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FACHLITERATUR INTERNATIONAL III
HORMONES - SURGICAL MENOPAUSE IS A LIE
We compound a significant amount of bioidentical hormone replacement therapy at our pharmacy and we often hear people use the term "surgical menopause" to describe their health situation. What they are actually saying is that they've had a total hysterectomy.
The purpose of this article is to point out that there are no true similarities between menopause and hysterectomy.
Menopause: Sometime in the late forties or early fifties a woman's body begins changing. What may have been a long experience of basically regular menstrual cycles starts to change. Sometimes the period is missing and sometimes they happen more frequently. Then, the periods stop. This time of variable periods is sometimes referred to a perimenopause. One well accepted definition of menopause is the lack of a period for 12 consecutive months.
Menopause is a time when hormone levels have declined. Estrogen levels fall anywhere from 40% to 60%. Progesterone and testosterone levels often fall more than that. The critical thing to note is that the hormone levels do NOT fall to zero. The human body does not just stop making hormones. While there are no longer sufficient levels to stimulate the release of a viable egg, the body is still making and using all kinds of hormones. Hormone levels continue to decline over the succeeding decades, but at a slower rate.
Surgery: A hysterectomy is the surgical removal of the uterus, and an oophorectomy is the surgical removal of one or both of the ovaries. Surgical removal of both the uterus and the ovaries is often referred to as a total hysterectomy, and removal of only the uterus is known as a simple hysterectomy. A hysterectomy with a bilateral oophorectomy (removal of both ovaries) causes a woman to abruptly stop producing estrogen. Erroneously, this is often called "surgical menopause." The consequences of abruptly stopping the production of hormones by surgery are far more severe. Menopause is a slow, natural decline in hormone levels. Surgery is almost instantaneous.
Changing Hormone Balance: Menopausal women who want or need hormone replacement therapy are in a completely different situation than women who have undergone surgery. During perimenopause it seems that progesterone levels fall more dramatically than estrogen levels. This is understandable if you consider the normal role of progesterone in a woman's body. The word, progesterone, is derived from PRO (means for) and GESTATION (means pregnancy). When an egg is released from the corpus luteum (the sack where the egg is stored) progesterone levels begin to rise. The corpus luteum generates the increasing progesterone levels for about two weeks. If there is a pregnancy, the new fetus takes over the job of stimulating the release of progesterone. A baby literally swims in a sea of progesterone. If pregnancy does not happen the corpus luteum "runs out of steam" and the levels of progesterone fall, rather abruptly. This falling level stimulates the sloughing of the endometrial lining and bleeding starts. It is the FALLING level of progesterone in relation to the levels of other hormones that stimulates the beginning of a period.
After menopause the body no longer releases eggs so there is no corpus luteum to stimulate progesterone. Of course, without an egg there isn't a pregnancy so there would be no fetus to stimulate progesterone. The two reasons for making progesterone are lost (corpus luteum and pregnancy). This doesn't mean that the need for progesterone declines. The human body contains a myriad of interacting reactions of checks and balances. It is a very delicate mechanism that can become imbalanced. One particular imbalance that seems to cause a lot of concern is the one that occurs when progesterone levels fall more than the offsetting estrogen levels in a woman's body. Dr. John R. Lee coined the phrase, "estrogen dominance" to describe a situation where the relationship between progesterone and estrogen is out of balance.
Hormone BALANCE: The relationship between progesterone and estrogen can be described as a ration. The ratio of progesterone to estrogen (as estradiol) can vary widely between women, but values above 200 are often associated with a beneficial balance. That means that progesterone levels 200 times greater than estradiol are usually preferred. At menopause this ratio often falls far below 200. In the hundreds of tests we've looked at over the years ratios less than 15 are not unheard of. Many women, then can benefit by using a small amount of progesterone as a supplement. We think it is best if a woman uses a quality progesterone cream approximately 25 days each calendar month. Because progesterone rose and fell during the productive years we suggest that using progesterone supplements according to a cycle pattern best meets the need of the woman. Some women do well using progesterone every day, but we find that many more seem happier when they use a small amount (20mg in a transdermal cream) daily for about 12 days, then twice daily until the 25th, then stopping. This mimics the rise and fall of progesterone and allows a few days each month for the progesterone receptors to clear and become sensitive again.
