HYSTEREKTOMIE - FOLGEN

Mögliche Folgen der Gebärmutterentfernung: auf wikipedia!

• heart disease
• osteoporosis
• bone, joint and muscle pain and immobility
• painful intercourse, vaginal damage
• displacement of bladder, bowel and other pelvic organs
• urinary tract infections, frequency, incontinence
• chronic constipation and digestive disorders
• altered body odor
• loss of short-term memory
• blunting of emotions, personality changes, despondency, irritability, anger, reclusiveness and suicidal thinking.

4.  No drugs or other treatments can replace ovarian or uterine hormones or functions. The loss is permanent.
5.  Most women are castrated (removal of ovaries) at hysterectomy.
6.  Twice as many women in their 20s and 30s are hysterectomized as women in their 50s and 60s.

NUTRITIONAL SUPPORT FOR WOMEN WITH HYSTERECTOMIES

• Digestive enzymes and probiotics
• Vitamin C
• B Complex
• Transdermal natural progesterone
• Royal Maca—an adaptogen herb for endocrine support
• Essential fatty acids
• Liver support herbs and vitamins
• Regular exercise 30-40 minutes four times per week
• Pure, spring water
• Reduced sugar, dairy, alcohol and carbohydrate consumption

A WOMAN’S UTERUS AND OVARIES REPRESENT THE ESSENCE OF HER FEMININE SELF. THE UTERUS IS THE womb of life while the ovaries are the fundamental reproductive organs pumping out the three key sex hormones, progesterone, estrogen and testosterone. However, there is much more to these dynamic organs than has been previously thought. In fact, only recently has medical science appreciated just what a wallop these amazing organs really pack.

These reproductive organs have another vital role. The uterus and ovaries are related to a woman’s innermost sense of self and her inner world. It reflects her inner emotional reality and her belief in herself at the deepest level. They are the center of a woman’s creative self.

Aside from the ovary’s important function of storing and maturing the eggs, it has another important role as an endocrine gland which produces hormones before, during and after menopause. Far from the popular myth that ovaries dry out, shrivel up and become completely useless at menopause, the ovaries continue to function throughout a woman’s life.

Considering the immense significance of the uterus and ovaries to the life of a woman, it is a rather shocking fact that a hysterectomy is the number one surgical procedure for women.

How popular? In the U.S. more than 750,000 hysterectomies are performed each year. One out of three women will have had a surgical menopause before 60 years of age—a hysterectomy that includes removal of the uterus and ovaries. To date about 20 million American women have had their uteruses removed. In Europe, hysterectomies gross over $4 billion annually.

Are hysterectomies really necessary? According to Dr. Stanley West, noted infertility specialist and chief of reproductive endocrinology at St. Vincent’s Hospital, New York, “more than 90 percent of hysterectomies are unnecessary. Worse still, the surgery can have long-lasting physical, emotional and sexual consequences that may seriously undermine a woman’s health and well-being.”

Since the vast majority of hysterectomies are not truly medically imperative, it is stunning how often dietary and nutritional support and healing modalities such as acupuncture, lifestyle changes, detoxification, stress management techniques and emotional/spiritual approaches can heal the vast majority of these problems.

What is a Hysterectomy?
An hysterectomy is, by definition, the removal of a vital female organ, the uterus. However, more than 40 percent of the time perfectly healthy ovaries are also removed. The fallopian tubes and cervix are sometimes removed as well. The term “total hysterectomy” is now popularly used to describe the removal of the uterus, ovaries, fallopian tubes and part of the cervix.

More than 75 percent of hysterectomies are performed on women between the ages of 20 and 49. The older the woman is when undergoing a hysterectomy, the more likely that she will also have her perfectly healthy ovaries removed as a preventative measure.

The consequences of losing one’s ovaries cannot be overstated. Premenopausal women will undergo an “instant” menopause, complete with symptoms that are far more severe than those that accompany normal menopause, which follows a natural adjustment in hormone production. The rationale for removing the ovaries during a hysterectomy is to prevent ovarian cancer. However, the risk of ovarian cancer is not totally eliminated because ovarian tissue still remains. Without her ovaries a woman will forever be at a greater risk for both osteoporosis and heart disease, both of which represent a far greater statistical threat than ovarian cancer.

