The decision whether or not to have your ovaries removed is an extremely complex and difficult one because at the present time there are no clear answers regarding the pros and cons of removing or retaining the ovaries.

Some gynecologists routinely remove the ovaries in women with endometriosis; others base their decision on the extent and severity of the woman’s disease and her age, while still others routinely retain them except under special circumstances.

It is extremely important that you find out what your gynecologist intends to do and that you make your decision perfectly clear as to whether you want your ovaries removed or retained.

If you retain your ovaries you will not undergo a premature menopause but there will be a greater likelihood that your endometriosis will persist or recur. Unfortunately, it is not known how often endometriosis persists or recurs following a total hysterectomy: the few statistics in the medical journals range from around 10% to 85%.

Many gynecologists believe that the ovaries should be retained in the majority of cases as they believe that the risk of recurrence is low and the risks of a premature menopause are considerable.

If your ovaries are removed you will undergo a premature menopause and have less likelihood of having a recurrence of endometriosis because it does not recur if you do not produce oestrogen. It is estimated that as few as 3% to 5% of women will have a recurrence if their ovaries are removed. The unusual cases where endometriosis recurs following a radical hysterectomy are usually due to the fact that a piece of an ovary was left behind because the gynecologist either could not see it or could not remove it safely.

Surgical menopause – menopause due to the surgical removal of the ovaries – is usually more severe than the natural menopause because it occurs instantaneously in a younger woman whose hormone levels are higher. The drop in the hormone levels is both dramatic and sudden and many women will experience significant symptoms as a result.

Most women will experience the early symptoms of the menopause soon after their surgery – often within 24 to 48 hours. The most common early symptoms are hot flushes and night sweats. Some women will also experience tiredness and lethargy and sometimes depression, particularly if their hot flushes and night sweats stop them sleeping.

After a couple of months most women will start to experience some of the other effects of menopause. These include a dry vagina, which may cause painful intercourse, a change in sexual response, decreased libido and decreased breast size.

The main long-term effects associated with surgical menopause are a substantially increased likelihood of developing heart disease and osteoporosis later in life.

*57/41/5*

Antioxidant Salad

4 stems broccoli

4 stems cauliflower

1 celery stick

4 large lettuce and kale leaves

4 large rocket leaves

1 handful green beans

È chopped Spanish purple onion

1 stick carrot

1/2 cucumber

10 cherry tomatoes

1 handful walnuts

Chop and mix all of the ingredients together in a glass bowl. Serve with Antioxidant Dressing.

Apple, Celery and Tuna Salad

80 grams tuna in spring water, drained (not brine)

1 green apple

2 sticks celery, sliced

1 gem lettuce, sliced

1 large handful bean sprouts

75 grams natural live yogurt

2 teaspoons apple cider vinegar

Black pepper to taste

Rye bread 1 avocado

Drain tuna and combine with the other salad ingredients. Blend the yogurt and vinegar into the salad. Season with black pepper. Serve with rye toast, thinly spread with avocado.

Brown Rice Salad

1 cup brown rice

2 stalks celery, chopped

1 handful snow peas

Sweet pepper, chopped

2-3 cloves garlic, crushed

1 small chunk of ginger, crushed

1 tablespoon tamari

1 tablespoon apple juice concentrate

1/2 lemon, squeezed

Boil the rice and drain. Add the chopped celery and sweet pepper, and the snow peas. Make a dressing from the rest of the ingredients by simply stirring them together. Drizzle dressing over the vegetables and serve.

Brown Rice, Tuna and Bean Sprout Salad

100 grams brown basmati rice

100 grams tuna in spring water, drained (not brine)

1 tablespoon olive oil

1 teaspoon tamari or soy sauce

The juice of half a lemon

100 grams bean sprouts

1 carrot, chopped

1 spring onion, finely sliced

Cook rice and allow to cool. Combine with the other ingredients.

Exotic Bulgar Salad

225 grams bulgar

400 ml boiling water

1 teaspoon salt

2 tablespoons chopped mint and parsley

2 tablespoons sunflower seeds

1 garlic clove, crushed

50 ml olive oil or flaxseed oil

50 ml lemon juice

Freshly ground black pepper

450 grams tomatoes, chopped

1 small cucumber

Mix the bulgar, water and salt. Leave to stand for 15 minutes. Add all but the tomatoes and cucumber, and leave until cold. Stir in the tomatoes and cucumber, and serve.

*228/34/5*