Uterine prolapse after menopause

[Samu15]

I am 51 years old and have 3rd stage uterus prolapsed and my menopause got over 2 he doctor has adviced me surgery. She took a few tests and in the pap smear it showed ASCUS cells. She said it is nothing to worry about but suggested the ovaries be removed as well because of my menopause and age so that it does not turn in to ovarian cancer in the future. I am very worried about the thought of removing ovaries. I have diabetes and blood pressure also and I have read that removal of ovaries results in oestoporosis later on. I worry that I may not have much strength after hysterectomy. Please if someone has gone through a similar case let me know what deicision to take. I don't know if I should take a second opinion to reconsider ovaries bring removed or to listen to the doctors advice. Kindly help

[ipurr2]

I had my ovaries removed...as well as my uterus....biggest regret! I also have had both a vaginal pop repair sutures only...as well as a Robotic-assisted laparoscopic mesh sacrocolpopexy...not all at once...first the hysterectomy with ovaries removed...for endometriosis...which it DID NOT cure! then I had the other surgeries...thanks to endo and taking out my organs...my pelvic floor structure is so weak...and I am now 8 abdominal/pelvic floor surgeries in...I am happy with my Robotic-assisted laparoscopic mesh sacrocolpopexy...but not the hysterectomy or the vaginal suture repairs...if I could have a do over...I would have NEVER agreed to let them take my female organs...as I feel that is a big part of why I have pop to deal with now...granted the endometriosis did it's damage by gluing my organs that should be able to move in my abdominal area...making them unable to function properly but I know that when they take our uterus and ovaries they cut ligaments (which are support structures) and blood supply, nerves...they make it seem like no big deal...but it's a HUGE deal...even at peri-menopause or after menopause the ovaries still communicate with the body letting them know...we don't need all this estrogen anymore...but when they are gone then that peice of the puzzle can no longer communicate so the other systems will keep sending signals trying to get a response from the ovaries but no ovaries to message back...it's a tough and personal choice that we all have to make for ourselves...but I can say from my personal experience...if I could have a "do over" I would not have had the hysterectomy with BSO...I would have the  Robotic-assisted laparoscopic mesh sacrocolpopexy again if it all fell today in a heart beat...no regrets on that one and I will be 2.5 years out in June...but this is another one that one really needs to research and the only dr. I would allow to do pop surgery on me would be a urogynecologist as they are the specialist trained in this field...ask them hard questions...like...have you had any problems with mesh? if so, how did you help the patient...if they say they have never had a problem...I would find another urogyn because they all have to learn...I saw 5 uro/gyn's before choosing the one I did that was states away...I now see my second choice who is local...both do mesh and did have a couple with problems in the learning phase of placements...one is very much for mesh and one is only if the suture repairs fail...which mine did...so I will in time have that repaired with mesh...but that is because I have so far had a good experience with it...that could change at any time but for now...2.5 years in...I am happy with my mesh...also had a mesh rectopexy at the same time as it was a 6.5 hour surgery...my pf was a disaster...I would definitely try a pessary first and all uninvasive things before surgery because it's a huge surgery with lots of risks...but I went in with my eyes wide open on the risks with that one and don't regret...I was very uneducated and trusting of my dr. who did the hysterectomy and really regret that one...so research, research, research! If you aren't sure...wait...until you have more clarity on what to do!
Good luck and if you have any questions...I am around...;)

[old_before_my_time]

Oops - I forgot to address the prolapse issue! Unfortunately, removal of the uterus increases the risk for bladder and bowel prolapse. And there are other adverse effects of hysterectomy (as mentioned in my other post) so you would trade one set of problems for another.

If your bladder is by chance already prolapsed as well, it would seem reasonable to suspend both the bladder and the uterus which would allow you to keep your uterus and its lifelong non-reproductive functions.

A non-surgical option which avoids all the risks of prolapse surgery or hysterectomy (these are major surgeries) would be to get fitted for a pessary which would hold up your uterus and bladder.  

[old_before_my_time]

You are right to be concerned and question your doctor's recommendation. For one, your pap smear result ASCUS says that the abnormal cells are of "Undetermined Significance." Oftentimes, this type of pap result is not cause for alarm and a repeat pap may be all that is needed. You mentioned that you are post-menopausal. The loss of estrogen to the urogenital and vaginal tissues (including the cervix) can in itself cause this result. The use of some vaginal estrogen cream or tablets (such as Premarin cream, Estrace cream, or Vagifem tablets) can restore these tissues and result in a normal pap smear. Also, even if the ASCUS result is not from this loss of estrogen, there are other harmless conditions that can cause ASCUS which is why a repeat pap is often recommended in 6 moths or so versus undergoing further testing or treatment.

But even so, going straight to hysterectomy does not make sense. The standard progression for a truly concerning pap smear result (such as LSIL or HSIL or CIN1, CIN2, or CIN3) would be to do a colposcopy to get a closer look at the tissues and obtain a biopsy. The biopsied tissue would then be sent to pathology to determine whether or not additional treatment such as cryosurgery/cryotherapy (freezing), LEEP, or conization is necessary to remove the abnormal cells. So even if you had more "definitive" results than ASCUS, hysterectomy would not be the first-line treatment and is overkill.

If you do not have a family history / predisposition for ovarian cancer then your risk for ovarian cancer is very low. In the U.S., a woman's LIFETIME risk of ovarian cancer is less than 2%. Since the ovaries are ESSENTIAL for lifelong health (they produce hormones at least until age 80), you do not want them removed unless it is necessary. Their removal is associated with numerous increased health risks, two of which are heart disease and osteoporosis. And there is a fairly high risk of ovarian failure after hysterectomy due to loss of blood flow which would leave you with the same health risks as ovary removal. Loss of pelvic and skeletal integrity as well as sexual dysfunction are additional harms of hysterectomy.

There is a lot of information out there on the internet about pap smears and cervical dysplasia treatments as well as the adverse effects of hysterectomy and/or ovary removal (oophorectomy).

It is so important that we do our own research and understand our diagnosis and all treatment options along with their risks as we are the ones who have to live with the consequences. Hysterectomy is a grossly overused surgery in a number of countries so we have to keep that in mind as well. In the U.S., only 2% are done for cancer.

My organs were unnecessarily removed 9 years ago at age 49 and I regret it every day. It has caused many more problems than it resolved.

Best of luck to you and please keep us posted on what you find out. And do not hesitate to ask questions if you need more information.