About a quarter of hysterectomy patients need treatment for psychological problems after the operation. The most common are depression, anxiety, grief reaction and lack of libido. The highest risk is among women whose symptoms aren’t relieved by the operation and those who’ve previously been treated for emotional disorders. Also at risk of poor emotional outcome are younger women and those who would have preferred more children. Inadequate understanding of the womb’s role in health and sexuality can also contribute to post-operative psychological problems. On the other hand, the majority of women enjoy better emotional health after hysterectomy, as would be expected when the
source of distressing symptoms is removed and health is restored.
Many of the old fears about the consequences of hysterectomy arose from a widely held but quite incorrect belief that it was the same as castration. As explained, the ovaries are preserved unless it’s impossible to do so. If your ovaries must be removed at the time of hysterectomy, you’ll be told about it and encouraged to use oestrogen replacement to eliminate the effects of lack of oestrogen on health and sexual function.
Another myth about hysterectomy is that it makes women gain weight. There is no physiological reason for weight gain after hysterectomy unless you eat more and exercise less than before. Women who become overweight after any surgery may do so because during convalesce they develop a pattern of overeating underexercising that can be hard to break.
The controversy about hysterectomy
Few subjects in gynaecology have caused
as much debate as hysterectomy. The controversy reached its peak in the 1970s when health authorities became alarm at the high rate of hysterectomy in Australia. The flames of the debate were fanned by the press with such sensational headlines as ‘Shock Survey on Hysterectomy: Convenience a Key Reason’.
A survey of hysterectomy in the late 1970s showed that two out of five Australian women had their uterus removed before the menopause, and nearly half of the female population had hysterectomy by the age of 65 years. This was much higher than the rate of hysterectomy in the UK and European countries.
Why had so many Australian women had hysterectomies? Did almost half of all Australian women have serious disease of the uterus that couldn’t be corrected by non-surgical means? (The answer to this must certainly be ‘No’.) Were hysterectomies being performed unnecessarily? Were women pressuring surgeons into performing hysterectomies for ‘convenience’? Worst of all, were surgeons recommending hysterectomy for their own financial gain?
It’s difficult to answer these questions in retrospect, but it seems likely that in the past some hysterectomies were performed for reasons that would be considered invalid today, including sterilisation, to do away with the inconvenience of menstruation, and to prevent possible future disease.
Most women who’d had hysterectomies didn’t think that they were unnecessary. The majority of a survey of 823 women who had hysterectomies in New South Wales in 1977 were satisfied about the outcome of the operation and believed that it had been done for a good reason. Still, some were unsure whether the operation was necessary and a few regretted it.
The controversy in the late 1970s and early ’80s has resulted in both women and surgeons becoming more careful about the decision for hysterectomy. Less hysterectomies are now performed. Other changes since the 1970s have contributed to the fall in the rate of hysterectomies.
• Women are now better informed about their gynaecological health and are encouraged to take a greater part in decisions about their health care.
• Improved non-surgical treatments have been developed for many bleeding problems, menstrual pain and endometriosis.
There will be even fewer hysterectomies in the future. The new technique of removing or destroying the endometrium through the hysteroscope (endometrial ablation) can eliminate many problems of bleeding without removing the whole uterus. Recent studies on progestogen-releasing IUDs have shown them to be as good or better than endometrial ablation in controlling some bleeding problems caused by progesterone deficiency.
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