The natural flow of hormones in the body is often referred to as the "hormone cascade." This demonstrates that there is a process in the body whereby one hormone can be transformed into another. For example, cholesterol can become pregnenolone, which can be converted to progesterone. From progesterone the body can make other hormones, like estrogen, testosterone, DHEA, and cortisol. Supplementing with progesterone, then, may be sufficient to cause the body to produce the other hormones whose levels have fallen over time. This means that not every menopausal woman may need estrogen. The progesterone alone can be enough when the hormone cascade process is in place.
At menopause estrogen falls some and progesterone falls a lot. Instead of supplementing with estrogen combinations menopausal women may want to first use a physiologic amount of progesterone. If symptoms occur simple tests can be performed to evaluate the overall hormone levels and changes can be made. If tests reveal actual low levels of estrogens they can be added to the supplement mixture. Be clear that we suggest adding estrogen only when testing shows a deficiency.
Oophorectomy: Women who have lost their ovaries are in an entirely different situation. They have had their "hormone factory" completely removed. Their estrogen levels don't fall "some" but almost all the way. The same is true of progesterone and all the other hormones that are produced in the ovaries. This is an abrupt change and very serious. Sadly, not everyone in the health professions agree that loosing ovaries is a significant health event. Some women are left with no hormone supplement and some are offered one of the "one size fits all" commercial products (some of which are derived form animal sources such as mares). When this doesn't help it is common for doctors to prescribe any number of drugs designed to ease the consequences of lost hormones. It's sad that some doctors think a psychotropic drug can substitute for a natural human substance. This is unkind, unprofessional, and harmful, especially as there are natural hormone supplements available and there are special pharmacists all across the land who know how to combine these natural hormones into compounds that can do a lot to help a woman fell more like herself.
Women without ovaries need a wider range of hormone supplements. Combinations of estradiol and estriol are common. These must be balanced with progesterone and sometimes testosterone and DHEA need to be added. Because the sex hormones are central to so many other hormone systems in the body a woman who has undergone life-changing surgery may also need supplements to help her thyroid, adrenals, and pancreas. Then, the possibility exists that adding those hormones may upset any balance that may have been achieved with the sex hormones (estrogen, progesterone, etc.) Loss of ovaries is a serious situation that must be followed closely after the operation. Failure to take it seriously is wrong. Few people seem to be seriously engaged in helping post-surgical women regain their health and vitality.
Hysterectomy with oophorectomy is NOT SURGICAL MENOPAUSE.
It is a life-changing surgical procedure.
http://www.thecompounder.com/hormonesurgicalmenopause.php
45
Hysterectomy is one of the most frequent surgical procedures
for women. Rates of hysterectomy are slightly
higher in Finland than in other Nordic countries.1-3 The
relationship of thyroid enlargement with puberty, menstruation,
pregnancy, and menopause has been known
for decades.4 Hysterectomy with bilateral oophorectomy
has been associated with an increased risk of thyroid cancer
since the 1980s.5-11 The possibility of an increased risk
for thyroid cancer in women who have undergone hysterectomy
without oophorectomy has not been evaluated
earlier. Our aim was to determine how hysterectomy and
ovarian removal are associated with subsequent thyroid
cancer risk.
Material and methods
Women who had undergone hysterectomy with or
without oophorectomy during the years 1986 to 1995 in
Finland were identified from the Hospital Discharge Registry.
Procedure codes in the Hospital Discharge Registry
have been available since 1986. The cohort was compared
with the Population Register of Finland, and the dates of
death and emigration were achieved for every cohort
member. All residents of Finland since January 1, 1967,
have a unique personal identifier code, which is used in
all main registers in Finland and allows reliable computerized
record linkages.
Follow-up for cancer through the files of the population-
based country-wide Finnish Cancer Registry was
done automatically by using the personal identifier code
as key. Follow-up for cancer started 6 months after hysterectomy,
to exclude cases who were actually hospitalized
for symptoms of thyroid cancer but whose final
diagnosis was registered a couple of months later. Followup
ended at death, at emigration, or on December 31,
1997, whichever was first. Further division was made by
the time elapsed since the hysterectomy.
