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Published in Menopause Internationa.
John Studd, 25th September 2008
It is time to review the hostility that is often felt towards hysterectomy. It is rare to see an article on this operation in newspapers or journals which do not claim that a hysterectomy causes depression, loss of sex life, destroys a marriage and generally is a health disaster. This is odd because every one of the 15 or so prospective studies, including mine, shows that women after hysterectomy with adequate HRT have less depression, less anxiety, better libido, better general health scores as well as the elimination of the cyclical symptoms of heavy painful periods. It is strange that journalists still promote this misinformation which is essentially a lie about hysterectomy.
As well as relieving the obvious symptoms which were the indication for a hysterectomy it is worth remembering that 4% of women in the UK die of cancer of the ovary, uterus or cervix. This risk is all eliminated. Women after hysterectomy and bilateral oophorectomy need to have hormone therapy in the form of transdermal oestrogens and usually testosterone to maintain their health, energy, libido and mood. Such HRT should be simple after hysterectomy as there is no need for the cyclical progestogen to create a bleed. There is new evidence that indicates that if there is a breast cancer and heart attack risk with HRT, it is almost certainly the progestogen component or the preparations. Women who are able to have unopposed oestrogens have fewer heart attacks, less osteoporosis, probably less breast cancer and certainly fewer deaths. Longterm studies of women who have had twenty years of oestrogens alone show that the calcium coronary scores (a non-invasive screening test for coronary disease) is nearly always zero but calcification does occur more commonly in women who need to have the progestogen component if they still have a uterus.
Nobody is suggesting this surgery just for prevention of cancer but the benefits are so enormous that patients with menorrhagia , cyclical pelvic pain, adnexal pain , severe PMS and menstrual migraine should not be discouraged from hysterectomy by the unproven fears of journalistic gossips. These symptoms which may effect a woman for 3 weeks out of every month and can be cured. It should not be seen as a radical operation of last resort or a confession of therapeutic failure. A well conducted hysterectomy performed by a good surgeon for appropriate symptoms has beneficial effects on the quality of life and can reduce the risk of heart attacks and gynaecological cancers in the future. A reappraisal is long overdue.