In a total hysterectomy is it better to remove everything (including the ovaries) or to leave them?

Up to you: If they take out the ovaries, you will go through menopause right away unless they give you hormones. If you are getting a hysterectomy due to cancer, get everything taken out. If the hysterectomy is for something other than cancer, you can leave the ovaries there and you will still have menopause but not until your usual age (usually 45 - 55).

Depends: For most postmenopausal women, leaving the ovaries provides few benefits and removing them substantially reduces the risk of ovarian cancer. In premenopausal women, it is important to weight the risks of a premature menopause such as heart disease, osteoporosis, and menopausal sxs, against the benefits of a reduced risk of breast and ovarian cancer. Each woman should carefully weigh the issues.