I’m having a hysterectomy Should I Keep My Ovaries?

Dr. N provides bio-identical treatment regimens that will resolve your  hot flashes, sweats, sleep disturbances, headaches, fatigue, depression, give you back your sex life and keep you looking younger. Our goal is for every one of our menopausal patients to be able to say … I’m Back to being me.

Click link below to see videos of Dr. N’s patients discussing their menopause and their therapy.

Menopause – Symptoms, Sex and Hormones – YouTube

If you are having a hysterectomy the rationale for keeping your ovaries, would be to maintain the source of your own sex hormone production. It is possible that your ovaries may continue to produce adequate amounts of estrogen and testosterone until the time you would have had experienced a natural menopause. The normally functioning postmenopausal ovary also may be capable of producing significant amounts of testosterone for several years following menopause. Testosterone is the hormone is closely associated with energy levels, lean body mass, libido and sexual function. In addition, if testosterone levels are present, some of it may be converted to estrogen by a process called, “aromatization”. This may be the reason that most naturally menopausal women are known to have less severe menopausal symptoms and fewer negative health consequences. as contrasted to women who have had their uterus and ovaries removed surgically.

However it should be noted, there is an increased incidence of ovarian failure following hysterectomy. This is discussed in some detail in the section of the web site, Ovarian Failure Following Hysterectomy

Is there any reason I might want my ovaries removed? 

There is always the argument that removing the ovary prevents the possibility of ovarian cancer. A woman has a 1 in 70 chance of developing cancer of the ovary during her lifetime. Due to a lack of symptoms initially, the presence of ovarian cancer is typically not discovered until a late stage and for this reason is often fatal. The peak incidence of ovarian cancer is between the ages of 70-80.

There is a type of ovarian cancer that is hereditary. The mutated genes responsible for most hereditary ovarian cancers have been identified, (BRCA1, BRCA2). There is a blood test available to identify carriers of this gene. Woman who are identified as having the mutated gene should consider the option of ovarian removal and non-carriers can be assured that their risk of ovarian cancer is not increased.

I’m concerned about the possibility of ovarian cancer, but I want to keep my ovaries. Is there anything I can do? 

If you were to decide to keep your ovaries, there are strategies that can be and I believe should be implemented by all women, to increase the possibility of discovering a developing ovarian cancer at an early stage and increase one’s chance of surviving this disease. (1)A yearly pelvic ultrasound utilizing one of the more advanced ultrasound technologies. (2)A yearly CA 125 blood test. (3)A yearly pelvic examination. (4)An immediate visit to the doctor for any persistent abdominal symptoms such as persistent bloating or abdominal or pelvic discomfort. Some sources believe that a yearly pelvic ultrasound and CA 125 blood test is not effective in the early discovery of ovarian cancer but I do not agree with this concept.

What if I have endometriosis?

If the reason for your hysterectomy is endometriosis, there is an additional consideration for removing the ovaries. There is research that documents that patients who were treated for endometriosis with ovarian conservation were at a substantially increased risk of recurrent symptoms and a frequent need for an additional surgical procedure as compared to those who had ovarian removal.

Is there an age that you recommended that your patients who needed a hysterectomy have their ovaries removed?

If I was asked, I usually recommended that patients 45 and over consider having their ovaries removed, assuming they are committed to using HRT. Not all women respond well to the more frequently used HRT regimens. Accordingly, one important factor in the decision making process is whether you have a physician resource available who is knowledgeable about menopausal issues and skilled in HRT treatment options including hormone pellet implants. This is discussed in the section of the web site, Hysterectomy.

If I have my ovaries removed, should I go on HRT?

I would certainly suggest that. I believe that women who are experiencing hormonal deprivation should consider appropriate HRT as a first line strategy for health and quality of life maintenance. Surgically menopausal users of HRT are known to have a lesser incidence of osteoporosis, cardiovascular disease and death, than non-users. In addition surgically menopausal women who are without the benefit of HRT, may experience severe and life altering menopausal symptoms.

What are the risks of going on HRT?

I believe, assuming that HRT is given in a physiologic manner and in my view means a non-oral route of administration, specifically a transdermal patch or gel. The most effective option is a hormone pellet implant in doses that result in physiologic blood levels of estradiol and testosterone, the risks would be no greater than having your own source of hormone production. Non oral HRT preparations have the advantage of avoiding the “bolus, first pass” liver consequences and enzyme alterations associated with oral administration of hormones. Oral administration of HRT is the most commonly used route of sex hormone delivery used in the world but it is my belief that non-oral routes of administration are safer and more effective.

I would like to share a scenario I often saw repeated in various forms.

I would be speaking to a menopausal woman from whom I had just taken a detailed history. She had related that she smoked 1 1/2 packs of cigarettes daily, drank 3-5 cocktails daily, took over-the-counter and prescription diet medication, did no exercise, was 30 lbs overweight, consumed a high fat diet, had undergone 3 cosmetic surgeries requiring an anesthetic, visited a tanning salon 3 times a week, did not wear a seat belt while driving, did not have regular pelvic exams or mammography and was having unprotected sex.

