The female internal organs, the cervix, the uterus, the ovaries and also the vagina, have to receive a treatment, since with hormonation long-term changes can take place and there is a risk of malignant degeneration.
It will be the surgeon, together with his medical team, who decides the most appropriate technique for each individual patient, analyzing their physical and social characteristics. However, the patient will have all the information to be able to take part in the final decision on the technique to choose.
We always have to consider removing the internal genitalia once the hormonation is started. There are two techniques to remove the uterus and ovaries: hysterectomy and double annexectomy. These interventions can be performed transvaginally, which is the least traumatic, or laparoscopy through the abdomen.
The decision to practice one or the other approach is based on the size of the patient's uterus, since if it is very large due to the presence of myomas, it is very difficult to remove it transvaginally.
If the technique to be performed is through the abdomen laparoscopically, only the uterus can be removed and the ovaries left. Because the ovaries can cause long-term malignant degeneration, both organs are normally removed simultaneously. Only in the case that the patient does not want to take hormones would the uterus be removed to avoid menstruation and the ovaries would be left.