The numbers of observed cases and person-years at risk
were counted, by 5-year age groups, separately for two calendar
periods (1986-1991 and 1992-1997). The expected
numbers of cases for thyroid cancer, also by histologic
subtype, were calculated by multiplying the number of
person-years in each age group by the corresponding average
cancer inci[ophy]dence in all of Finland during
the period of observation.
To calculate the standardized incidence ratios (SIRs),
the observed numbers of cases were divided by the expected
numbers. The 95% CIs for the SIR are based on
the assumption that the number of observed cases followed
a Poisson distribution.
From the Tampere School of Public Health, University of Tampere,a the
Department of Obstetrics and Gynecology, Turku University Central Hospital,
b the and Finnish Cancer Registry.c
Academy of Finland has financially supported the first author (R. L.).
Received for publication January 9, 2002; revised May 24, 2002; accepted
July 12, 2002.
Reprints not available from the authors.
© 2003, Mosby, Inc. All rights reserved.
0002-9378/2003 $30.00 + 0
doi:10.1067/mob.2003.121
Increased risk of thyroid cancer among women
with hysterectomies
Riitta Luoto, MD,a Seija Grenman, MD,b Salla Salonen, StudMed,b and Eero Pukkala, PhDc
Tampere, Turku, and Helsinki, Finland
OBJECTIVE: Hysterectomy with bilateral oophorectomy has been suggested to increase the risk of thyroid
cancer.We studied the relationship between hysterectomy and thyroid cancer in a population-based setting
in Finland.
STUDY DESIGN: Women undergoing hysterectomy between 1986 and 1995 (n = 17,900) were identified
from the National Hospital Discharge Registry. The cohort was followed up through the Finnish Cancer Registry
until 1997.
RESULTS: There were 118 cases of thyroid cancer diagnosed, 103 papillary and 15 follicular or medullar
type. The incidence for thyroid cancer was significantly elevated (standardized incidence ratio [SIR] 1.38,
95% CI 1.15-1.64). The increase in the incidence of thyroid cancer was not dependent on the extent of operation
but on the length of follow-up. Thyroid cancer incidence was increased 0.5 to 1.4 years after hysterectomy
(SIR 2.00, 95% CI 1.31-2.93), but decreased thereafter (SIR 1.30, 95% CI 0.99-1.67). Hysterectomy
with and without oophorectomy was associated with a similar increase in the incidence of thyroid cancer.
CONCLUSION: Women who have undergone hysterectomy have an increased risk of thyroid cancer during
the first 2 years after the operation. Thyroid cancer and bleeding disorders may share a common background.
(Am J Obstet Gynecol 2003;188:45-8.)
Key words: hysterectomy, thyroid cancer, epidemiology, bleeding disorders
46 Luoto et al January 2003
Am J Obstet Gynecol
Results
There were 93,282 women under follow-up in the cohort,
with 563,136 person-years (Table I). Sixty-three percent
(58,721 women) had undergone total or subtotal
hysterectomy alone, 9% (8,082) had undergone hysterectomy
with unilateral oophorectomy, and 28% (26,479)
had undergone hysterectomy with bilateral oophorectomy.
The mean length of follow-up of a woman was 6.0
years.
During the follow-up, 118 cases of thyroid cancer were
diagnosed; the expected number was 85.2. The incidence
for cancer of the thyroid (SIR 1.38, 95% CI 1.15-1.64) was
significantly elevated (Table I). Hysterectomy combined
with oophorectomy was associated with a similar increase
of incidence as with hysterectomy alone.
The incidence of thyroid cancer was significantly increased
during the period of 0.5 to 1.4 years after the operation
(SIR 2.00, 95% CI 1.31-2.93) but decreased
thereafter (Table II).
The majority of thyroid cancer cases were of the papillary
type (n = 103), and only 15 cases were follicular or
medullar thyroid cancers. Although the thyroid cancer
risk of all histologic types was increased, follicular or
medullar thyroid cancer types did not reach significancy
possibly because of the small number of cancer cases (not
shown in tables). Significantly increased risk of thyroid
cancer was found in women younger than 59 years (30-45
years 1.61 [95% CI 1.02-2.41], 45-59 years 1.36 [95% CI
1.07-1.70]).
Comment
Our study is in line with earlier findings that show increased
risk of thyroid cancer among women who had
undergone a hysterectomy. The novel features in our
findings were the increased risk soon after the operation
and the independence of the extent of surgery. Hysterectomy,
irrespective of possible oophorectomy, was associated
with an increased risk of thyroid cancer.
