Dear Dr N, I am scheduled for a hysterectomy for endometriosis and I am 35 years old. I do not want to have pain anymore. Should I have my ovaries out too? signed puzzled

Dear Puzzled- This is a great question! On one hand I am certain that you want to feel better with less pain and suffering from the disease of endometriosis. I am certain you and your clinician have tried many forms of conservative therapy if you have arrived at a hysterectomy. It used to be that if you were having surgery to manage pain, and wanted it to be definitive, we were taught to remove the ovaries and replace the hormones. There are many new studies now in support of conserving the ovaries, which has always been my preference. Early menopause increases the risk of osteoporosis. It also increases the risk of ‘all-cause’ mortality, meaning that it may shorten your life span if women’s ovaries are removed before 45 and hormones are not replaced. There are also a small, but not significant number of women that just don’t feel right after having their ovaries removed either with menopausal symptoms or an affect on cognition and libido despite our efforts to given them their hormones back. In my opinion, it is better to be conservative to start and see if it will manage the pain well enough. Do not add surgical menopause to the problem and then if the pain persists, your surgeon can always go back laparoscopically and remove the ovaries.If they are removed, be sure and have hormonal supplementation for at least 10 years. Your body needs it. There are studies that support the removal of the fallopian tubes to lower the risk of ovarian cancer at the time of hysterectomy. I DO support this. In short, I believe in ovarian conservation while you are still using them unless you are close to menopause 48-51.
By all means talk to your provider, you two have all the facts. Good Luck. Dr N