Hildegard asks: I have been diagnosed with Adenomatous Hyperplasia
and advised to have a hysterectomy. I am 56 years old and haven't
had a period in almost three years. I had spotting for about two
weeks in January of this year. My doctor performed a D & C and
gave me the foregoing prognosis. He stated the cells showed to be
pre-cancerous. Should I have my ovaries also removed if I go ahead
with the hysterectomy? I have had an easy menopause and don't
want to create any problems in that category by having my ovaries
removed. Can you please provide me with some words of wisdom?
Thank you kindly.
First, I would make sure that atypical cells (atypia) were found during the D&C. Adenomatous hyperplasia (also called complex hyperplasia) can be present with or without atypia. There has been some historical debate over whether there are really separate categories of endometrial hyperplasia, or whether it is all on a precancerous continuum. Your doctor may be among those who consider all hyperplasia to be precancerous, even though hyperplasia is not very likely to progress to cancer unless atypical cells are present. For more information on this, see the article Making Sense of Hyperplasia.
As far as whether to remove the ovaries, there is no right or wrong about this. Many gynecologists will just say to take them out after menopause, that they aren't doing much for you at this point, and it reduces the risk of ovarian cancer. On the other hand, a woman's ovaries do continue to function throughout her life, and the fact is that we just don't understand all of what they do. We do know they produce testosterone throughout life, as well as a variety of other hormones and chemicals. There is at least one study that shows that women who keep their ovaries have lower rates of heart disease.
If a woman is having a hysterectomy due to cancer, that is a different situation: the usual recommendation is to include the ovaries in the surgery, as they are a site for metastatsis (cancer spreading). Also, a history of ovarian problems or endometriosis might change the picture when making the decision.
Otherwise, though, an approach that makes sense to me (and many doctors) is to assess your risk for ovarian cancer and family history of breast cancer. If these don't give you a good reason to let go of your ovaries, then keep 'em.
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