After I had discussed HRT at length, including the weight of evidence that HRT is an effective health maintenance strategy, she would look at me and say, “but I am afraid of the risks of HRT!”


Appointments with Dr. Nosanchuk can be made by calling: (248) 644-7200 and speaking to Caroline Monday through Friday from 10AM to 6PM

IMPORTANT: This website is for educational purposes only.  It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.

Ovarian Failure following a Hysterectomy

Dr. N provides natural hormone regimens for both men and women including hormone pellet implants to keep you looking years younger, restore your sex life, maintain lean body mass, resolve hot flashes, sweats, sleep disturbances, headaches, fatigue and depression. Get back to being you. Call (248) 644-7200 or email: jln35210@gmail.com

If your uterus has been surgically removed before you have reached menopause but you still have your ovaries you could reasonably expect your ovaries to continue to produce sex hormones. Unfortunately, this is not always true and ovarian failure occurs frequently in retained ovaries following a hysterectomy.

There are reasonable considerations for keeping your ovaries when a hysterectomy is indicated. This is certainly true prior to age 45 and in some cases even after. This may not be possible when the ovaries are diseased, or if there are conditions such as extensive endometriosis, or a malignancy of pelvic organs.

The rationale is that your ovaries may to continue to produce estradiol and testosterone until the age your natural menopause would occur between the ages of 48-52.

In addition, following a natural menopause even if the ovaries no longer produce significant amounts of estrogen they may continue to produce testosterone the hormone most closely associated with sex drive, energy levels and maintenance of lean body tissue. Some of the testosterone may also be converted to estrogen in tissues of the body by a process called aromatization. Estrogen levels that result from this process may play a role in maintaining the integrity of your estrogen-dependent tissues

Accordingly, it makes sense to keep your ovaries if possible as it may preclude your need for hormone replacement until the time of your expected menopause.

“I had a hysterectomy and I kept my ovaries but I have menopausal symptoms, hot flashes, I’m tired all the time and I can’t even think of sex. I went to my Dr and he says I don’t need hormones because I still have my ovaries. Is he right?”

No some physicians just assume that if the ovaries are there they must be functioning.

“So, what do I do about this?”

First, you are probably right and your problems are related to ovarian failure. You can have blood tests performed to document that ovarian failure has occurred. If your present physician is not inclined to order the tests for you find one that will. Have your blood estradiol and testosterone tested. If the levels of estradiol and testosterone are low and your Follicle Stimulating Hormone (FSH) is elevated there is little question that ovarian failure has occurred. FSH, is the hormone secreted by the pituitary gland that signals the ovary to make more estrogen. If the ovary is failing in its ability to do this, the pituitary produces higher levels of FSH in an effort to drive the failing ovary to produce more estrogen. Even if these tests are in the normal range if the ovaries are struggling symptoms may still be present.

“Okay, then what do I do?”

If the blood tests are normal and the symptoms are suggestive of being of menopausal origin, a trial of hormone therapy if desired is indicated. If the symptoms resolve, you have the answer.

“What if the hormones don’t relieve your symptoms?”

The most frequent reason for persistent symptoms is your current HRT program is not effective. If your physician cannot provide you with a more effective program try and find one that can. Ultimately when other methods of HRT have failed I have found that hormone pellet implants of estradiol and testosterone rarely fail to relieve symptoms and restore sexuality. If you would like to know more about hormone implant therapy click the link below,

Bio-Identical Hormone Implant Therapy

“What if my doctor tells me that I have ovaries and I don’t need hormones?”

You are in charge your physician works for you. Not all physicians are amenable to shared decision making. You might consider finding a physician.

Dr. N has specialized in the care of menopausal women for over 30 years.  His office is located in Bingham Farms, Michigan.  For an appointment call (248) 644-7200

IMPORTANT: This website is for educational purposes only.  It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.


Hysterectomy Overview


A hysterectomy is a surgical removal of the entire womb or uterus, which induces a “surgical menopause”. Frequently, in addition to the uterus, one or both of the ovaries are removed during the same operative procedure.


Although, we usually refer to premenopausal women who have had a hysterectomy as having experienced a “surgical menopause” they are not menopausal in a “hormonal” sense unless their ovaries have been removed.


Women, in whom the ovaries are retained, although they no longer have monthly periods, will not experience menopausal symptoms or the effects of hormonal deprivation. That is, as long as the ovaries continue to function normally, or until the age an expected natural menopause would have occurred, or sooner if the ovaries have been compromised by the surgery.

Unfortunately, even if the ovaries are preserved, they become dysfunctional up to 50% of the time within 3 years following the surgery. Nevertheless, in women under the age of 45 preservation of the ovaries is an important consideration when reasonable.


If both of the ovaries are removed the source of estrogen and testosterone production is lost. The fall in hormone levels is sudden and severe. It is a very different circumstance, than a natural menopause where the decline in estrogen levels may be gradual in onset and ovarian testosterone production may continue for several years.

