Myomectomy or Hysterectomy > Keeping Ovaries
Androgen Levels lowest in women with Oophorectomy
The Journal of Clinical Endocrinology & Metabolism published a report recently about androgen levels in a large survey of women.
The cross-section was otherwise healthy women aged 18-75. Some were pre-menopausal, some post-menopausal and some had surgically induced menopause.
"We report that serum androgen levels decline steeply in the early reproductive years and do not vary because a consequence of natural menopause and that the postmenopausal ovary appears to be an ongoing site of testosterone production. These significant variations in androgens with age must be taken into account when normal ranges are reported and in studies of the role of androgens in women."
What this seems to indicate to me is that ovaries are important to the female endocrine system and function far beyond the fertile years. What these androgens do, precicely, is not completely understood, but I'd guess that we need them.
There was further news as well that serum testosterone levels apparently have little correlation with women's libido. Though the report concedes that testosterone may still be integral to sex drive, the levels detected in the blood may have little to do with it.
This may put a lot of this research back to square one and should alert women that there is certainly no pill or patch at this time that can take the place of ovaries.
Posted by Elizabeth M. at 6:42 PM
HRT After Menopause Increases Bladder Incontinence
HRT has been shown to be worse for bladder troubles than nothing at all. We all thought it was the opposite, didn't we? We all recognize that one of the side effects of menopause is an increase in urinary incontinence so one of the benefits of HRT was always supposed to be a decrease in bladder problems.
Not so, unfortunately.
A new study published February in the Journal of American Medicine found that:
The researchers found that menopausal hormone therapy increased the incidence of all types of UI at 1 year among women who were continent at baseline. The risk was highest for stress UI (1.87-fold increased risk with CEE + MPA; CEE alone, 2.15-fold increased risk), followed by mixed UI (1.49-fold increased risk with CEE + MPA; CEE alone, 1.79-fold increased risk). The combination of CEE + MPA had no significant effect on developing urge UI, but CEE alone increased the risk by 1.32 fold. Among women who reported having UI at baseline, both frequency and amount of UI worsened in both trials. Women receiving menopausal hormone therapy were more likely to report that UI limited their daily activities and bothered or disturbed them at 1 year. (conjugated equine estrogen = CEE / estrogen plus progestin CEE plus medroxyprogesterone acetate = MPA)
On that page with the article is also a rebuttal which emphasizes that this was merely one attempt at studying estrogen, which was conjugated equine estrogen. Some people believe very strongly in finding sources of bioidentical estrogens and that medroxyprogesterone acetate is NOT the same as the progesterone our body produces. No study as been released yet that studies the effectiveness of estrogen creams on the same urinary incontinence problems either.
Until then, keep your ovaries if you can!
Posted by Elizabeth M. at 3:49 PM
HRT/Oophorectomy & Strokes
In my continuing crusade to inform women about the value of their ovaries, I saw this article in a UK newspaper online yesterday.
A study released by the University of Nottingham using a base of 40,000 women and found that women on HRT had a 29% greater risk of strokes.
This comes in the same week that I saw the results on HysterSisters.com of their annual survey, which includes a base of respondents of a little less than 6,000.
The most startling thing of course is that half of the women who'd had hysterectomies also had oophorectomies (I think that's about 2,580 of the respondents since not all had hysterectomies at the time they took the survey).
79% said that they had moderate to high intensity of menopause symptoms (and let's consider all those symptoms that aren't "felt" like osteopororis and arterial damage).
42% of women who went on HRT were not satisfied with the forumlation
62% who changed formulation reported better results, but 11% still didn't have their mix right.
What disturbs me so much is that I still see ladies in their forties being told that their doctors prefer to remove their ovaries at that time to reduce their risk of ovarian cancer - or worse, because they don't need them anymore. I, of course, and doing my best to help show them the most recent information. The American College of Gynecology and Obstetrics abandoned the prophylactic removal of ovaries for women over forty-five back in the nineties.
One of the ladies on the board pointed to an excellent article (PDF file) called - Rationale for Ovarian Conservation by Donna Shoupe MD. Any woman considering any gynecological surgery should read that article. The article is five years old and seems to have made very little dent from what I've seen on the hystersisters boards. For every woman who asks for advice on the topic, I'm guessing there are five that blindly follow their doctor's counsel.
New Tests on their way for Ovarian Cancer
I know I wrote a lengthy article last week about keeping your ovaries. One of the things that I mentioned is that there will be tests available soon to detect ovarian cancer before it advances into the less treatable later stages.
There was great news in last month's issue of Cancer Research. Johns Hopkins Kimmel Cancer Center have developed a test examining three markers in the blood. Used in conjunction with the existing CA-125 test it was 83% effective at diagnosis early stage ovarian cancer. Not only that, the false positives were reduced from 48% of the time to 6%.
The blood test screens for three different proteins that are unique to those with ovarian cancer. Not only does this allow doctors to diagnose the cancer earlier, but it may eventually lead to a better understanding of how the cancer develops, what causes it and to find the genetic markers that predispose women to this disease. The test still needs more testing with a larger group of test subjects before it will be widely available. More info here.
