Not unless Medically Necessary

I have had a few patients recently, who rather worryingly have had their ovaries “whipped out” for no other reason it would seem, than the surgeon was “in there anyway” and was removing their womb for something benign like Fibroids. These women were younger than the average expected age of perimenopause or menopause which meant that by removing the ovaries, the surgeon put them straight into Menopause suddenly and dramatically at a younger age than was natural. This made me Mad! Mad! Mad! …And it is likely to send women mad too as menopause before the age of 45, is associated with an increased risk of dementia.

Now, don’t get me wrong. Sometimes it IS necessary to remove the ovaries, for example with certain cancers etc. However, If this is done before the age of 45, this predisposes the lady to many serious long-term complications such as:

1. Thinning of the bones (Osteoporosis) and subsequent fracture risk
2.Dementia.
3.Heart disease

That is why, if medically possible, women who have to have the ovaries removed early should be offered Hormone Replacement Therapy (HRT) at least up until the age of 51. HRT will help protect against the above three conditions. Now, admittedly this isn’t ALWAYS possible, for example if the woman had an Oestrogen dependent cancer. However, Fibroids are benign growths within the womb and DO NOT require the ovaries to be removed. I mean, can you imagine a surgeon offering to whip out a Man’s testicles for no reason?

I have already seen 3 women this month who now have thin bones because their ovaries were removed when their womb was removed for Fibroids and they were NOT offered Hormone replacement therapy, until the age of 51, in accordance with international guidance. Sometimes if a Woman has gone through Menopause when this is done, or she is over 50, a surgeon might suggest this because by removing the ovaries you prevent future ovarian cancer. But NOT before the age of 45 unless you have certain gene mutations like a BRCA gene. Even then, women should be offered HRT until the age of 51.

Furthermore, when your ovaries are removed BEFORE you go into a natural menopause the plunge is sudden. There is no GRADUAL decline in estrogen. This can mean that menopause symptoms are far more sudden and severe than if menopause occurred gradually and naturally. The ovaries also make Testosterone, which women also need for libido and muscle strength, 50% of our Testosterone comes from the ovaries and the other 50% comes from the Adrenal glands. Women who have their ovaries removed are much more likely to suffer with low libido. If after their estrogen is adequately replaced, and they are still suffering with a lack of desire, they may also need Testosterone.

So, two things to note:

1. Always ask if removing the ovaries is really necessary, and if it is, ask about the possibility of hormone replacement therapy at least until the age of 51, the average age of the natural menopause.

2. If you do suffer with very low libido despite Estrogen replacement, then you my benefit from Testosterone therapy.