Congratulations on your breast cancer victory! :) That is wonderful! This is such a difficult question to answer. I had ovarian cancer almost 4 years ago and have had a full hysterectomy and no HRT. I was 37 when this occurred. So, it has been very tough on me and I already do have health issues related to the lack of estrogen (osteoporosis, bladder prolapse, etc).
But, on the flip side, I want to raise my odds of lack of recurrence and so I have chosen what I feel is the lesser of two evils. For me, my tumors were fed by estrogen and I decided to take away the food supply of any stray cells that may be left around. I realize our fat cells and some foods also release estrogen, so my risk is not zero of having estrogen present in my body. But, I have known three women who were the same stage and type as myself who took HRT and they have now passed. It may or not be related to the HRT, but two of them felt it was. Also, my gyn/onc doesn't want me to take it and he has over twenty years of experience treating gyn cancers. You will not find consensus on this, but you have to go with your gut.
I am not a doctor and can only give my opinion. But, if I were in your shoes, I would have a full hysterectomy. Dermoids are almost always benign. But, rarely, they do recur and can have malignant transformation. It is somewhat odd to have one past menopause. Are you seeing a gynecologic oncologist for your surgery? Hopefully, you are because the only way to know for sure if a mass is benign or malignant is to have it removed intact and have it biopsied. I was told my mass was either a dermoid or endometrioma and it turned out to be ovarian cancer. Your ovaries are exposed to your entire abdomen and it is very easy for the contents of the mass to spread. So, it is important that you get the best surgery possible. Gyn/oncs can be there to step in and stage you if malignancy is found.
The fact that you already have entered menopause means your body won't have a sudden shock as far as hormone loss. This is another reason I would opt for the full hysterectomy. It probably won't produce bothersome symptoms like extreme hot flashes. Your body has already had a couple of years to transition. I also have a strong family history of heart disease. But, there are alternatives like supplements, exercise and a healthy diet that end up being more important than the estrogen loss in relation to heart disease risk. The libido has decreased for me, but all still works. Over time, this also has improved. In the end, you have to go with your own gut instinct.
So, that is my 2 cents. I wish you luck on making your decision! I hope all goes well with your surgery!
Thanks Shelly for your reply. I had not really thought about my ability to make positive changes towards better heart health vs. the loss of estrogen related to heart disease if I remove my ovary/uterus. Good point!
My surgeon will have a gyn/oncologist in the operating room to check the mass when it is removed.
Your comments were worth way more than two cents. Bless you!
I had a large cyst that was discovered 2 years after menopause and my gyn/onc felt strongly about removing both ovaries/tubes to prevent cysts from happening again but he was against removal of the uterus which was healthy. If you do not have problems with the uterus, it would be excessive surgery to remove it. Just one other option to consider. I think I read somewhere that keeping the uterus intact allows a woman to still have normal orgasm (whereas ovaries are not needed). Loss of estrogen production post menopause is not that much different than loss of ovaries post menopause. I felt no difference after I lost my ovaries. If anything I felt more stable. I think it is because I was so much healthier without the cyst.