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Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: OB GYN
Satisfied Customers: 52492
Experience:  GP in the United States
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My 55 year old partner is due to have either one or both

Customer Question

My 55 year old partner is due to have either one or both ovaries removed, and my question concerns which is best? The reason is a large (9cm) pelvic mass recently found, which the gynaecologist is pretty sure is a long standing, benign dermatoid cyst loosely
attached to one ovary. She’s never had children so has never had this found by ultrasound before. Pelvic pains lead to the ultrasound which found it. In the last year she lost 5 stone (hard dieting, nothing sinister!) which by shrinking internal fat may have
led to its movement and occasional pain spasms. All blood tests including the CA125 marker for Ovarian cancer are clear. At the first meeting, the gynaecologist explained the rather shocking news and said both ovaries would have to go with the cyst. At a second
meeting today, we asked about keeping the apparently healthy second ovary and his reaction was ambivalent. Obviously, if the second Ovary looks bad in theatre, he will need to remove it too, but otherwise he seemed to be leaving the decision to my partner.
One online gynaecologist’s website says that if a mass is over 6cm then both must go, but we heard nothing as clear as this from ours. He pointed out that losing the second Ovary too would remove the 1 in 70 risk of Ovarian cancer. But the loss of Testosterone
would end any remaining libido he said. The latter concerns me from the point of view of how my partner will feel in her own mind/body, some women seemingly being psychologically affected by this. Online research suggests that losing both Ovaries carries health
risks (Cardiovascular, Osteoporosis, Dementia etc) due to the abrupt loss of what would otherwise be tapering levels of protective hormones (Testosterone). Oddly, the gynaecologist disputed this health risk saying ‘it was the same with menopause in general’.
I've also read that sparing the second Ovary might lead to maintaining the tapering hormone levels, though clearly at the cost of the Ovarian cancer risk still remaining. Is the risk halved with one Ovary remaining? Our young GP, who we both like, said the
Ovaries would be of no use now so should be removed to avert any Ovarian cancer risk. On that subject, my partner’s risk factors appear to be having had no children and having been overweight much of her life, though not now. She was on the Contraceptive pill
for 20 years (apparently a plus) and has had a Mirena coil for the last 13 years, having no periods as a result. Our GP is fairly anti-HRT, so my partner is not on this. We’d gone hoping for some friendly advice, but found the meeting rather cold and uninformative.
I feel my partner is being left to make a significant decision with only a layman’s knowledge. I am wondering if you would be more direct in advising a course of action and the likely consequences of that?
Submitted: 1 year ago.
Category: OB GYN
Expert:  Dr. Phil, MD replied 1 year ago.
any other medical issues?
Customer: replied 1 year ago.
Hi Dr Phil,No other medical issues, long term good health other than this. Local Dr ordered a wide range of blood tests (including CA125) which were all fine. Hospital Gynaecologist repeated blood tests (including CA125 again) which were again fine. Gynaecologist checked with their oncologist who said chances of pelvic mass being cancer were 1 in 1,000.Roy.
Expert:  Dr. Phil, MD replied 1 year ago.
I totally agree with the GP. There hormone levels are basically nil given the current age.I would remove them both and eliminate any chance of cancer down the road
Expert:  Dr. Phil, MD replied 1 year ago.
Please don't forget a positive rating. I appreciate it. :)
If you have more questions, just reply
Customer: replied 1 year ago.
Dear Dr Phil,I was expecting rather more of a reply than this, having requested a 'detailed' response. In particular, you have not expressed any opinion on the effect of losing both both ovaries (beyond averting any cancer risk) regarding the raised Cardiovascular, Osteoporosis etc risks. The fact that these seem to rise suggests that the hormones released at 55 cannot be nil, or there would be no documented risks after both are removed? Likewise, our Gynaecologists said any remaining libido would go. Please can you give your opinion on these consequences?Thanks,Roy.
Expert:  Dr. Phil, MD replied 1 year ago.
I would challenge you to provide proof that these risks increase because of ovary removal. They don't. They increase with menopause. At 55, this person is very likely in menopause. So the effect of removal is nil.Let me know if you need clarification
Customer: replied 1 year ago.
The Wikipedia article on Mortality associated with oophorectomy states:The effect is not limited to women who have oophorectomy performed before menopause; an impact on survival is expected even for surgeries performed up to the age of 65.[15] Surgery at age 50-54 reduces the probability of survival until age 80 by 8% (from 62% to 54% survival), surgery at age 55-59 by 4%. Most of this effect is due to excess cardiovascular risk and hip fractures.[15]The cited paper is:
Shoupe, D.; Parker, W. H.; Broder, M. S.; Liu, Z.; Farquhar, C.; Berek, J. S. (2007). "Elective oophorectomy for benign gynecological disorders". Menopause 14 (Suppl. 1): 580–585. doi:10.1097/gme.0b013e31803c56a4. PMID 17476148.Are you aware of these claims, which I've read elsewhere, or do you not accept them?
Expert:  Dr. Phil, MD replied 1 year ago.
I don't accept that risk. 4% excess risk is way too high
Expert:  Dr. Phil, MD replied 1 year ago.
Please don't forget a positive rating.
If you have more questions, just reply. :)

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