According to a linkage study between the Finnish Mass
Screening Registry (MSR) and Cancer Registry, the risk
of thyroid cancer was 2-fold (relative risk [RR] = 2.1, 95%
CI 1.5-3.1) among women reporting hysterectomy at Papanicolaou
smear screening.11 In that study, the followup
started from screening and the risk of thyroid cancer
increased throughout the follow-up period.
The current cohort consisted of all women who had
undergone any type of hysterectomy from 1986 to 1995,
and the follow-up for cancer was started 6 months after
the hysterectomy. The identification of cohort members
and follow-up for death and emigration were complete.
Coverage of the hospital discharge registry has been estimated
to be over 90%,12 and incompleteness is not associated
with subsequent cancer outcome. Cancer
registration system in Finland is virtually complete and
the computerized record linkage procedure precise.13
Technical problems or incompleteness in the data collection
phase did not cause bias in our results.
Main indications for hysterectomy in Finland are
leiomyomas and bleeding disorders.1,3 Disturbances of
Table I. SIR and 95% CI of thyroid cancer in a follow-up of 93,282 women with a history of hysterectomy, by extent of
hysterectomy
Extent of hysterectomy No. of persons in follow-up Person-years Observed Expected SIR 95% CI
Subtotal 17,900 114, 818 22 17.2 1.28 0.80-1.93
Total 40,821 250, 644 58 38.2 1.52 1.15-1.96
Total + unilateral oophorectomy 8,082 52, 521 7 7.9 0.89 0.36-1.82
Total + bilateral oophorectomy 26,479 145, 153 31 21.9 1.41 0.96-2.00
All 93,282 563, 136 118 85.2 1.38 1.15-1.64
Table II. SIR and 95% CI of thyroid cancer in a follow-up of 93,282 women with a history of hysterectomy, by extent of
hysterectomy and time since hysterectomy
Time since hysterectomy (y)
0.5-1.4 1.5-5.4 5.5+ Total
Extent of hysterectomy No. SIR 95% CI No. SIR 95% CI No. SIR 95% CI No. SIR 95% CI
Subtotal 6 2.48 (0.91-5.48) 11 1.22 (0.61-2.18) 5 0.87 (0.28-2.02) 22 1.28 (0.80-1.93)
Total 12 2.11 (1.09-3.68) 28 1.38 (0.91-1.98) 18 1.48 (0.88-2.34) 58 1.52 (1.15-1.96)*
Total + unilateral — 0.00 (0.00-3.32) 4 0.98 (0.27-2.49) 3 1.11 (0.23-3.25) 7 0.89 (0.36-1.82)
oophorectomy
Total + bilateral 8 2.11 (0.91-4.16) 16 1.33 (0.76-2.16) 7 1.14 (0.46-2.34) 31 1.41 (0.96-2.00)
oophorectomy
All 26 2.00 (1.31-2.93)† 59 1.30 (0.99-1.67) 33 1.23 (0.85-1.73) 118 1.38 (1.15-1.64)†
*P < .05.
†P < .01.
Volume 188, Number 1 Luoto et al 47
Am J Obstet Gynecol
thyroid function correlate with menstrual disorders.4,14,15
On the other hand, hormonal changes during the menstrual
cycle have effects on the thyroid gland, which has
been shown to enlarge during the luteal phase.16 When
women with mild primary hypothyroidism were given Lthyroxine,
menorrhagia disappeared within half a year
and did not reappear in 3 years of follow-up.17 In the study
by Krassas et al,18 23% of the 171 hypothyroid patients had
irregular periods. Hypothyroidism is connected to menorrhagia
as a result of estrogen breakthrough bleeding secondary
to anovulation.18 Menstrual irregularities
correlate with the severity of hypothyroidism.19
Menorrhagic patients have been shown to have uterine
thyroid mass tumors.19 Women with Hashimoto’s thyroiditis
had an increased hysterectomy rate (RR 4.0, 95%
CI 1.1-22.1).20 In animal studies, hysterectomy caused decrease
in plasma tyroid-stimulating hormone and triiodothyrinone
concentrations.21 This suggests that uterus
produces biologically active, nonsteroidal substances,
which have a complex effect on the endocrine system.