Why Have One?
A hysterectomy is offered as a treatment for several conditions. In the U.S. the leading cause for surgery is uterine fibroids, benign growths that, while sometimes troublesome and painful, are not life threatening. Fibroids account for about 30 percent of all hysterectomies. Endometriosis ranks second and leads to about 24 percent of all hysterectomies. The third-ranking indication is a prolapsed uterus caused by the loosening of the muscular supports. Prolapses account for about 20 percent. Endometrial hyperplasia (abnormal proliferation of cells in the endometrium due to excessive estrogen stimulation) ranks fourth at six percent. The remaining 20 percent include menstrual disorders, ovarian cysts and pelvic inflammatory disease.

Only 10 percent of all hysterectomies is due to cancer. According to Dr. West, “Chances are that you are in the 90 percent, not the 10 percent.” He believes that the only 100 percent appropriate reason for performing an hysterectomy is cancer of the reproductive organs.

While an hysterectomy is a fairly simple operation that involves detaching the uterus from the ligaments that support it and the blood vessels, it is far from safe. Up to one-half of all patients develop complications, some of which can be quite serious. Many of these complications are the preventable outcome of sloppy surgery and may involve adhesions, infections and damage to the bladder, bowel and uterus. Postoperative bleeding can lead to fatal hemorrhaging. An alarming statistic is that one out of 1000 patients will die.

The Side-effects
The after effects of an hysterectomy are most dramatic. In a relatively short period of time a woman may experience fatigue, insomnia, urinary problems, headaches, dizziness, vertigo, nervousness, irritability, anxiety, heart palpitations, joint pain, weight gain, vaginal dryness, diminished physical strength, difficult or painful sexual intercourse, hair loss and a variety of skin problems.

The incidence of post-hysterectomy depression appears relatively widespread. Dr. Susan Love, author of Dr. Susan Love’s Hormone Book, states that some 30 to 50 percent of women suffer from depression while some other researchers estimate the number to be as much as 70 percent. For some it is minor and short lived while for others it becomes a chronic state. Other psychological disturbances include mood change, anxiety and irritability. The hormonal disruptions brought on by the surgery can be far-reaching, affecting the nerve and hormone interactions responsible for a sense of emotional well-being.

Another troubling problem still to be accounted for is an increased risk of heart disease. The risk of heart disease is greatest when the ovaries are removed. In addition, some women who have their ovaries removed have higher rates of osteoporosis, even while taking hormone therapy.

Without the uterus holding the other pelvic cavity organs in place, there is a tendency for the bowel and bladder to prolapse. After an hysterectomy, the hip bones tend to widen, causing back, leg and foot problems.

What Women Aren’t Being Told
The uterus is far from a disposable organ. It makes a little known hormone called prostacyclin which protects against heart disease and unwanted blood clotting. Since prostacyclin cannot be synthetically manufactured, once the uterus is removed its protective benefits are gone forever.

The uterus also is an important sex organ. The accelerating pitch of sexual excitement prompts the uterus to contract and rise out of the vagina. At orgasm, it undergoes a series of contractions. All the other so-called orgasms—vaginal, clitoral and nipple—are the initiators of sexual excitement but uterine contractions are the end point of this excitement. The female orgasm requires these contractions. Without a uterus, orgasm can be difficult to achieve.

A hysterectomy may also sever some of the nerves which go to the abdomen, the clitoris and the upper thigh. This can lead to a loss of tactile sensation from the waist to the mid-thigh region. Given these findings, there is no doubt that the loss of libido that is often reported after an hysterectomy is real, not imagined.

The medical terminology for removal of the ovaries (or testicles) is castration. No man in his right mind would ever consider having his testicles removed unless his life was seriously endangered. He certainly would never believe any doctor who told him this procedure would enhance his sex life. Yet gynecologists routinely encourage the removal of healthy ovaries and then promise women that their sex lives will be better than ever. It is therefore imperative for women to understand that their uteruses and/or ovaries should not be willingly sacrificed until all other avenues have been thoroughly explored.

Women who have their uteri removed will automatically be put on some form of estrogen, usually a patch. This is, indeed, a most curious treatment since the uterus does not produce estrogen. In fact, the two leading reasons for a hysterectomy, fibroids and endometriosis, are conditions known to be caused by an excess of estrogen. Removing an organ that is an expression of an underlying imbalance will never resolve the problem. In this case, adding estrogen supplementation can create or even worsen health problems which include weight gain, depression, fluid retention, immune and autoimmune dysfunction, thyroid problems, migraines, foggy memory, breast cancer, liver and gall bladder disease and blood clots.