In other news, the Fox Chase Cancer Center have taken a different tactic for detecting ovarian tumors by searching for indications of hypermethylation of two tumor-supressor genes. I don't fully understand this approach, but because it's not looking for protein markers like the Johns Hopkins test, it seems that it offers yet another front to attack this elusive cancer. This same team used the same approach with detecting prostate cancer and kidney cancer with the same tactics. More info here.
Other encouraging findings include a study out of the University of Southern Florida College of Medicine point to using aspirin to inhibit growth of ovarian cancer. Trials are underway in order to determine if women should be directed to take aspirin to prevent ovarian cancer. More info here.
My hope is that one or more of these tests will be available within a year, even if it's just a limited trial. My confidence is that within the next five years there will be a simple battery of blood tests that women take just like a pap smear to screen for not just ovarian cancer, but other cancers that can be easily treated when found early.
Any questions or feedback? Feel free to email me.
Posted by Elizabeth M. at 6:38 PM
A Case for Keeping Ovaries
I've been hanging out over at HysterSisters and have been noticing a trend - women asking for advice about whether or not to keep their ovaries. Without a strong indication for them to be removed (existing ovarian cancer or strong genetic link, endometriosis, persistent cysts) I'd like to advocate keeping them. And instead of my opinion, I did some research to make a realistic, fact-based case.
First of all, ovarian cancer is not common. In fact, as female cancers go, it's downright rare. And when it is found, the women are most likely over the age of seventy. Yes, it is called the most deadly women's cancer, but that is largely because the pap test now catches early cervical cancer and regular mammograms and breast exams have been catching breast cancer sooner.
In 1994, there were an estimated 24,000 new cases and 13,600 deaths from ovarian cancer in the United States (Boring et al., 1994). Since 1973, incidence has increased slightly while mortality has declined. The 1987-91 age-adjusted incidence was 14.8 cases per 100,000 women; the incidence increases with age until age 75 when rates decline (Ries et al., 1994). Five years after a diagnosis of ovarian cancer, survival is approximately 42 percent (Ries et al., 1994). linkSo Who Is Most Likely to Develop Ovarian Cancer?
* Have 2 or more relatives who have had ovarian cancerOn the other hand, statistically ovarian cancer risk is reduced in these cases:
* Have a family history of multiple cancers: ovarian, breast or colon cancer
* Were diagnosed with breast cancer under the age of 50
* Have a personal history of multiple exposures to fertility drugs
* Are of Ashkenazi Jewish decent
* Have had uninterrupted ovulation (never used birth control pills, or no pregnancies)
* Have the BRCA1 or BRCA2 gene mutation
* Are over the age of 50
* Multiple children-women with children have a 45% decrease in risk of ovarian cancer relative to those women who have not borne children. Each child is associated with a 10-15% reduction in risk. * Breast feeding-a reduction in lifetime risk for ovarian cancer of nearly 1% for each month of lactation has been reported. * Oral contraceptive use-OC use appears to reduce the risk of ovarian cancer by 30-60% depending upon the duration of use. * Tubal ligation (sterilization)-33% decrease in risk * Removal of the ovaries (Prophylactic oophorectomy)-this is only considered in patients proven to carry the following inherited cancer syndromes: familial site-specific ovarian cancer, familial breast/ovarian cancer, Lynch II syndrome. The benefits are as yet unproven and should be discussed with a genetic counselor. * Hysterectomy link
Did you see that last one listed? Yes, you read correctly, hysterectomy reduces the risk. I did a little checking and found this that perhaps explains it:
The risk of ovarian cancer goes down if the ovaries remain after hysterectomy. The reason for this is not clear, but it may be that the path for potential carcinogens from the vagina to the ovaries is interrupted when the uterus is removed. Thus, the risk of a woman developing ovarian cancer after hysterectomy is probably closer to 1 in 300 rather than 1 in 80 for women who have not had a hysterectomy. The benefit of removing ovaries for ovarian cancer prevention has been overstated in the medical literature and is, therefore, misunderstood by most physicians. link
What do you do if you're afraid of ovarian cancer?
Get regular gynocological exams. Even if you've had a hysterectomy, continue to visit your gynecologist and discuss your hormonal health, your bowels, your bladder and any other indications of your hormone levels (breast changes, appetite, weight loss and gain, bloating, distended belly). There is a blood test, the CA125 test that measures the CA-125 antigen in the blood, which rises in the presence of ovarian cancer. It's not foolproof, but it's relatively painless and an easy test. It's not foolproof though and can give false negatives and false positives. There are also new tests on the way.
What Kills Women?
Yes, ovarian cancer is serious. But far more menacing as cancer goes are lung cancer, breast cancer, colon cancer and in African-Americans pancreatic and cervical cancer also out-pace ovarian cancer mortality.
I'm not trying to minimize the risk of ovarian cancer. But let's face it, ovarian cancer is not what kills women. Obesity related diseases kill women - diabetes, strokes and most of all, heart attacks.
Here's a little breakdown for the year 2000:
The Important Things
Yes, sometimes genetics gives us a raw deal, but instead of worrying taking out functioning organs, concentrate on the things that you do have control over. Keep fit, watch your diet, stay out of the sun, get a positive attitude, expand your mind, spend time with the people you love, make other's existence better. Enjoy life.
Any questions or feedback? Feel free to email me.
Posted by Elizabeth M. at 6:56 PM