Psycho-social problems of women who had undergone hysterectomy

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cancer in her lifetime and between 4% and 14% of these women will have hadantecedental hysterectomies in which ovaries were retained (Sightler SE, BoikeGM, Estape RE, Averette HE).Hysterectomy is the commonest gynecological surgery performed. Decision toremove the ovaries or not depends on the age of patient, menopause, and high riskfactors and on patient’s decision. A proper counseling plays a very important rolein deciding knowing the implication. Removal of one ovary does not protect ordecrease the incidence of ovarian cancer. If ovarian pathology is found athysterectomy after 40 years of age bilateral oopherectomy is indicated.Prophylactic oopherectomy should be considered for women who are at risk ofinherited ovarian cancer. HRT should be avoided to these women to avoidincreased risks of osteoporosis and cardiovascular problems. (Rani Reddy, KKSReddy; oopherectomy at hysterectomy; journal; dept of radiotherapy, Jawaharlalinstitute of postgraduate medical education and research, pondicherry)Why Would a Woman Resist Hysterectomy?In the United States 550,000 hysterectomies are performed each year. In the vastmajority of these cases the indications for surgery are benign, non life-threateningconditions. Only 10% of hysterectomies are performed for cancer.The common rationale for advising hysterectomy and oophorectomy (removal ofthe uterus and the ovaries) is as follows: the role of the uterus is that of an"incubator," to carry babies into this world. Once the incubator role is over, be itbecause of a woman's age or her lack of desire for more children, the uterus is anuisance. The uterus may bleed, cause pain, prolapse, and/or develop cancer. Atthis point, hysterectomy is an advantage to a woman's well being and longevity.Regarding the ovaries, it is commonly felt that after age 40 ovarian function(hormone production) is approaching its end, and since the ovaries can developcancer it is only logical to remove the ovaries as well during hysterectomy. The
esulting absence of ovarian estrogen, it is proposed, can be easily overcome withestrogen replacement therapy.Is this attitude supported by scientific evidence and recent research? An increasingnumber of women, as well as many physicians, believe strongly that it is not. Theuterus has many roles, not just that of an incubator. Consequently, hysterectomymay be followed by negative consequences, which may significantly impact, onthe quality of a woman's life. First, let us consider the old rationale thathysterectomy and oophorectomy can prolong a woman's life by preventing uterineand/or ovarian cancer. The lifetime probability that a 50 year-old woman will dieof uterine cancer (including cervical cancer) is 0.5%, for ovarian cancer thisprobability is 0.8%. In contrast, the same woman's risk of dying of cardiovascular(heart and blood vessels) disease is 33%. It has been shown that hysterectomy(even without oophorectomy) during a woman's reproductive years increases therisk (triple the risk according to some studies) of heart attack during the remainingreproductive years. If the ovaries are removed as well, the risk of developing heartdisease and osteoporosis is further increased. In addition, it has been shown thatafter hysterectomy, even without oophorectomy, women tend to enter menopauseearlier, by as much as 4 years on the average according to one study. Estrogenproduced by the ovaries reduces the risk of osteoporosis and possibly the risk ofheart disease. Estrogen may also help to maintain cognitive and sexual function.Theoretically then, hormone replacement therapy after hysterectomy andoophorectomy could counter the negative effects of estrogen deficiency. However,a recent study reports a slight increase in the risk of heart disease, thromboembolicdisease, and breast cancer in women on combined estrogen-progesterone(Prempro) replacement therapy which has made the decision regarding whether touse hormone replacement therapy more difficult, requiring individualconsideration of risk versus benefit and quality of life issues. Even prior to thislatest study it had been shown that only about 50-60% of women for whom
Page 1 and 2: ABSTRACTTitle - Psychosocial Proble
Page 3 and 4: PSYCHOSOCIAL PROBLEMS OF WOMEN WHO
Page 5 and 6: Dysfunctional uterus bleeding (DUB)
Page 7 and 8: Vaginal hysterectomy is prefered wh
Page 9 and 10: Vaginal bleeding—this should dimi
Page 11 and 12: hospital reported 1547 hysterectomi
Page 13 and 14: ) The study also gathered first han
Page 15 and 16: and found no evidence of hormone di
Page 17: Any kind of surgical intervention o
Page 21 and 22: penetration during intercourse, and
Page 23 and 24: heavy, prolonged and irregular blee
Page 25 and 26: hysterectomy. She complained of wei
Page 27 and 28: Case no: 2Nirmala is 42 years old a
Page 29 and 30: She did not perceive it as a “los
Page 31 and 32: esult of her hysterectomy. She was
Page 33 and 34: miscarriage following tubular pregn
Page 35 and 36: A change was found in the intensity
Page 37 and 38: Depression in the patient before su

Psycho-social problems of women who had undergone hysterectomy

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