The incidence of thyroid cancer is 3- to 4-fold higher in
women than in men and is higher in postmenopausal
than premenopausal women.22 However, endocrinologic
risk factors of thyroid cancer are poorly understood. This
applies also to hormonal changes caused by thyroid dysfunction.
The growth of papillary carcinomas, the most
common lesions, may be stimulated by thyroxin-stimulating
hormone. In a recent article by Franseschi et al,23
pooling 12 case-control studies concerning the association
between benign thyroid diseases and thyroid cancer,
a history of hypothyroidism was not associated with thyroid
cancer risk, but hyperthyroidism increased thyroid
cancer risk 1.4-fold. A history of goiter (odds ratio [OR]
5.9, 95% CI 4.2-8.1) as well as risk of history of benign
nodules/adenomas (OR 30.0, 95% CI 14.5-62.0) showed
high risk of thyroid cancer for women. The excess risk for
goiter and benign nodules/adenomas was greatest within
2 to 4 years before thyroid cancer diagnosis, but an elevated
risk was present for 10 years before cancer.23
Thyroid cancer survival has increased in the last
decades; the relative 5-year survival rate for cases diagnosed
1985 through 1994 is 88%.24 In 1997 and 1999, thyroid
cancer was 14th on the list of the most common
female cancers in Finland.22 The age-adjusted incidence
rate of thyroid cancer has increased from 2.3 of 100,000 in
1960 to 1964 to 8.1 of 100,000 woman-years in 1995
through 1999.22 In Finland the rate of hysterectomy continues
to increase among women older than 50 years, but
decreases slightly among younger age groups.3 This increase
is likely to be attributable to surgery-oriented treatment
policy and not to the increase of bleeding disorders
or other indications for hysterectomy. The prevalence rate
of hysterectomized women in reference population agegroup
60 to 64 years is 21%.25 Assuming this proportion to
be on average similar in all relevant age groups, the SIR
for thyroid cancer in our cohort would raise from 1.38 to
1.48, if compared with nonhysterectomized women.
Our study clearly indicates the need for further elaboration
of thyroidal status of menorrhagic women. The key
question is the possible common background of dysfunctional
bleeding and thyroid cancer. Hysterectomy can be
considered as a indicator of prolonged menstrual disorders,
not as a cause of thyroid cancer. The high risk of
thyroid cancer during the first 2 years after hysterectomy
is partly a consequence of long history of menstrual and
thyroidal dysfunction with unknown origin. Progress of
menstrual disorders and thyroid dysfunction leading to
thyroid cancer should be further studied.
We thank Ritva Hurskainen, MD, for helping in finding
the background literature.
REFERENCES
1. Luoto R, Kaprio J, Keskimäki I, Pohjanlahti J-P, Rutanen E-M.
Hysterectomy in Finland 1987-1989—incidence, indications and
surgical approaches. Int J Epidemiol 1994;23:348-58.
2. Settnes A, Jorgensen T. Hysterectomy in a Danish cohort: prevalence,
incidence and socio-demographic characteristics. Acta
Obstet Gynecol Scand 1996;75:274-80.
3. Vuorma S, Teperi J, Hurskainen R, Keskimäki I, Kujansuu E. Hysterectomy
trends in Finland in 1987-1995—a register based
analysis. Acta Obstet Gynecol Scand 1998;77:770-6.
4. Krassas GE. Thyroid disease and female reproduction. Fertil
Steril 2000;74:1063-70.
5. McTiernan AM, Weiss NS, Daling JR. Incidence of thyroid cancer
in women in relation to reproductive and hormonal factors.
Am J Epidemiol 1984;120:423-35.
6. Preston-Martin S, Bernstein L, Maldonado AS, Henderson BE.
Thyroid cancer among young women related to prior thyroid
disease and pregnancy history. Br J Cancer 1987;55:191-5.
7. Ron E, Kleinerman R, Boice JE, Livolsi VA, Flannery JT. A population-
based case-control study of thyroid cancer. J Natl Cancer
Inst 1987;79:1-12.
8. Franceschi S, Fassina A, Talamini R, Mazzolini A, Vianello S,
Bidoli E, et al. Risk factors for thyroid cancer in North Italy. Int J
Epidemiol 1989;18:578-84.