Regaining Control Over Our Bodies
There is no doubt that there are valid and justified reasons for having an hysterectomy. Women who have been suffering from chronic, painful and sometimes lifethreatening conditions have indeed benefited immensely from surgery. It is crucial, however, that every woman is adequately educated about the risks as well as the many alternative treatments. After all, common sense tells us that it is impossible to just pluck out an organ or disturb the body’s balance without paying a price.

For those women who have already undergone hysterectomies, there is much that a woman can do to insure her health and well-being. For many women, estrogen is not even a necessary treatment. However, since an hysterectomy does increase the risk of a variety of health concerns, it is imperative that women seek guidance and treatment from qualified holistic health practitioners and be committed to making the appropriate lifestyle and dietary changes.

Perhaps the best advice for women facing the decision of a hysterectomy comes from Dr. West: “The challenge informed women face is to persuade doctors to turn away from the panaceas of the past to the treatments of the future. The last few decades have shown how forceful and resourceful women can be in pursuit of the economic and political power they were so long denied. Just as basic to full autonomy is control of your body and the right to make decisions about your health and health care on the basis of all available information, free from pressure, scare tactics and outdated doctor-knows-best paternalism. It is time we doctors stopped disassembling healthy women. But nothing will change until more women look their doctors in the eye and calmly state their determination to remain intact women.”

http://www.americanwellnessnetwork.com/HYSTERECTOMIES-Surgical-Assault-of-Women.html

Gebärmutterentfernung und Gewichtszunahme

Journal of Biosocial Science (2000), 32:37-46 Cambridge University Press
Copyright © 2000 Cambridge University Press

Research Article
HYSTERECTOMY IS ASSOCIATED WITH POSTMENOPAUSAL BODY COMPOSITION CHARACTERISTICS

SYLVIA KIRCHENGAST a1 , DORIS GRUBER a2 , MICHAEL SATOR a2 and JOHANNES HUBER a2
a1 Institute for Human Biology, University of Vienna, Austria
a2 University Clinic of Gynecology and Obstetrics, Department for Endocrinology, University of Vienna, Austria

Abstract
The impact of hysterectomy without oophorectomy and with no malignant purpose on body composition and postmenopausal weight gain was tested in 184 Viennese females aged between 47 and 57 years (mean 52•9). Hysterectomized women were significantly heavier than those who experienced a spontaneous menopause (controls). The amount of fat tissue, especially in the abdominal region, was significantly higher in hysterectomized women. Furthermore, they were reported to have experienced a significantly higher weight gain since menopause (9•1 versus 6•0 kg). No significant differences in bone mass were found. Psychological stress factors and hormonal changes following hysterectomy are discussed as possible causes of these differences.

http://journals.cambridge.org/action/displayAbstract;jsessionid=56C39B2B8C5A142CBD228BFB34D45892.tomcat1?fromPage=online&aid=9917

Is the Uterus Necessary After Childbearing is Completed?

Frederick R. Jelovsek MD
"What are the advantages of keeping your uterus over a lifetime? Does the uterus perform any functions past child-bearing years? Some sources say the uterus continues to produce needed hormones during a woman's entire life; that it is part of the endocrine system; and that the loss of the uterus decreases sexual enjoyment.

I am 50 and still having regular periods. In the 1960's my mother had a hysterectomy. Those years seemed to be the start of an epidemic of hysterectomies similar to tonsillectomies, which now are being thought to be often unecessary. Thanks!".  z at aol

This is certainly a loaded question that gets to the multiple different effects that have been attributed to having a hysterectomy. The issue gets quite confused if the ovaries are removed at the same time as the hysterectomy because then you have a sudden menopause superimposed upon the surgery itself. I assume that the above question is directed at the independent effect of a hysterectomy and not that of both removal of the ovaries and the uterus before menopause. However, at age 50, it is likely that the surgery will also include removal of the ovaries and if you are not yet menopausal, this will add additional menopausal effects.

Does the uterus secrete proteins or hormones independent of ovarian function?

