I am 52 and scheduled for a hysterectomy in May. There are varied views about leaving the ovaries. I have had precancerous Pap smears for four years and have had a lot of bleeding for the past year. My hormones have been changed numerous times. My doctor says that some research shows that leaving the ovaries can decrease heart disease risk. My mother has had five bypasses, as has my brother. However, my mother also had cancer of the uterus. Do you have any information to help me decide whether I should keep my ovaries?

-- Carol

If you are 52 and on hormones, then you are menopausal; your ovaries are no longer producing appreciable amounts of estrogen -- you are taking hormones to replace the estrogen your ovaries once made. Estrogen does decrease the risk of heart disease and osteoporosis, but you get that same protection whether the estrogen comes from your ovaries or from your local pharmacy!

If you were 32 instead of 52, the story would be different; in that case, we would expect your ovaries to continue producing estrogen for about another 20 years. In that case, if at all possible, the ovaries should be left in place.

Once you are menopausal and the ovaries are no longer producing estrogen, almost every gynecologist would agree that they should be removed during the course of a hysterectomy. There is a chance -- albeit small -- of developing a problem such as ovarian cancer later if they remain. You are already on estrogen replacement and that will continue after your hysterectomy. You will no longer need to take a progestin like Provera once you have the surgery.