9. Kolonel LH, Hankin JH, Wilkins LR, Fukunaga FH, Hinds MW.
An epidemiologic study of thyroid cancer in Hawaii. Cancer
Causes Control 1990;1:223-34.
10. Levi F, Franceschi S, Gulie C, Negri E, La Vecchia C. Female thyroid
cancer: the role of reproductive and hormonal factors in
Switzerland. Oncology 1993:50:309-15.
11. Luoto R, Auvinen A, Pukkala E, Hakama M. Hysterectomy and
subsequent risk of cancer. Int J Epidemiol 1997;26:476-83.
12. Keskimäki I, Aro S. Accuracy of data on diagnoses, procedures
and accidents in the Finnish hospital discharge register. Int J
Health Sci 1991;2:15-21.
13. Pukkala E. Use of record linkage in small-area studies. In: Elliot
P, Guzick J, English D, Stern R, editors. Geographical and environmental
epidemiology. Oxford: Oxford University Press;
1992. p. 125-31.
14. Fraser IS. Menorrhagia—a pragmatic approach to the understanding
of causes and the need for investigations. Br J Obstet
Gynaecol 1994;101(11 Suppl):3-7.
15. Higham JM, Shaw RW. The effect of thyroxine replacement on
menstrual blood loss in a hypothyroid patient. Br J Obstet Gynaecol
1992;99:695-6.
16. Hegedus LS, Karstrup S, Rasmussen N. Evidence of cyclic alterations
of thyroid size during the menstrual cycle in healthy
women. Am J Obstet Gynecol 1986;155:142-5.
17. Wilansky DL, Greisman B. Early hypothyroidism in patients with
menorrhagia. Am J Obstet Gynecol 1989;160:673-7.
48 Luoto et al January 2003
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18. Krassas GE, Pontikides N, Kaltsas TH, Papadopoulou PH,
Paunkovic J, Paukovic N, et al. Disturbances of menstruation in
hypothyroidism. Clin Endocrinol 1999;50:655-9.
19. Cappello F, Barbato F, Tomasino RM. Mature teratoma of the uterine
corpus with thyroid differentiation. Pathol Int 2000;50:546-8.
20. Phillips DI, Lazarus JH, Butland BK. The influence of pregnancy
and reproductive span on the occurrence of autoimmune thyroiditis.
Clin Endocrinol 1990;32:301-6.
21. Biro J, Ritzen EM, Hall K, Eneroth P. Effects of hysterectomy and
uterine extracts on growth hormone, somatomedin, prolactin,
thyrotrophin and thyroid hormones in adult rats. Acta Endocrinol
1983;103:172-9.
22. Cancer Incidence in Finland. Finnish Cancer Registry. Available
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23. Franceschi S, Preston-Martin S, Dal Maso L, Negri E, LaVecchia
C, Mack WJ, et al. A pooled analysis of case-control studies of thyroid
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Söderman B, et al. Survival of cancer patients in Finland 1955-
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Sexologos n° 30
Fevrier 2008 Elisabeth
GALIMARD-MAISONNEUVE
Publications
http://www.sfscsexo.com/publi/puz3000.htm
Un deuil fonctionnel hormonal en cas d’ovariectomie chez une femme non ménopausée.
La carence brutale en estrogènes (E2) et testostérone (Te) ampute la sexualité de son déterminisme biologique hormonal.
La Carence en E2 peut entraîner une baisse de la qualité de vie avec des bouffées de chaleur, des troubles du sommeil et de l’humeur, des polyarthralgies, une sécheresse vaginale, une baisse des sensations sexuelles, des troubles urogénitaux, sécheresse cutanée, perte d’éclat et prise de poids androïde vécus comme l’apparition des stigmates du vieillissement.
La Baisse brutale de 50 % de Te entraîne une asthénie, une baisse du désir sexuel chez 30 à 50 % des femmes avec une souffrance dans 1/3 des cas. L’activité fantasmatique est perturbée avec des fantasmes moins actifs, moins spontanés, moins efficaces.
L’ovariectomie entraîne significativement plus de dépression, d’anxiété et de Mal être mais il semblerait que l’effet négatif s’atténue à 2 ans.
La brutalité de la baisse en E2 et Te joue certainement un rôle dans la mauvaise tolérance et la difficulté d’adaptation de l’organisme à cette carence. Les études retrouvent plus de regrets par rapport à la fertilité: 13% versus 5% et 43% versus 21% à 3 ans.
