The post-hysterectomy patient

Abstract 

In NHS hospitals in England from 2002 to 2003, forty-two thousand women underwent hysterectomy. While the majority will be performed for benign pathology such as menstrual disorders, some will be for gynaecological cancer. Hysterectomy may or may not be accompanied by oophorectomy and may be total or subtotal, depending on whether the cervix is removed. Various approaches may be employed: abdominal, vaginal and laparoscopically assisted. Even if the ovaries are conserved, there are concerns that the menopause may occur early. Other concerns include mental well-being, psychosexual dysfunction, urinary tract and bowel symptoms. Prospective studies have shown an improvement in well-being after hysterectomy and no deterioration in psychosexual function and urinary and bowel symptoms. Furthermore, there seems to be no difference between the types of hysterectomy. Hormone replacement therapy after hysterectomy is undertaken in the majority of cases with oestrogen alone, with no need for progestogen addition. Alternative and complementary therapies are also discussed.

Keywords:  menorrhagia and other menstrual problems , hormone replacement therapy , hysterectomy , menopause , ovarian function , psychosexual function

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