What Happens To Your Body When You Have Your Ovaries Removed, According To Doctors
On Oct. 16, 2018, JustJared reported that Lena Dunham had her left ovary removed. On Oct. 17, Dunham posted a photo her mother took of her post-op on Instagram, writing, “Yesterday I had a two hour surgery to remove my left ovary, which was encased in scar tissue & fibrosis, attached to my bowel and pressing on nerves that made it kinda hard to walk/pee/vamp. Over the last month it got worse and worse until I was simply a burrito posing as a human.” Although ovary removal at Dunham's age isn't very common, it does beg the question: what happens to your body when your ovaries are removed?
"If a woman has only one ovary removed she likely won't notice any extremely adverse symptoms long term," Dr. Patrice Harold, director of Minimally Invasive Gynecology at Detroit Medical Center's Hutzel Women's Hospital, tells Bustle. "If both ovaries are removed and she is premenopausal, she will most likely start to experience hot flashes, a change in sex drive, among other things in the immediate post-operative period (one to three days)."
The removal of Dunham's ovary comes less than a year after Dunham’s hysterectomy, an experience that she wrote about in Vogue’s March 2018 issue. She chose to have the procedure at 31 when her struggle with endometriosis had become unbearable. While someone who's removed an ovary will experience changes to their body, still having the other ovary will reduce the severity of the symptoms and issues that might come up. "One ovary can compensate for the other being removed," Tiffanny Jones, MD FACOG, reproductive endocrinology and infertility specialist at Dallas IVF, tells Bustle. "When both are removed, the estrogen levels fall dramatically."
Here's what else someone can expect when their ovaries are removed, according to doctors
1. There Will Be Initial Pain And Bleeding
As is the case immediately after any surgery, someone who has had their ovaries removed is likely to feel and experience physical pain before anything else.
"Immediate symptoms that women may experience are bleeding, lower abdominal pain, changes in sex drive, and depression, just to name a few," OB/GYN, Teresa K. Leung DO, tells Bustle.
But as to just how much a patient is physically affected depends on which procedure they get. "It also may be difficult to walk for a few days to a week post-surgery, depending if surgery was performed laparoscopically or more invasively," Leung.
In the case of a laparoscopy, the surgeons make several small cuts that are no longer than a half-inch in size. Through these small openings, they insert a camera and the necessary tools to perform the surgery. This option results in fewer scars and the patient doesn't need too much time to heal.
The other option is a laparotomy, in which the surgeon makes on long cut in your lower abdomen, as opposed to several small cuts, to remove the ovaries. As to what surgery you'll need, is up to your surgeon.
2. Hormone Levels Will Quickly Drop
"After the ovaries are removed, hormones levels will abruptly drop," Jones says. "The major hormone that is secreted from the ovaries is estrogen."
When the ovaries are removed, taking the estrogen with them, the body is undergoes what is medically known as surgical menopause. "[The patient] can experience hot flashes, night sweats, [and] vaginal dryness almost immediately," Jones says
If you've ever heard your mother or grandmother — or even friends who have gone through early menopause — talk about it, then you've probably already heard quite a bit about those infamous menopause-related hot flashes.
While there are ways to deal with these symptoms, it's still not quite the same as the estrogen level you've been used to your whole life. As for the sexual aspect of things, should you feel inclined to have intercourse, personal lubricant will probably be needed so as to prevent pain during intercourse.
3. But You Won't Lose All Your Estrogen
Even if someone has both ovaries removed, it doesn't mean that your body won't have any estrogen.
"[Having the ovaries removed] does not remove all of the estrogen," Dr. Richard Honaker, M.D., chief medical officer of Your Doctors Online, tells Bustle, "but almost all of it."
While the majority of estrogen is produced in the ovaries, smaller amounts can be found in the liver, pancreas, adrenal glands, skin, brain, and even the breasts. This estrogen is considered secondary, but is extremely important to anyone who has undergone surgery or menopause. Again, although estrogen supplements, like Estradiol, are an option, there are side effects
According to the Mayo Clinic, those supplement-related side effects can range anywhere from body pain, fevers, difficulty breathing, painful intercourse, to more extreme, albeit less common side effects like rashes, sores, and difficulty walking. As is the case with all major changes in the body, from either a surgery or a natural hormonal change that comes with age, it's all about figuring out what you're willing to deal with and what's worse. Are the hot flashes easier to accept than difficulty in breathing? It's important decision that needs to be made.
4. There May Be A Shift In Mood And Cognition
Not only is there the possibility for depression after someone has their ovaries removed, but other changes in mood and cognitive issues can arise, too.
"She may also begin to experience mood swings, irritability, difficulty concentrating, and decreased cognitive skills shortly after," Dr. Harold says. "If she is already postmenopausal, these symptoms are not likely to occur."
