Question:

I am a 53-year-old African American woman with severe menstrual bleeding due to fibroids. Over the last 19 years, I have had two myomectomies and two UFEs. I am scheduled to have a hysterectomy because the fibroids keep returning. Several people have suggested that I have an oophorectomy due to my family history of cancer. With my medical and familial history, what is my likelihood of developing ovarian cancer?

Answer:

Determining your risk of ovarian cancer may influence your decision in which fibroid treatment option is best for you. If you have a family history of ovarian cancer, breast cancer, or colorectal cancer, you could be at greater risk of developing ovarian cancer. This is because family cancer syndrome due to the inheritance of certain gene mutations may cause these cancers. Your risk of ovarian cancer is higher if you’ve inherited breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2). BRCA1 increases your risk by 35 to 70 percent and BRCA2 increases your risk by 10 to 30 percent. In this case, you may want to consider genetic counseling and testing to determine if you have inherited mutated genes.

There are many options available to treat fibroids and it is important to explore them all. Depending on the size of the fibroids, an intrauterine device (IUD) containing the progestogen hormone Levonorgestrel can reduce severe menstrual bleeding caused by fibroids. This treatment option is more effective for managing smaller fibroids, and might not be effective for someone with larger fibroids that distort the inside of the uterus. Birth control pills can also help with bleeding. Another treatment option is myolysis, which uses energy to shrink and destroy fibroids. Hysterectomy is a surgical treatment option for many reproductive health related issues, including fibroids; however, many of the performed procedures are not necessary. The National Women’s Health Network suggests getting a hysterectomy as a last resort.

If you do choose to have a hysterectomy, your healthcare provider might suggest removing your ovaries at the same time claiming it will eliminate your risk of ovarian cancer, but this is not always recommended. If you are at high-risk of developing ovarian cancer, you may want to consider removing your ovaries, but if you are not, then it may be best to keep them. Removing your ovaries may cause you more harm than good. A recent study revealed that ovary removal during a hysterectomy is linked to an increased risk of heart disease, more prevalent cancers, and premature death. If you are at higher risk of developing heart disease than ovarian cancer, it may be better to preserve your ovaries, as coronary heart disease is the number one killer of men and women in the United States.

It is important to consider all the potential risk factors and treatment options available. Discuss these options with your healthcare provider so you can make the best decision for your health care needs.

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