Women's Health Community

Dear lilvampgurl: Here is a link to get you into the site of the North American Menopause Society (NAMS):

http://www.menopause.org/for-women/expert-answers/faqs-menopause-basics

The most recent consensus statement from NAMS, on women who become menopausal before age 40, suggests that hormone therapy (HT) can be continued into one's 50's. The statement also notes that risks for cardiovascular side effects are likely to be less in younger women.

Because of your stage 4 endometriosis you might want to know how your GYN feels about using estrogen only. Also the loss of ovaries can, in some women, make low dose testosterone an option.

If you have not found 'Hystersisters" yet here is a link:

http://www.hystersisters.com/

There are discussion groups for all types of hysterectomy issues, including loss of ovaries.

You are to be lauded for doing all this investigation up front. Your own GYN can be a good source of answers for any specific questions, too.

Yours,
Jane

Here's what I've personally experienced and some of what I've found through research. I was close to menopause at the time of my hysterectomy with ovary removal. It's had a negative impact on every aspect of my life even though I'm on estrogen. I don't even look the same; I look quite a bit older than I did before surgery. My eyesight even deteriorated overnight. I used to be the picture of health and happiness. The loss of my hormones also caused severe depression and anxiety as well as the typical menopausal type symptoms. I'm now dependent on estrogen as my anti-depressant and to help with all the other symptoms. Oh and my sex life — it's suffered greatly too. I have very little sensation down there and orgasms are difficult to achieve and disappointing when they occur. And my body's changed too. Between that and my aged appearance, I avoid mirrors!

I assume you know that hysterectomy isn't a cure for endometriosis. It's difficult to remove all implants as they can be found throughout the pelvis including in the bowels. Excision surgery (versus laser or cauterization) by an endometriosis specialist is supposed to be the most effective. But implants can still be left whether or not you have organs removed. And if organs are removed, unopposed estrogen can feed those implants. Yet, going without estrogen especially at your young age increases your risk for many health problems as well as a low quality of life (although I know chronic pain has its own quality of life issues). Here's a summary article in PubMed about the effects of ovary removal - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585770/ .
"Premature loss of ovarian function by elective oophorectomy before natural menopause is associated with an increased risk for premature death, cardiovascular disease, cognitive impairment or dementia, parkinsonism, a decline in psychological well-being and, in some studies, a decline in sexual function. Whether these consequences are due to the abrupt drop in estrogen, testosterone, or progesterone levels, or whether the changes might be mediated through effects on the hypothalamic-pituitary axis via an increase in gonadatropins remains unknown. Estrogen levels are higher in women with ovaries intact than in women after bilateral oophorectomy, even in older women."

This study - http://www.ncbi.nlm.nih.gov/pubmed/10690870 - cited in the previous one shows that the postmenopausal ovaries in intact women continue to produce hormones - "Among oophorectomized women, total and bioavailable testosterone levels did not vary with age and were 40-50% lower than those in intact women throughout the 50-89 yr age range. These results demonstrate that the postmenopausal ovary remains a critical source of androgen throughout the lifespan of older women."

You can search for additional articles in PubMed. Also, it may be helpful to spend a bit of time on a forum dedicated to hysterectomy to see what women are dealing with post-op in the short and long-term. Also a Google search for hysterectomy consequences, side effects, or adverse effects may be helpful.

I assume you've tried most other treatments - hormonal, diet, excision surgery, pelvic floor therapy, etc. One hormonal treatment that I haven't seen listed on many websites and has been used more recently is an aromatase inhibitor (Femara). Here are a couple of articles about it:http://www.endometriosiszone.org/display.asp?page=news_0402_letrozole
http://women.webmd.com/endometriosis/news/20040213/breast-cancer-drug-may-ease-endometriosis

And in case you haven't reviewed some of the endo websites, here are a couple:
http://endometriosis.org/
http://www.endometriosisassn.org/