Okay, so why when a hyster is done do the medicos leave the ovaries and say  meno will proceed "naturally."  The blood supply is cut off then, too, no?

        What happens to the ovaries after surgery is dependent on the skill of the surgeon, the individual woman's pattern of arteries, the individual woman's abdominal conditions, etc.  --- 

         Just on the pattern of arteries:  we tend to think that everyone has arteries (and veins) just like the picture in the anatomy textbook, but there is a lot of variation in that (as there is in facial contours, body shapes, chemical sensitivities, etc.).  Generally the bigger the artery the more likely it is to be like the textbook, but in my cadaver when I was taking gross anatomy a major artery in the right arm was simply not there -- it was a job to puzzle out just how each of the muscles that was supposed to be supplied by that artery  was getting its blood supply.  Most organs have a collateral blood supply (that is, the organ is supplied with blood from two or more different arteries);  if the major supplier is cut off, the other supply can take over to some extent. 

 According to Current Obstetric and Gynecological Diagnosis and  Treatment , p. 46: 

"The ovarian artery is the chief source of blood for the ovary.  Though both [right and left ovarian] arteries may originate as branches of the abdominal aorta, the left frequently originates from the left renal artery:  the right, less frequently.   .... An additional blood supply is formed from anastomosis with the ovarian branch of the uterine artery ...." 

 "The blood supply to the tubes is derived from the ovarian and uterine arteries. ...[Branches of both arteries] form ... anastomoses in the mesosalpinx [ligament supporting the tubes]." 

         So it wouldn't be surprising if some women get a major part of their ovarian blood from the branch of the uterine artery, and the amount available if the uterine artery is ligated is insufficient.  That might be why a significant percent of women whose ovaries are left in at hysterectomy have premature ovarian failure (30% in a research paper I read).  And some women may have derived a major part of their ovarian blood supply via the anastomoses in the mesosalpinx, which might be disrupted by tubal ligation;  this would be a much less common variant, but not anatomically surprising. 

        And, heaven only knows (at least until your autopsy ;-) ), the doctor might have accidently done something directly to the ovaries while he was in there. 

                                Mary B. 
 

First, she refers to a paper published in the Journal of The American Medical Association in 1990 by Andy Stergachis, et al. which showed that women who have tubal ligations between the ages of 20 and 29 , or whose husbands had a vasectomy, are 3.4 times more likely to have a subsequent hysterectomy.  The authors concluded that there was no greater incidence of disease, but that there was a positive attitude towards surgery in those women. 

Then she says that in a series of research papers published through the 1970's and '80's shows that tubal ligations affect the hormonal cycle of the woman.  With one method, the "unipolar high-frequency technique," 31% of the women experienced changes in the menstrual cycle and many of those had significantly lower levels of progesterone in their luteal phase.  22% of the 1700 women also reported severe menstrual pain who had not had menstrual pain preoperatively. 

Cutler did not conclude that all tubal ligations are bad.  She says that 70% of the time it resolves an important contraceptive need. 

A number of negative postoperative effects are reported in about 1/3 of the women of each study.  They were:  menstrual-cycle length abnormalities (becoming shorter or longer), pelvic pain, and in some women, menopausal-type complains, such as hot flashes. 

According to Cutler, some methods, such as the Hulka clip, produce results equivalent to women who had no pelvic surgery (85% with normal cycles and normal hormone levels.)  Other methods, such as the high-frequency and endocoagulaiton methods, yielded lower likelihoods of hormonal normalcy.  About 62 % of those women continued to have normal hormone levels. 

(She then goes on to recommend 24-hour urine estrogen tests to diganose abnormal cycles in those women, and treatment with HRT.) 

For what it's worth, my mother had a tubal ligation after her fifth child, done in 1959.  I don't know what method was used (except that it was a regular abdominal incision, before the time of mini-incision laparoscopies) .  She had perimenopause in her early 40s (as I am also experiencing) and reached menopause at age 48.  (That is not early menopause.)  I have not had a tubal ligation -- my  husband had a vasectomy. 

(I did have a D & C, in my early 30's, which I now believe interfered with my hormones.  My menstrual cycles have been shortened (26 days, until they decreased to 23 days in perimenopause) for many years... beginning after that D & C.  Or maybe they would have been shortened anyway.  I just thought it was a sign of growing older.) 

Lianne

                                     Frederick R. Jelovsek MD