The uterus secretes hormones and proteins but they are almost always in response to the cyclical hormonal changes from the ovaries or the prolonged high levels of hormones during pregnancy. Various prostaglandin hormones, cellular growth factors and other compounds are made in response to the changing hormones and the lining of the uterus (endometrium). After the ovaries are non functional such as with surgical or natural menopause, there are no hormones or proteins that are secreted into the body's blood stream that I am aware of. Certainly the muscle cells of the uterus secrete enough local substances that have to do with keeping the cells alive but those substances are pretty much confined locally and do not have any systemic effect.

With the above general comments about the lack of any general hormone secretion from the uterus after menopause already expressed, there are some notable exceptions. It is likely that the local effects of some of the uterine proteins are perceived under special circumstances after menopause. The main one I am aware of is in response to sexual stimulation and intercourse. The physiologic response of blood vessels swelling full of blood during sexual arousal is likely a systemic response of nerves going directly to the blood vessels and not from secretions of the uterus, however there are more blood vessels to become swollen if the uterus is still in place. The substances that cause uterine contractions during orgasm probably do come from the uterus even after menopause. If the uterus is removed, not only do the secreted substances fail to be produced but also their target organ, the muscles of the uterus are gone. Thus the feeling of light uterine cramps during orgasm is gone after hysterectomy.

Does the uterus contribute to sexual response or desire?

As described above, the uterus definitely plays a role in sexual response. It undergoes vascular congestion during arousal and then rapid drainage of the vascular congestion after orgasm (climax). Also there are rapid small amplitude contractions of the uterine muscle during orgasm as well as contractions of the vagina and urethral muscles. After hysterectomy those uterine contractions with orgasm disappear although some contractions are still present in the lower genital tract. Most women will report a difference in orgasm after hysterectomy but not necessarily less enjoyable. There is a current trend among some physicians and patients to perform or request a subtotal hysterectomy in which the main uterine muscle and lining are removed (body of uterus) while leaving the cervix. As you can imagine, it is very difficult to study whether the small amount of muscle in the cervix (it is mostly just connecting tissue and not as much muscle) preserves any degree of uterine contractions during orgasm. I would guess that the cervix alone would not contribute that much.

The genital changes that take place during a sexual response according to the Masters and Johnson classification are:
• Excitement phase - vaginal lubrication, vasocongestion, separation of the lips of the vaginal opening (labia majora), vaginal walls thicken, early uterine elevation, lengthening of the vagina
• Plateau phase - uterine elevation, clitoral elevation, vaginal expansion, maximum lubrication, outer third of vagina forms orgasmic platform
• Orgasm phase - uterine contractions, tenting effects of vagina, orgasm contractions
• Resolution phase - sexual flush disappears, changes go in reverse
As you can see, most of the same changes will take palce after hysterectomy as before hysterectomy except uterine elevation and uterine contractions and the vasocongestion that takes place in the pelvis above the vagina.

The problem with most of the scientific studies that have been done on the effect of hysterectomy on sexual response, is that the investigators often lumped together many situations which confuse whether or not a postoperative change is due to the removal of the uterus alone or due to other factors. For example it is well known that menopause itself reduces sexual desire and sexual response because of the loss of estrogen. Even if estrogen is replaced, it can be less than perfect at restoring preoperative sexual desired and response.

One study (1) looked at body image and sexuality in three groups, a control group with no surgery, a hysterectomy group and women having removal of the ovaries with and without hormone replacement. They found NO differences in mood (measured by patient questions) or vaginal blood flow (measured by instruments) and a woman's subjective arousal to an erotic stimulus. They did however find that women who had had an oophorectomy and either had no estrogen replacement or estrogen replacement without testosterone had significantly lower self-reported desire and arousal than any of the remaining groups. This study and others (2, 3) imply that the main problem after hysterectomy is lack of desire (libido) if the ovaries are removed, but not the ability to undergo sexual arousal in response to an erotic stimulus. This may be able to be overcome by adequate testosterone replacement along with estrogen replacement. (See also testosterone article)

Another factor often forgotten in clinical studies is what was the degree of satisfaction with one's sexual partner and sexual desire prior to the surgery. An interesting Scandinavian study (4) looked at 104 women having subtotal hysterectomies. Sexual desire, activity, satisfaction and dysfunction were compared between women without, with a poor, and with a good partner relationship prior to the surgery. They found an improved sexuality, one year post hysterectomy, in 61% of women with a good partner relationship, in 17% of those with a poor relationship but no improvement was seen in women who had no regular partner relationship. Therefore it is extremely important in your judging of medical data that purports to show either positive or negative change with hysterectomy, that the study took into account preoperative partner satisfaction. This study concluded that "women with no or with ambivalent partner relationships are more at risk for deterioration of sexuality after hysterectomy. "

Does the uterus help support the pelvic structures and its removal cause prolapse?