Women in this category, who are without the benefit of HRT, often have the most severe menopausal symptoms and long-term consequences of sex hormone deficiency. Health, quality of life and longevity are affected. There is a statistically shorter life expectancy, associated with a higher rate of death, mostly from heart attacks, strokes, and osteoporosis. Libido and sexual function deteriorate.

A hallmark study published 1983 in the Journal of the American Medical Association revealed a significantly increased death rate among women 40-50 years of age who had had a hysterectomy and who were without the benefit of estrogen replacement, as compared to those who were estrogen users. For those who had their uterus removed, the rate was 3 times higher. For those who also had both ovaries removed, the rate was 8 times higher. It is apparent that careful consideration should be given to HRT after a surgical menopause.


Most of the routinely prescribed programs of HRT are usually effective in preventing the long-term consequences of hormone deficiency and maintaining quality of life.


Unfortunately, following the surgery, there is a group of women who experience life-altering symptoms, which are unresponsive to the routinely prescribed regimens of HRT. This often presents a dilemma. We have a woman who has undergone a major surgical procedure. She has been told that if she takes HRT, her quality of life, including her libido and sexual function, will be the same, if not better.

If she is fatigued, having symptoms and has no libido in the immediate post-operative period, it may not seem unreasonable to her. After all, she just had a major surgery., didn’t she? A few months go by and she is still fatigued, having flushes, insomnia, problems with her memory and she has no sex drive.

She does the reasonable thing. She returns to her physician, who changes her HRT regimen several times. Months go by, and she feels no better. She returns to the doctor again and restates her concerns. The physician looks at her, shakes his or her head, almost, but not imperceptibly, and speaks.

“You weren’t psychologically ready for this surgery,” or ” Are you having trouble at home.” And then, “This has nothing to do with the surgery … you need to see a therapist.”

She looks at the physician in disbelief, just having suffered the indignity of having her legitimate concerns invalidated. She feels betrayed, and wonders what she has to do, after leaving this “jerk’s” office to regain her life. So, she goes to several new physicians, and is placed on several additional HRT regimens, without success. Next, she purchases several vitamin and/or herbal preparations and rubs on progesterone cream with no improvement. She reads everything she can that seems to address her problem. Ultimately, if nothing helps, she begins to doubt that she will ever feel like herself again. And, sometimes she even begins to wonder if some of the problem is actually in her mind.

Well, it’s not in her mind. If she felt fine prior to her surgery, and now does not, it is probably related to the surgery. On the other hand, it could be an amazing coincidence, but I keep reading that great detectives don’t believe in coincidences, so why should we.

Does this sound like an unlikely scenario? Well, it’s not. There are many women who feel exactly this way and are desperately trying to regain their quality of life.


They need to find a physician who is knowledgeable in the treatment of menopausal women and who has expertise in the wide range of HRT therapeutic options. Ultimately, if nothing else seems to work, “subcutaneous hormone implants” are almost always effective. The sections of the web site, MENOPAUSAL SYMPTOMS, ABOUT HRT, METHODS OF HRT and REGIMENS, will provide more information about this.


It would be helpful to contact a compounding pharmacy, such as College Pharmacy for information about some of the HRT options that are available. They will provide information about their products to patients and their physicians regarding availability and appropriate use. There is a link to their web site on the links page. If necessary they can also provide the names of physicians to whom they provide specialized HRT products.


No one should have a hysterectomy or any surgery if it’s not necessary. In the past far too many hysterectomies were performed. Even today patients need to remain vigilant and consider the benefits and potential consequences before making a decision.

But there are instances when surgery is reasonable. One indication for surgery is the presence a malignant or premalignant involvement of the uterus, cervix or ovaries. Another, is uncontrolled uterine bleeding, which is unresponsive to more conservative therapy. Vaginal bleeding can cause life-threatening anemia and often surgery is the only option. Endometriosis, and a condition called adenomyosis, can be painful and life altering and surgery is still the best option in many cases. Surgery is often the most reasonable option for women who have a ‘uterine prolapse,’ a condition where the uterus protrudes into the lower vagina. The surgery also performed for benign growths of the uterus, called “uterine fibroids,” when they are thought to be the cause of bleeding unresponsive to non-surgical therapy, pain or impingement of other organs.

Sometimes, women who have surgery for these indications find that their quality of life is significantly improved. This is particularly true when the problem is endometriosis, vaginal hemorrhage and uterine prolapse.

Ovarian Failure Following Hysterectomy
Hypothetically, if you’re premenopausal and still have your ovaries following a hysterectomy, one would expect continued production of ovarian sex hormones. Unfortunately, it has been well documented that this is often not the case. A number of medical studies have documented that ovarian failure occurs frequently in retained ovaries following a hysterectomy …

I Want To Know If I Should I Keep My Ovaries
There is no right, or wrong decision. The choice in keeping or taking the ovaries ultimately is a personal one…

Dr. Jerry Nosanchuk is a practicing physician who has specialized in the care of menopausal women for over 30 years.  His office is located in Bingham Farms, Michigan.  Appointments with Dr. Nosanchuk can be made by calling: (248) 644-7200 and speaking to Caroline Monday through Friday from 10AM to 6PM

IMPORTANT: This website is for educational purposes only.  It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.