Guess what? I have a date for my surgery—April 7!
It’s a little more in the future than we’d originally envisioned, by about a month. Which gives me some time to do what I do best… over-think it!
Part of the reason for the delayed date is that is that we needed to find an available time for not just one, but two surgeons. One surgeon to remove my colon and another to remove my ovaries at the same time.
Wait, what? You’re thinking, if you’ve been keeping up so far, when did the ovaries get involved here?
It goes back to that fun Lynch Syndrome chart that tells us that while the risk of colorectal and endometrial cancers are the highest, the risk of ovarian cancer is also pretty high (between 8-38% according to the chart). When someone has a high risk because of a genetic mutation, the option is always on the table to remove the risky organ as a prophylactic (preventative) measure. If I have my ovaries removed, my chances of getting ovarian cancer are decreased by 95%. (Yeah, I know it seems like it should be 100%, but for some reason it’s not.)
For years, I’ve been doing ultrasounds and a special blood test for a marker called CA-125 to look out for signs of ovarian cancer, but both of these tests are felt to be very limited—definitely not as sure a bet as removing my ovaries. So for years, doctors have been checking in with me to see if I want to get rid of my ovaries, and I’ve been saying “Guys, not yet! Can’t you see I’m still using them!” This is because even though I’ve had my uterus removed (a hysterectomy), my ovaries continue to pump out hormones, which means I haven’t yet gone through menopause, and there are definite benefits to that.
But now… I’m probably within a few years of not using them so much (they are producing less hormones, approaching a natural menopause) and, of course there are going to be some holes cut into my abdominal region anyway… why not do two-for-the-price-of-one? (Note: I’m fairly certain I will NOT get two surgeries for the price of one! But it will be going under anesthesia only one time, getting cut into only one time and I’ll can maybe max out my insurance deductible just once.)
Given all this, it seems like it makes sense to, a lá Marie Kondo, thank my ovaries for their service, for the joy and protection they have provided, and let them go…
… Except that when I met with to my surgeon the other day, she said something in passing like “yes, even though mortality rates go up with ovary removal, in makes sense to blah blah, medical stuff…”
Wait… what was that about mortality rates?
Thus far, no one had mentioned this fact before now, but it pinged my radar enough to spur some internet digging, which turned up articles like this one, from 2017, called “Bilateral Ovarian Removal Associated with Increased All-Cause Mortality,” and one from 2013, called “Long-term Mortality Associated with Oophorectomy versus Ovarian Conservation in the Nurses’ Health Study.” In short, women who have their ovaries removed before their natural menopause die sooner, either from heart-related issues, or just… other stuff. As my doctor put it “we don’t exactly know why.” (However, there are also articles like this one, that say the difference in mortality is are less or perhaps negligible if the removal happens after age 50. Others say 55. One assumes that one’s age of natural menopause is a factor, but would be hard to incorporate into a study.)
So maybe, I’m thinking now, I should hang on to my ovaries a little longer — maybe they’re still sparking joy after all?
And maybe my overall risk ovarian cancer / dying from ovarian cancer isn’t quite as simple as the scary chart would indicate. My overall risk of ovarian cancer is lower because I’ve had my fallopian tubes in the past. The study sited in “Ovarian Cancer risk after salpingectomy” says the decrease in risk might be as much as 50%. This paper I kind-of-partly-undertand called “Features of ovarian cancer in Lynch Syndrome” seems to be saying that the survival rates for Lynch relate ovarian cancers are statistically higher than for sporadic cancers (not that I’m keen to test it and find out) due to being diagnosed at an earlier stage and also to having different properties.
Mortality aside, I’ve also discovered there are a number of more immediate effects to menopause — maybe exacerbated by being a sudden, surgical menopause—that I hadn’t realized. While we associate hot flashes to menopause, no one has ever sat me down and talked to me about potential hair loss, fatigue, anxiety, depression and brain fog. These symptoms are not a given, and they are not life threatening, but they are quality-of-life threatening.
Needless to say, I’m going to be ruminating…