What Your Dr. May Not Tell You about Your Ovaries

ovarian cancerHang onto your ovaries if you can—they're good for your health and longevity.

By John R. Lee, M.D.

A woman's ovaries are the anatomical equivalent of a man's testicles. A man’s testicles are a source of hormone-generated energy and libido, and a woman's ovaries serve a similar function. And just as removing a man's testicles is castration, removing a woman’s ovaries is known as female castration. I’m not making this up. That is the medical term for removing a woman's ovaries and it carries all the physical results and implications that go with that loaded word.

The effect of castration upon a woman is just as profound as it is on a man, although some doctors may be adamant that it will solve all of a woman's problems. It's possible that those doctors are correct in their assertion, in the same sense that castrating a man will solve all of his “problems.”

Even a partial hysterectomy, in which the uterus is removed but the ovaries are left intact, will ultimately result in functional castration. Removing the uterus will severely restrict blood flow to the ovaries, and within a few years the ovaries will no longer function. Many women believe that this complete loss of ovarian function will occur anyway as a result of menopause, but this is not true. Normally, the ovaries are functional well after menopause, producing male hormones which can be converted to estrogen in fat cells.

A woman who is castrated and no longer makes any appreciable amounts of estrogen, progesterone and testosterone will often become depressed, have little to no libido, and with the addition of some Premarin (a synthetic estrogen) prescribed by her doctor, she will retain water and probably will be a little anxious as well. She will also increase her risk of osteoporosis and heart disease even if she is put on replacement hormones. If she is put just on Premarin and Provera (e.g. PremPro), the standard medical practice, her risk of heart disease, stroke and breast cancer will rise, especially after five years. Even if she supplements with all of the steroid hormones, they will not be as well regulated as they would have been by her ovaries.

The vast majority of female castrations, also called oophorectomies, are unnecessary. One reason that doctors tend to be eager to remove the ovaries is that they fear ovarian cancer, and see oophorectomy as preventive medicine. Even though ovarian cancer is relatively rare, it is very frightening to those who have been through it, because it is difficult to diagnose until it is fairly advanced, and has a very low rate of remission in response to conventional medicine.

Ovarian Cancer Isn't Easy to Diagnose Early
Ovarian cancer accounts for nearly 20 percent of gynecologic cancers, and ranks fifth in cancer fatalities in women. It causes about 13,500 deaths per year, or 5.3 percent of the 254,000 deaths from cancer per year among women in the U.S. Most ovarian cancer occurs in menopausal women who are around the age of 50.

Benign (non-cancerous) ovarian cysts are very common in premenopausal women, and as the cysts go through the process of “resolving” or dissolving, they can create all manner of symptoms, which greatly complicates the diagnosis of ovarian cancer. Symptoms of ovarian cancer can include abdominal pain and bloating, sharp pains and cramps, a feeling of indigestion and, sometimes, irregular bleeding. Unfortunately, for many women, those aren’t unique symptoms. Between erratic ovaries that ovulate some months and not others, (a common occurrence in premenopausal women), and an occasionally fussy uterus that cramps, most women become accustomed to sporadic aches and pains in that part of the body. As a result, the symptoms of ovarian cancer may go unnoticed until it has affected other parts of the pelvic cavity.

Symptoms associated with excessive or deficient estrogen, progesterone, or androgens (male hormones), can also be symptoms of ovarian cancer, because the tumor may create an excess or deficiency of these hormones. Yet these are symptoms that could easily be dismissed by a premenopausal woman whose hormones are fluctuating. In most cases, these types of symptoms are not cause for alarm until you are well into your menopausal years, in which case you should see your doctor about them.

The rarity of ovarian cancer makes it difficult to accumulate enough cases to research its cause or causes. It is, however, generally considered to be a hormone-dependent cancer, along with breast, endometrial, and prostate cancer.

WHAT WE KNOW ABOUT THE CAUSES OF OVARIAN CANCER

Estrogen is a likely suspect, and so are birth control pills and fertility drugs.

In 1995, an important report from the Division of Epidemiology, Emory University School of Public Health, and the American Cancer Society, described the correlation between estrogen replacement therapy and fatal ovarian cancer. In this study, 240,073 peri- and postmenopausal women, who first enrolled in the study in 1982, were followed for at least 7 years during which time 436 of them died of ovarian cancer. It was found that the incidence of ovarian cancer increased with the duration of estrogen replacement therapy. Among those who used ERT for 6 years or more, the risk of fatal ovarian cancer increased by 72 percent, relative to those who had never used it.

This increased risk was not modified by any other potential factors. It should be noted that this report concerns women receiving unopposed estrogen (ERT), and provides no data on those who receive hormone replacement therapy (HRT), which also includes progestins or progesterone.

Fertility Drugs Can Cause Ovarian Cancer
One of the causes of the increasing rate of ovarian cancer is the widespread use of fertility drugs that stimulate the ovaries to mature follicles. The longer the drugs are used, the more the risk of ovarian cancer increases. One study found that using fertility drugs increased ovarian cancer risk three times, but in women who had never been pregnant the risk was increased 27-fold. Other studies have shown that women who are infertile, and women who delay childbearing, also have a higher risk of ovarian cancer, so a woman who uses fertility drugs may be significantly increasing an already elevated risk.

Other Causes of Ovarian Cancer
Some researchers believe that the ovulation process causes cellular trauma that stimulates cells in the ovary to divide, leading to malignancy. This hypothesis is supported by the statistics which show that the more full-term pregnancies a woman has had, the lower her risk of ovarian cancer. Pregnancy is a time when the ovaries get a rest for nine months. As a result, a woman who has had several full term pregnancies has ovulated less frequently in her lifetime than a woman who hasn't had children, while a woman who has not had a full-term pregnancy ovulates continuously, every month. In addition, during pregnancy progesterone levels are very high, and progesterone is protective against reproductive cancers.

Statistically, we know that your risk of ovarian cancer increases if you have used birth control pills; if you have a relative who has had it; if your consumption of dairy products is high; and if you use talcum powder. It is thought that the powder, which contains toxins such as heavy metals, actually migrates up the vagina, through the cervix, into the uterus and onto the ovaries.

Given everything we’ve discussed, it seems clear and reasonable to me that ovarian cancer which is not directly caused by fertility drugs or birth control pills, is most likely to be primarily related to unopposed estrogen and a deficiency in progesterone. I believe that the proper medical care of women should include a sensitivity to the problem of estrogen dominance and progesterone deficiency, which has become epidemic during early adult life in American women. Ovarian cancer is just one of the diseases that we may be able to prevent through appropriate supplementation with natural progesterone in women with estrogen dominance.

References

Rodriques C, Calle EE, Loates RJ et al, “Estrogen replacement therapy and fatal ovarian cancer,” American J Epidemiology 141:828-834, 1995.

Cavalieri EL, Stack DE, Devanesan PD et al, “Molecular Origin of Cancer: Catechol estrogen-3,4-quinones as endogenous tumor initiators,” Proc Natl Acad Sci 94:10937-10942, 1997.