) or a shrug and an "I don't know"

I hoped the MRI would have come up with something but the gynae won't discuss it as it isn't gynae

I thought it was menopause tbh and was dealing with it - I just wanted my (now visible through clothing) bulge dealing with - I felt it was connected to my gallstones but have been told not

Done a bit of research; spoke to a retired gynae

At my age having a surgical menopause should be fairly uneventful

5cm cysts are borderline for removal but as the ovaries are stopping working fairly soon anyway and the possibility of them going wrong (again at my age) outways the risks of the removal (10 yrs ago - different story)

Yes they could leave the other one but why bother at 50 (again leave it behind if you are 40 or younger)

Fibroids tend to be left alone unless size becomes an issue

& I'll speak to the GP about HRT & about getting another referral for my lump

5cm cysts are borderline for removal but as the ovaries are stopping working fairly soon anyway and the possibility of them going wrong (again at my age) outways the risks of the removal (10 yrs ago - different story)

Removal of ovaries is still a very big step. You would need HRT which is no big deal but the long term consequences of removal don't necessarily outweigh the risks in terms of getting the right balance of HRT and maybe testosterone too.

A large number of cysts disappear on their own. Recommendations on the RCOG website for drs say use watch and wait to see if the cyst goes away.

I don't understand why no one has diagnosed your lump. That's just plain weird.

@KatyMac

This is a useful read.. (It's for women who are pre menopause which you are if you are still having cycles.)

www.rcog.org.uk/globalassets/documents/guidelines/gtg_62.pdf

If you scroll down to point 6 it says that cysts under 5cms should be left alone as they usually go away in 2-3 cycles.

Cysts between 5-7cms should be left alone and monitored once a year with ultrasound. It says MRI scans are not necessary but just do a TVS.

What sort of cyst is it?

But am I completely premenopausal?

My lump, if it were symmetrical would look like about 5 months pregnant!

What is TVS?

I didn't ask what type of cyst, sorry

That's talking about women with a median age of 26

The chap I spoke to said at 30 or even 40 he would advise completely differently to at 50
The position of my lump is (imagine a clock with the belly button being the middle and my head at 12 o'clock) if I put my hand diagonally between the outer edge of my ribs and my belly button at between 10 & 11 it more than fills my hand and today for the first time I can see it sat down

It's bloody odd

I think push for having my gallstones done and getting my ovaries re-MRI'd before doing anything else

Sounds as if you need a list of qs for when you see your consultant.

You are not post menopause. THAT is important because anyone post meno and not having cycles at all is a different case. Cysts in women who ovulate even now and then are completely different re risks to women who are post menopause. it's not age that is the issue it's where you are in menopause.

How did you come to find a retired gynae to talk to anyway? (curious!)

Ovarian cysts come in all types- some are always benign, others are possibly more tricky. You ought to have been told what sort it was. Simple, fluid filled cysts are common.

TVS-=transvaginal scan - the best way to find and monitor a cyst or anything pelvic- shows up far more than an ultrasound over the belly. MRIs are not the way to look at a cyst.

Not sure who you are seeing but it all sounds really odd. Hope you get some answers. (BTW I know all of this as I had a cyst and had it monitored for 2 years. post meno)

Ok we started with an ultrasound and a TVS so they saw that bit

Messaged you about retired gynae

questions for gp are coming on I'll list later

i think the issues is they tell youn ask if you have questions and your mind goes blank - and i think ikd been gearing up for questions about cancer this thew me a bit

This has all the info on cysts post menopause.

www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg_34.pdf

scroll down to around page 6-7 to see the flow diagram.

Yout cyst of 5cms falls on the cusp of no treatment / treament.

They are supposed to give you a risk factor score.

If it is a simple cyst with no symptoms and is under 5cms they scan every 4-6 months (my own experience.)

If it is over 5cms they may decide to remove both ovaries but it depends on your risk score.

The doc is very detailed and it's worth reading it. 5cms falls into both categories- it depends if it's bothering you and if they think it's more than just a simple cyst which is benign.

You need a CA125 blood test to give you a risk factor (combined with the type of cyst and whether you are pre or post menopause.)

CA125 was 41 I know that

So I need a type of cyst and a risk factor score - I can speak to the GP about that

According to the info on that chart, it doesn't look as if you come into the over 200 score (which is when they suggest surgery.)

You score 40 for CA125, 0 for being pre-meno and whatever (up to 3?) for the type of cyst.

sorry, 1 for pre menopausal and max 3 for a complex cyst.