and Oestrogen following Hysterectomy and Bilateral Oophorectomy
Hormone therapy is required
following hysterectomy and oophorectomy and it is usual
for women to have low dose oestrogens prescribed for a few
months to ten years. This may be adequate to prevent vasomotor
symptoms and often adequate to protect the skeleton but
these women have lost their ovarian androgens and frequently
suffer from the female androgen deficiency syndrome (FADS).
This is characterised by loss of energy, loss of libido,
loss of self-confidence, depression, and an increase in
Many studies, particularly
Sherwin and Gelfand, have shown the importance of the addition
of testosterone. The long-term study of 200 such patients
by Khastgir and Studd have shown the long-term benefits
of sexuality, depression, vasomotor symptoms, general health
scores, and anxiety when compared with pre-operative scores.
Such patients having oestradiol and testosterone have a
continuation rate of 97% at five years and 88% at 10 years
indicating the health benefits experienced by the patients
without the side-effects of bleeding and cyclical progestogen.
Thus HRT after hysterectomy and oophorectomy should be straight-forward
and, with the addition of testosterone, should produce a
long-lasting improvement in quality of life.
. Sherwin,BB., Gelfand, MM. (1985) Differential symptom
response to parenteral estrogen and/or androgen administration
in the surgical menopause. Am.J.Obstet.Gynecol. 151(2),
. Khastgir, G., Studd, JWW., Catalan, J (1999) Psychological
outcome of hysterectomy. Br.J.Obstet.Gynaecol. 106 (7) 620-2
. Khastgir, G, Studd J. (2000) Patients' outlook, experience
and satisfaction with hysterectomy, bilateral oophorectomy,
and subsequent continuation of hormone replacement therapy.
Am.J.Obstet.Gynecol. 183 (6) 1427-33