Mood swings and irritability is no good for anyone — most notably the person who just had the surgery. Also, a decrease in cognitive skills can be dangerous. If you can't understand things as clearly as you once did and are easily confused, then it can make everything not just more difficult, but even scary. If these side effects occur, it's paramount that you contact your doctor.
5. Hormonal Supplements Will Become Necessary
If both ovaries are removed, it'll be necessary to regulate your hormones through supplements. Without those supplements, according to Dr. Jones, the patient is more likely to develop cardiovascular diseases and osteoporosis, and life expectancy can decrease as well.
"Hormone therapy may be needed after removing both ovaries depending on indication for removal," Dr. Leung says. "If there are no contraindications, a woman can consider taking estrogen therapy since the body would no longer make estrogen after removing both ovaries. If only one ovary is removed, a woman may not need a hormonal supplement as she would still produce estrogen in one ovary... If a woman still has her uterus, she may also need progesterone therapy."
Naturally, there's a lot of ifs in there, and those ifs can only be figured out by the patient, along with their doctor. There are many pros and cons to each option, and educating yourself about all of them, then deciding what's best for you post-surgery is your call.
6. Age Plays A Role In How The Body Reacts After The Removal
Although according to Dr. Leung, "Typical response to ovarian surgery will be similar across ages," someone's age does affect how their body reacts, from a hormonal standpoint.
Depending on where someone is in their menstrual cycle — lifetime cycle, not monthly cycle — the further they are from menopause, the more they're going to be affected by having their ovaries removed.
"In a young woman, estrogen levels are high depending in what phase of the menstrual cycle she is in," Dr. Jones says. "In older women who are post menopausal (usually above 51 years old), the ovaries produce very little estrogen so the effect of having the ovaries removed from a surgical standpoint is not as drastic. The ovary does secrete androgens as well so removing post-menopausal ovaries can have varying effects on a woman."
7. Premature Thinning Of The Bones May Become A Concern
When it comes to our bones, aging takes its toll. The depletion of estrogen after having your ovaries removed can speed up the process of the thinning of the bones.
"Bones are constantly undergoing destruction of bone and replenishment of bone," Dr. Honaker says. "This is done by osteoclasts and osteoblast, respectively. Estrogen helps the replenishment part of this balance and so when it is taken away, the destruction outpaces the replenishment, thus thin bones (osteopenia and osteoporosis)."
You may think that your calcium intake throughout your life can protect your bones, but while calcium is great to keep bones strong, it can't prevent thinning of bones or keep that necessary replenishment part of this whole process going.
Again, this is where the decision to take supplements is going to be important.
8. It Can Take A Long Time Before The Body Adjusts To The New Changes
With so many changes that occur in the body after a person has their ovaries removed, is there a timeline as to how long it can take the body to adjust?
"That is a difficult question to answer," Dr. Jones says. "All women experience menopausal symptoms differently. Without hormone replacement the adjustment can take years."
Dr. Leung echoes a similar sentiment: it's really hard to pinpoint recovery time. "As with any surgery, the body will need time to recover from the trauma of surgery," Dr. Leung says. "Recovery time from ovarian surgery can take anywhere from two to six weeks, physically, depending on whether or not the procedure was done laparoscopically or if it is more invasive."
But if both ovaries are removed, the patient may go through a larger change and the adjustment period will, of course, be longer.
"Removal of both ovaries requires the body to go through more of a change because the reproductive system where a woman stores her eggs has been removed," Dr. Leung says. "This can be a huge adjustment for a woman psychologically speaking."
9. It Can Provide A Sense Of Relief
According to statistics, one in 10 women has endometriosis, a very disease in which the uterine lining grows outside the uterus, but behaves like a typical period and sheds without a place to exist. Dr. Sanjay Agarwal, director of Fertility Services, Professor of Obstetrics, Gynecology and Reproductive Sciences at UC San Diego Health, tells Bustle that while it's far from uncommon, 70% of women continue to live with that pain. When the pain becomes unbearable, surgery is a treatment option to create relief.
Despite the changes, the initial pain, and the possible side effects, Dr. Harold points out that "If she had severe endometriosis and had definitive surgical therapy (total hysterectomy bilateral salpingo-opherctomy), she may be pain free for the first time in a very long time therefore the hot flashes are not problematic."
Hot flashes, in addition to other side effects that come with surgical menopause, may be a small price to pay for being able to live pain-free.
Dunham has always been extremely outspoken about her endometriosis and hasn’t shied away from posting photos on social media that convey the pain she’s experienced because of it. Because of this, it only makes sense that Dunham would choose to be powerfully candid about her ovary removal, too.
While our bodies are far more than just our reproductive organs, those organs are chockfull of hormones that regulate us in ways that we far too often take for granted. But with the right care, the hormonal supplements, and an understanding of how and why our body is acting the way it's acting after the removal of those ovaries, it is something that can be managed — and, in some women's cases, that removal is a sigh of relief more than anything else.