Pre-menstrual-syndrome and hysterectomy

THE VACANT PLOT - Can anyone blame the woman, who for years has endured wretched miseries each month, if she dreams of the day when those troublesome organs are removed by one clean swoop of the surgeon's knife?

"ANGELA'S STORY" - The 48 year-old wife of a USAF colonel, had a successful hysterectomy for fibroids which were causing heavy bleeding. She made an excellent recovery and assumed full household duties until nine months later, when she suddenly had four days of extreme tiredness. She stayed in bed attributing it to 'flu or some nasty virus. The following month it recurred, but this time she stayed in bed for six days. Gradually the duration of the tiredness lengthened until it represented two weeks in each month. It would start gradually with mere tiredness and she would manage to keep up for a few days, but then bed became essential. The end of the attacks was quite definite, and afterwards she had no other symptoms and resumed her normal social life. She started taking nutritional supplements and her symptoms are definately becoming less noticable.

Invariably the pre-menstrual-syndrome is more marked after a hysterectomy than before, and there may also be extra symptoms.

One woman, a part-time worker, was first seen after she had been charged at the police station. Two years previously a hysterectomy had been carried out. Prior to the operation she had suffered from pre-menstrual tension and headaches. After the operation her pre-menstrual-syndrome had increased in severity and for a few days each month she would also experience breast fullness and a distressing feeling of unreality and confusion. She related these episodes to the time of her expected premenstruum and carefully charted the days on a calendar. Once she was started on nutritional supplements she felt a lot better and her symptoms started to decrease.

"Brenda's Story" - A 47 year-old, talked about how her husband had been moved from one town to another, how she had made a suicidal attempt within days of arriving there and had been hospitalized for several months. Within a week or two of her discharge she moved back to her previous home, but made another suicide attempt the following week and was again admitted. It was only after a long and confused history, assisted by her husband, that mention was made of a hysterectomy and the fact that she was now experiencing cyclical attacks of depression and moodiness. Once the cyclical nature of her symptoms was appreciated and confirmed by a two-month record it was possible to give her nutritional supplements and restore her to normality.

Two recent stroies have emphasized the high incidence of depression occurring in women one to three years after a hysterectomy, with or without the removal of the ovaries. The depression appears to be greatest in those under 40 years at the time of the operation; those with a previous history of depression, especially postnatal depression; those in whom no gynecological abnormality could be found by the pathologist who examined the womb after operation.

Another disturbing finding was that more than half the women gained more than 28lbs. in the year following their hysterectomy. How often is a woman warned before the operation that the odds are two to one that such a marked weight gain might occur? The reason for the depression and weight gain after hysterectomy may be appreciated by recognising the proximity of the menstrual clock to the mood controlling center and the weight controlling center in the hypothalamus.

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