L’ovariectomie entraîne significativement plus de baisse du désir sexuel, d’émotions négatives, (je décevais mon partenaire (90 %), je me sentais malheureuse (80 %), moins féminine (55 %), humiliée (39 %), etc, (n= 119) et d’altération de la sexualité (Abaissement significatif des scores de satisfaction des 7 domaines du «Profile female sexual function» : désir, excitation, plaisir, réactivité, inquiétudes, orgasme, self image).
L’incidence d’une baisse du désir secondaire à l’ovariectomie est significativement plus fréquente chez les femmes de 20-49 ans (+13 %) comparativement au femmes déjà ménopausées (+ 4 %) avec 2 fois plus de souffrance liée à ce désir abaissé (HSDD) : 53% versus 26% chez les femmes de 50-70 ans. La baisse de 50% de la testostérone entre 20 à 45 ans chez toute femme explique probablement le moindre retentissement de l’ovariectomie sur le désir des femmes de 50-70ans.
Eine hormonell-funktionell bedingte Trauer im Fall der Ovarektomie bei einer Frau, die nicht in der Menopause ist
Das brutale Ausbleiben von Östrogenen (E2) und Testosteron (Te) amputiert die Sexualität von seinem biologisch hormonellen Determinismus.
Das Ausbleiben von E2 kann eine Verminderung der Lebensqualität durch Hitzewallungen, Schlafstörungen und Störungen der Gemütsverfassung, durch Polyarthralgien, durch vaginale Trockenheit, durch den Rückgang der sexuellen Empfindungen, durch urogenitale Probleme, durch Hauttrockenheit bewirken und mit Energieverlust und androider Gewichtszunahme einhergehen, die als Stigmata des Alterns erlebt werden.
Der brutale Sturz des Testosteron von 50% bringt eine Kraftlosigkeit mit sich, einen Rückgang des sexuellen Verlangens bei 30 bis 50% der Frauen, mit einem Leidendruck in einem Drittel der Fälle. Die phantasmatische Aktivität ist gestört mit Fantasmen, die weniger aktiv sind, weniger spontan, weniger wirksam.
Die Ovarektomie bringt signifikant mehr Depressionen mit sich, mehr Angstzustände und Unwohlbefinden, aber es scheint dass die negative Auswirkung sich in 2 Jahren mildern würde.
Die Brutalität des Rückgangs von E2 und Te spielt sicherlich eine Rolle in der schlechten Toleranz und der Schwierigkeit für den Organismus sich an diese Karenz zu gewöhnen. Die Studien finden wieder mehr Leid wegen der Fruchtbarkeit: 13% gegenüber 5% und 43% gegenüber 21% in 3 Jahren.
Die Ovarektomie bringt deutlich mehr Rückgang an sexueller Lust, an negativen Empfindungen (ich enttäuschte meinen Partner (90%), ich fühlte mich unglücklich (80%), weniger weiblich (55%), gedemütigt (39%) etc. (n= 119) und die Veränderung der Sexualität (signifikanter Rückgang der Befriedigung in den 7 Bereichen des „Profils der weiblichen Sexualfunktion“): Begehren, Exaltation, Lustempfinden, Aktionsfähigkeit, Besorgtheit, Orgasmus, Selbstbildnis).
Die Auswirkung des Rückganges der Lust als Effekt der Ovarektomie ist deutlich häufiger bei den Frauen zwischen 20 und 49 Jahren (+13%) im Vergleich zu Frauen, die schon in der Menopause sind (+4%) mit doppelt hohem Leidensdruck, der mit dem Rückgang des Lust einhergeht (HSDD): 53% gegenüber 26% bei den Frauen zwischen 50 und 70 Jahren. Der Rückgang von 50% des Testosterons zwischen 20 bis 45 Jahren bei jeder Frau erklärt wahrscheinlich die geringere Auswirkung der Ovarektomie auf die Lust von Frauen zwischen 50 und 70 Jahren.
Un deuil symbolique
Eine symbolische Trauer
un deuil des règles
Trauer um die Regelblutung
un deuil de la maternité
Trauer um die Mutterschaft
un deuil de la Féminité et de la sexualité
Trauer um die Weiblichkeit und um die Sexualität
Un deuil existentiel
Eine existentielle Trauer
Un deuil de l’Image du corps au coeur de la féminité et de la sexualité.
