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Weighing up the benefits and problems of hysterectomy WEIGHING UP THE BENEFITS AND PROBLEMS OF HYSTERECTOMY
Many women report a marked improvement in their symptoms after hysterectomy. Others experience a worsening of some symptoms, or the emergence of new symptoms that they attribute to the operation. The University of Newcastle/Macquarie University study mentioned earlier in this chapter found that while two-thirds of women considered that the symptoms they had before hysterectomy were improved by the operation, nearly as many women had symptoms which they thought were made worse or were caused by their hysterectomy. Participating women generally experienced less abdominal and back pain than before the operation, their incontinence improved, sex was less painful and they were less tired and tearful. However 29% were concerned about the development of hot flushes since their hysterectomy, 21% now had vaginal dryness and 17% had weight problems. Many also said they found the convalescence more difficult than they had expected, with pain a particular problem. Sizeable numbers would have liked more information about what was involved in recovering from hysterectomy before deciding on the operation, as well as more help in dealing with emotional problems associated with it and more information about alternative treatments. A small proportion thought they were worse off; 4% said the operation caused more problems than it solved and 7% that they would not have gone ahead had they fully understood what it entailed. Despite this, 96% of the women said they were satisfied that they had had the right treatment, and 95% said they would make the same decision again if the circumstances were the same.
The Maine study of hysterectomy also reported on the advantages and disadvantages of the operation. Many of the women who took part experienced relief from symptoms — especially pelvic pain, urinary symptoms, fatigue, psychological symptoms and sexual problems — although once again some women experienced new problems after hysterectomy including hot flushes (13%), weight gain (12%), depression (8%) and lack of interest in sex (7%). Many of the symptoms women experience after hysterectomy seem to relate to a downturn in the function of their ovaries. If women are aware of this they can give consideration before surgery to the possibility that hysterectomy and hormone therapy may turn out to be a 'package', both components of which are necessary to achieve an improved quality of life.
It is difficult to reconcile the prevalence of new or unresolved symptoms following hysterectomy and the generally high levels of satisfaction with it. Obviously there are many aspects that each woman needs to explore before embarking on a major medical treatment like hysterectomy. This may be more easily said than done; it amounts to putting a value on removal of our present problems while trying to estimate what value we place on a range of future possibilities that may or may not occur. In other words, the symptoms of pelvic pain, difficult bleeding and fatigue that encourage many women to have a hysterectomy are in the 'here and now'. They make everyday living a chore, or worse, a nightmare. Furthermore many women who have hysterectomies have tried other treatments and found them wanting. In contrast, the outcome of hysterectomy is in the future. Every woman having the operation hopes it will relieve every symptom she has and create no new problems. Realistically, this may not occur. While one can comprehend in one's mind the fact that up to half of the women who have a hysterectomy experience some adverse effects, and that these may resolve quickly or have a negative impact on quality of life long-term, there is always the possibility that a particular individual will be fortunate and experience no down side. Perhaps women with an optimistic frame of mind are more likely to 'take the punt' on hysterectomy than those with a pessimistic bent. Making a decision that takes account of all the possibilities is more difficult.
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