Antidepressants Blog

Once your body is no longer receiving the replacement oestrogen, the symptoms of oestrogen deficiency will start to return. For hot Rushes, unless you are several years past the menopause (or have been cutting down gradually), you will probably notice them appear within a few days; but you will continue to have the benefit of oestrogen on the condition of your skin, bones, vagina and bladder for a few months after you stop. Eventually, however, your skin will become thinner, your vagina drier, your bones less dense, and bladder problems may return.

Nature has pre-detennined for you how long your hot flushes and other short-term symptoms will last, and taking HRT will not affect this. So, for example, if you were genetically destined to have flushes for two years and you stop HRT after eighteen months, then the flushes will last for another six months; if you stop HRT after two and a half years, you will probably get some flushes as your body’s level of oestrogen falls, but once you have stopped taking it and oestrogen levels have stabilised again, the flushes should stop. What you can’t know, however, is what timespan. Nature has in mind for you, so it is impossible to predict exactly how you will be affected by the withdrawal of replacement oestrogen.

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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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The study of biological clocks and rhythms has now evolved into a special science called chronobiology. Chronobiologists are not only interested in the biological rhythm of sleep but also in other biological functions such as the rhythm of hormonal secretion, urinary excretion, gastric function, body temperature, and the periodical fluctuation of human performance during the 24 hour cycle. Some chronobiologists are even interested in the biological rhythms in animals and plants.

Franz Halberg, a US chronobiologist, divided biological rhythms into three types. In 1959 he described the familiar circadian rhythm— its period is about a day. Then, in 1967, he described ultradian rhythms, which are biological rhythms with periods of less than a day. These include the 90 minute sleep cycle, also known as the REM/NREM cycle or Kleitman’s basic rest activity cycle (BRAC). This has been described in chapter 5, Two kinds of Sleep. Rhythms of the third type are called infradian rhythms. These rhythms have periods in excess of a day; the most familiar is the monthly menstrual period. These biological rhythms can be summarised as follows:

(1) Ultradian rhythms: less than a day

(2) Circadian rhythms: about a day

(3) Infradian rhythms: more than a day

The ultradian rhythm with its periodicity of about 90 minutes determines human performance and arousal state both day and night throughout the 24 hour period. This 90 minute cycle has also been found to operate in other human biological activities; for example, urinary volume and concentration, gastric contraction activity, pupil size under constant illumination, respiratory rate, and even heart rate. This rhythm exerts its influence both in the awake and in the sleeping state.

The periodicity of the ultradian rhythm varies from species to species. In man, it is about 90 minutes; in cats, 20 minutes; in rhesus monkeys, 60 minutes. The significance of this ultradian rhythm and the reason for its existence is still a mystery.

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