About 20% of women in the
UK end up having a hysterectomy, the most common major surgery
performed. This should be greatly beneficial to the woman
if the indications are appropriate, the operation done well,
with adequate long-term hormone replacement. If the ovaries
are removed replacement androgens are also required.
Although there are now 20
prospective studies showing that such women have an improvement
in libido, sexuality, depression, general health scores,
anxiety scores, there is still a belief supported by the
Press which tell women that the consequences of hysterectomy
are marital breakdown, depression, loss of sex drive etc.
This is the opposite of the truth and one can only wonder
at the motivation of the journalists who continue to write
reports which are manifestly untrue.
Women may be troubled with
heavy, painful periods, premenstrual syndrome, menstrual
headaches, exhaustion, depression, and may only have seven
good days a month regardless of medical therapy. It is these
women who will request - or even demand - a hysterectomy
because they are aware that their ill health is cyclical
related to the periods, the ovaries and the uterus. We should
not regard this as an extreme last choice treatment or even
a confession of failure as it does relieve the appropriate
symptoms once and for all. Hormone replacement should be
effective either by oestrogen tablets, patches or gel or,
if androgens are needed, by the insertion of an oestradiol
and testosterone implant.
. Khastgir, G., Studd J. (2000) Patient's outlook, experience
and satisfaction with hysterectomy, bilateral oophorectomy,
and subsequent continuation of hormone replacement therapy.
Am.J.Obstet.Gynecol. 183 (6) 1427-33
. Khastgir, G., Studd JWW. (1998) Hysterectomy, hormones
and depression. The Yearbook of Obstetrics and Gynaecology.
Ed. PMS O'Brien. RCOG Press 402-413
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