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Besides affecting the ability to have children, does a hysterectomy have other consequences, eg hormonal? Name and address withheld

Yes. A hysterectomy may induce an early menopause. This doesn’t always happen, but when it does it is thought to be caused by the inevitable disruption of the blood supply to the ovaries that occurs during surgery or may be a consequence of it.

There are three basic fears about hysterectomies that, although firmly rooted, should now be irrelevant. Irrelevant or not they are often given by patients as reasons why hysterectomies are undesirable. Most doctors agree that no woman should have major surgery when lesser procedures are now available for many of the conditions for which hysterectomies were recommended.

Perhaps the most important worry was that the woman will lose her libido, and that even if she retained her libido the minimal shortening of the vagina and loss of the cervix that follows a total hysterectomy removes some of the pleasure of sex. It is also claimed that women frequently became anorgasmic because of the damage. Shortening of the vagina is minimal and doesn’t produce any problems for either the man or the woman. Even if a woman believes in the controversial G-spot they can rest assured that the area where it is alleged to exist is not removed during a hysterectomy. In the past women sometimes did have problems both with their pelvic floor, bladder control and their sexual response. Some years ago important and well-constructed research showed that when these symptoms occurred they were usually the result of the surgical technique. The damage was often done when a surgeon, acting with commendable caution, inspected the lymphatic glands in front of the aorta. In doing so the fine web of nerves that provides the nerve supply to the pelvis could be damaged. Similar problems afflict men after a radical prostatectomy, but whereas in this operation damage can’t always be avoided, in a hysterectomy it can be.

The second fear is that the patient will put on a gross amount of weight. This would only apply if a hysterectomy induced the menopause. It should be born in mind that many hysterectomies are postponed until any likelihood of childbearing is over, and by that time many people are putting on weight in any case, so that it is hard to identify the precise reason for the weight gain.

The third anxiety is that women always become depressed after the menopause. Sometimes if they do it is because of the hormonal changes that may have followed it. The best treatment for menopausal depression is hormone replacement therapy for a short time and this should be tried before resorting to anti-depressants. Other women are depressed because it is a passing of the mile stone, the youthful reproductive phase of life is over and some people grieve about this. Others are rather relieved and may find that new horizons open up as they become more forceful, because of proportionally more testosterone, or are no longer worried about pregnancy.

In a month's time, I am having surgery for a prolapse of the bladder, a vaginal prolapse and a rectal repair. It has been suggested that it makes sense to do a hysterectomy at the same time - do you have a view? Aline Lorimer

Only the reader’s gynaecologist will know the answer to this question. I am afraid the reader obviously has a very severe prolapse in that she has problems with her uterus, bladder and rectum. The repair will require considerable skill and the experience of the gynaecologist will be all-important. He or she will judge the method of operation so as to give their patient the best chance of a good pelvic floor, continence and an easier sex life. Doing a hysterectomy routinely when repairing some forms of prolapse was considered the operation of choice by many gynaecologists some years ago, but it is now done less often. You don’t tell us your age but if you are post-menopausal, or close to the menopause, the uterus doesn’t have any function, and the ovaries if left are always a possible source of difficult to detect cancer. The repair of many prolapses are postponed until after the menopause, as by then the pelvic organs and muscles have settled down, become accustomed to the new hormonal state and the likelihood of having to repeat the operation is reduced.

Is it always necessary to take hormones after a hysterectomy? And if so, will I have to do this for the rest of my life, or is there a natural alternative? Chanel Dubois, Essex

It depends on the reader’s age. If she is still young and had it not been for surgery would have been pre-menopausal, she should take hormonal treatment. Without normal oestrogen levels at this age there is an unfortunate increase in the incidence of cardiovascular disease, especially coronary arterial disease but also of strokes. Fortunately once the uterus has been removed women can take oestrogen alone to replace the oestrogen that is not being produced by the absent ovaries. It is the progestogens that are blamed (rightly) for the mood changes that cause one woman in three to give up HRT. HRT still has a role in medicine even though it shouldn’t be used long term in the hope of preventing osteoporosis. After the normal age of the menopause a woman who has had ovarian failure after hysterectomy is in exactly the same position as her contemporaries who haven’t had surgery.

Is a suction hysterectomy (I'm not sure this is the correct term) preferable to an operation? Name and address withheld