Many women falsely believe that a total hysterectomy implies that their ovaries will be removed during the procedure.  Up until recently it was common practice to prophylactically remove ovaries to decrease the risk of ovarian cancer concurrent with hysterectomy for benign disease in women beyond 45 years of age.  A recent study looked at maximizing survival demonstrated that ovarian conservation should be practiced until at least age 65. Interestingly women who had their ovaries removed were more likely to succumb to coronary heart disease, or hip fracture, especially if they did not receive estrogen afterwards to compensate for it being lost with this surgery.  Unnecessary fears can be alleviated by clarifying that for benign uterine disease (eg. Fibroids) only the uterus needs to be removed, and the ovaries will be spared. They will continue to function producing female hormones until they cease at their biologically programmed age of menopause (average age ~51).  Consequently, following hysterectomy most women appreciate the benefits, primarily relief from their problem periods, yet maintain their desired feminine characteristics.   However, recommendations differ for women at increased risk for ovarian cancer.  In women carrying breast cancer genes, known as BRCA, multiple studies have demonstrated that prophylactic removal of the fallopian tubes and ovaries improves overall survival as well as reducing cancer specific mortality due to both breast and ovarian malignancies.  An 80% reduction in cancer risk in a recent major study makes compelling evidence to offer this intervention to at risk women once they have completed childbearing.  A different study reassures us that offering estrogen short term to these women after their surgery alleviates distressing premature menopause symptoms like hot flashes, night sweats, and vaginal dryness, without compromising the reduction in risk of developing breast cancer.  In most cases, this operation can be accomplished via outpatient, minimally invasive laparoscopy, which results in less pain and allows most women to return to regular activities within one week. So if you are at average risk for breast or ovarian cancer then hold on to your ovaries.  If you have a mother or sister with breast cancer, then suggest to them to get BRCA tests.  If your family member is a BRCA carrier then you should also be tested.  If you are negative then be reassured you are at average risk.  However if you are a BRCA carrier then you should consider prophylactic surgery to lower your risk of developing cancer. Wishing you Happy New Years & a Healthy 2009! Women’s Health Specialists 2299 Mowry Avenue, Suite #3C Fremont, CA 94538 510.796.7057 www.WomensHealthFremont.com Share this newsletter with those you care… sisters, mothers, friends

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