Trauer um das Körperbild im Herzen der Weiblichkeit und der Sexualität
Conclusion
L’intention n’est pas de diaboliser l’hystérectomie avec ou sans ovariectomie car de nombreuses femmes sont satisfaites et certaines indications sont incontournables mais de permettre un meilleur repérage des femmes à risque de décompensation, d’enrichir les ressources «au delà du corps» des femmes qui s’enlisent dans un mal être après l’intervention, d’encourager les motivations aux alternatives non chirurgicales, ainsi qu’une réflexion éthique et existentielle (ovariectomie associée : systématique ou non ?, plaisir utérin : mythe ou réalité ?). Pour motiver l’écoute interactive sans s’y perdre et combler les vides de prise en charge ces réflexions exposent les pièces du puzzle d’un Deuil qui part du corps et le traverse jusqu’ «Au delà» rencontrant, pour se dépasser, des obstacles sociaux et médicaux empreints des mythes et stéréotypes qui «vrillent» le féminin de cette fatalité psychique nourrie aux silences sexuels des corps de certaines et de l’idée d’une compétence sexuelle préservée tant que le «recevoir» est possible. Bien que ciblées sur la déconstruction toutes ces réflexions se veulent, bien sûr, constructives pour permettre, si possible, l’émergence de pratiques médicales moins généralistes et plus attentives au respect des éléments du corps qui jouent leur partie dans la sexualité et dans le vital. En cas de perte inévitable une meilleure reconnaissance de la sexualité de la femme et des acteurs du deuil permettra un meilleur accompagnement pour l’aider à puiser dans ses ressources et à tracer les chemins d’une nouvelle sexualité adaptée à la réalité. Celle-ci pourrait alors renouveler le sens heureux qu’elle prenait dans cette relation intime et connivente à l’Autre auquel cette femme a ouvert Son Monde.
Schlussfolgerung
Es geht nicht darum die Hysterektomie zu verteufeln mit oder ohne Ovarektomie, weil viele Frauen zufrieden und gewisse Indikationen unabwendbar sind; aber es geht darum eine bessere Behandlung von Frauen mit Risiko zur Dekompensation zu gewährleisten, die Ressourcen zu bereichern „über den Körper hinaus“, für Frauen, die im Unwohlsein nach dem Eingriff stecken bleiben, sie zu ermutigen, die Beweggründe für nichtchirurgische Alternativen zu erlauben, ebenso wie eine ethische und existentielle Reflexion ( begleitende Ovarektomie: systematisch: ja oder nein? Uterines Lustempfinden: Mythos oder Realität?)
Um zum interaktiven Zuhören anzuregen ohne darüber die Zwischenräume der Wahrnehmung zu verlieren und anzufüllen, stellen diese Reflexionen Teile des Puzzles einer Trauer dar, die vom Körper ausgeht , ihn durchdringt bis „darüber hinaus“, und dabei auf soziale Hindernisse und medizinische Abdrücke, Mythen und Stereotypen trifft, die das Weibliche dieser psychischen Fatalität „verdrehen“, das genährt wird vom sexuellen Schweigen gewisser Körper und von der Idee einer möglichen Sachkenntnis solange dies zu „erhalten“ möglich ist.
Obwohl sie auf die Dekonstruktion abzielen, wollen alle diese Reflexionen natürlich konstruktiv sein, um, wenn geht, die Emergenz weniger allgemeiner medizinischer Praktiken zu ermöglichen und aufmerksamer den Elementen des Körpers Respekt zu zollen, die ihren Part in der Sexualität und im Leben spielen.
Im Fall eines unabwendbaren Verlustes wird die bessere Anerkennung der Sexualität der Frau und der Trauerformen eine bessere Betreuung ermöglichen, um ihr zu helfen aus ihren Ressourcen zu schöpfen und um die Wege einer neuen Sexualität, die an die Realität angepasst ist, zu beschreiten.
So könnte sie also die Richtung erneuern die sie in dieser intimen und verständnisinnigen Beziehung einnahm der Wahrnehmung dieser Reflexionen hin zum Anderen, dem diese Frau IHRE WELT geöffnet hat.