Ive had chronic pelvic pain for about 24 months now. Should I just get the surgery over with?

Im 46 yr old and have had lap surgery in August to diagnose pelvic pain. I have a large fibroid about the size of a lemon in my right lower quadrant. I went to a gynecologist who told me to have a total abdominal hysterectomy. NO WAY! I do not want my ovaries removed, so I had a 2nd opinion and he told me he would leave 1 ovary for hormones and take out my uterus and cervix.
My mother had a hysterectomy at 40, and my sister had one when she was 25. Mom died from alzheimers disease at 63, and now my sister has early dementia at 56 just like my mom did.
Ive studied up on dementia from hormone loss. A couple studies say the body should not lose hormones until the natural age of menopause at 50. I have been in misreable pain at times. Should I just get it over with or hang in there until I am 50 to have a hysterectomy, with 1 ovary left intact? I take regular doses of Naproxen, and Tylenol, or whatever is available at the time. I havent resorted to any narcotics.

1) If you just have a fibroid, then you don’t need to get either of your ovaries removed. Just your uterus. Because the fibroid is on your uterus, not your ovaries. It’s common, esp. in USA, for docs to take out ovaries when they take out the uterus. But they dont’ have to, and in Europe, it’s a lot less common to remove healthy organs just because you’re doing surgery in the same area.

2) Have you gone to any large teaching hospitals when you have seen docs? Have any docs recommended uterine artery embolization (UAE)? That’s a non-surgical way to shrink your fibroid. They block the artery that supplies blood to the fibroid, so the fibroid is starved out and shrinks and goes away. A simple, outpatient procedure. Look into it. It’s a relatively new procedure, which is why a doc at a smaller hospital might not ever have done it, nor suggest it. But a big teaching hospital is up on all the new stuff (by “new” I don’t mean last week–it’s been around for 10 years or so and well tested and safe) and will have the ability to do it.

3) I agree with your concerns about getting your ovaries removed unnecessarily. And as I’ve explained above, it’s probably not necessary. But don’t freak out–even if you have them removed, you can still take hormones, and that will likely protect you from the early dementia you fear. Be sure to use estrogen patches, not pills.

4) It sounds to me like NO, you should NOT be hanging in there until 50 with the severe pain you have. It is greatly affecting quality of life. And 50 is not a magic number in terms of your body’s health. That is, like, when one is pregnant, one week can make a huge difference in terms of the health of the fetus. But going through menopause at 46 rather than 50 is not going to make a huge difference in your health. HOWEVER: in studies of the cognitive effects of menopause, the current thinking now (and this is all very new, so this might change) is that the largest cognitive damage is caused in the first few months of hormone deprivation. After that, restoring the lost hormones won’t make a difference in brain health because the damage has already been done. What this means is that women who go through natural menopause end of faring worse, cognitively, than women who go through surgical menopause in many cases. This is because when going through surgical menopause, you start taking hormones immediately after surgery. You never have a time period in which you have no hormones. But with natural menopause, women typically don’t start hormone replacement until they’ve been hormone deprived for awhile. The damage was done while they were not taking hormones because they didn’t have hot flashes. Hot flashes occur when estrogen has gotten very very low, while it may be that brain damage occurs when they still have relatively more estrogen. So in that sense, surgical menopause can actually end up protecting your brain more than natural menopause. But this is all very new information, and the jury is still out. And it’s always possible that your mother and your sister’s dementia has nothing to do with hormones. Also. See this study: http://www.neurology.org/content/69/11/1074.abstract
In sum: shock, shock, shock at the extent of cognitive impairment due to surgical menopause. Even greater shock that GETTING JUST ONE OVARY REMOVED also increases risk of dementia. Given that, I don’t really get why docs go around leaving just one ovary in when they remove the uterus (though, this study is 3 years old, so very very new). If you get your uterus removed (and I think you should, but ONLY IF uterine artery embolization is not a possibility for you), make sure they leave both ovaries in. But: I don’t want to scare you further, but getting your uterus removed can throw you into surgical menopause even if you keep your ovaries, because blood supply to ovaries is reduced. In someone your age, so close to menopause already, it’s pretty likely to occur. So if you have to have your uterus removed, it might just be better to get the ovaries out, too. But you could also just start taking birth control pills after surgery, as that will keep your hormones at a good level regardless of whether or not your ovaries are up to full performance.

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