The uterus and top of the vagina are supported in the pelvis by several attachments to the strong tendons and ligaments of the pelvis bone. I do not know if the scientific names of these areas are important to you -- pubovesicocervical fascia, rectovaginal fascia, uterosacral ligaments and cardinal ligaments -- but the concept is important to grasp (5). All of these attachments are cut during hysterectomy and as long as they are reattached to the end of the vagina, prolapse should not occur very frequently. You would think that this is a very easy task surgically but those support ligaments are not visable most of the time. They are below a layer(s) of tissue and there may be breaks in those connections at invisible places other than their attachments to the uterus and vagina.

For example a common instance of prolapse occurs after hysterectomy for uterine fibroids. The uterus is enlarged and the size alone may support the uterus in the pelvis so that breaks in the ligaments are not appreciated before surgery. Then within 3-12 months after surgery, the vaginal vault and the bladder drop down. This causes many women to conclude that hysterectomy "causes " prolapse when in fact a better term would be that potential prolapse was being prevented by the enlarged uterus. This can happen to all surgeons such that even with appropriate surgical repair, the abdominal pressures shift from the repaired points to the weakest anatomical points in the lower pelvis. Thus different areas seem to "fall down" even after successfull surgical repair.

Are there a lot of unnecessary hysterectomies performed?

I'm sure there are many "unnecessary" hysterectomies performed. How many is unknown by anyone. Ever since the mid 1950's there has been criticism of doctors performing too many uterine removals. The rate of hysterectomy in the U.S. varies from geographical region to region but on the whole is about twice that of other industrialized countries. Therefore you would think there would be quite a few unnecessary procedures. The problem becomes the definition of "unnecessary". In whose eyes is a procedure deemed as "needed" versus "unnecessary". There seems to be disagreement about this. The only unnecessary hysterectomy is the one that I or you or someone else disagrees with!

For example in insurance programs requiring 2nd opinions, about 8% of hysterectomies are recommended as not needed at the time (6) In an interesting note, this study mentioned that in the Northeast region of the U.S., women whose second opinion thought the hysterectomy was unnecessary did not go on and have the procedure done. Whereas in the South and North Central regions, women chose to have the hysterectomy even though it was not recommended. This means that they thought it was in their best interest even though the 2nd physician did not. Even 8% unnecessary hysterectomies by that study does not explain the higher rate in the U.S.

I am sure there are doctors who tend to overuse hysterectomy especially for pain and abnormal bleeding problems. They see the procedure as the solution to a problem that may be difficult to manage. Many women look at these symptoms as a quality of life problem. In putting up with pain or bleeding, there can be a moderate amount of inconvenience in work, school or leisure activities. Hysterectomy may be looked at as the quick, long term medication-free answer. We live in an impatient world. On the doctor's part, there may be the perception without thoroughly discussing with the patient, that the woman is unlikely to tolerate the medical therapy, frequent office visits and sometimes minor biopsy procedures that would be needed for the condition complained about.

The best protection a woman has from an unnecessary hysterectomy is an informed education and consideration of all of the treatment options.

What can I expect after hysterectomy aside from the effects of whether the ovaries are functioning?

As best I can tell from both experience and the medical scientific literature, hysterectomy alone, without ovarian removal in the premenopausal woman, or with ovarian removal in the menopausal woman will result in:
• a change in sexual response during orgasm, but not an adverse change
• increased tiredness for several months after the hysterectomy
• in general a recovery time of almost 6 months be complete return to preoperative function.

Frederick R. Jelovsek, MD
Department of Obstetrics and Gynecology
East Tennessee State University
PO Box 70569
Johnson City, TN 37614

http://www.sgsonline.org/sgsinc/patiented/educate_articles/edps003.htm

http://www.wdxcyber.com/nmood13.htm
http://www.sgsonline.org/sgsinc/patiented/educate_articles/edps003.htm