Boston – Hysterectomy and oophorectomy (the removal of ovaries) are performed to treat various diseases in women, including cancer. These procedures are accompanied not only by a decline in estrogen but also testosterone levels in the blood. Many women who have undergone surgical removal of their uterus and/or ovaries can develop symptoms of sexual dysfunction, fatigue, low mood and decreased muscle mass. New research from Brigham and Women’s Hospital (BWH) has found that testosterone administration in women with low testosterone levels, whom previously had undergone hysterectomy with or without oophorectomy, was associated with improvements in sexual function, muscle mass and physical function. This research appears in the November 27, 2013 online issue of Menopause.
“Recently, there has been a lot of interest in testosterone treatment in postmenopausal women for sexual dysfunction and other various health conditions. However, no previous studies have evaluated the benefits and negative effects of testosterone replacement over a wide range of doses,” explained Grace Huang, MD, a research physician in BWH’s Department of Endocrinology and lead author on this study.
There has been emerging interest in supplemental hormonal treatment with testosterone for disrupted sexual functioning, loss of muscle mass, physical limitations and osteoporosis in postmenopausal women. In this study, researchers sought to determine the dose-dependent effects of testosterone on sexual function, body composition, muscle performance and physical function in women with low testosterone levels who had undergone hysterectomy with or without oophorectomy. They studied 71 women over the course of 24 weeks. Participants were randomly assigned either to placebo or one of four testosterone doses given weekly. They found that the higher dose, 25mg, of testosterone tested in this trial after 24 weeks was associated with gains in sexual function, muscle mass and measures of physical performance.
“A primary concern with testosterone therapy is that it can cause symptoms of masculinization among women. These symptoms include unwanted hair growth, acne and lower voice tone. It’s important to note that very few of these side effects were seen in our study,” explained Huang.
Currently the FDA has not approved testosterone therapy for women because of inadequate long-term safety data. The researchers note that longer term studies are needed to determine if testosterone can be given safely to women to improve important health outcomes without inducing other health risks such as heart disease and breast cancer.
What is a hysterectomy?
Hysterectomy means the removal of the uterus (womb). A hysterectomy may or may not be combined with the removal of the Fallopian tubes and one or both ovaries.
Removal of a tube and ovary is called salpingo-oophorectomy, removal of both tubes and ovaries is called bi-lateral salpingo-oophorectomies (BSO for short).
There are different types of hysterectomy, which are described according to which organs are removed.
- A total hysterectomy is the most common operation and this means removal of the uterus and cervix (neck of the womb).
- A sub-total hysterectomy means the removal of the body of the uterus, leaving the cervix behind.
- A radical hysterectomy involves the removal of the uterus, cervix, a small portion of the upper part of the vagina and some soft tissue from within the pelvis. A radical hysterectomy is only performed in cases of cancer of the cervix by gynaecologists who have received special training.
This study was supported by the National Institute of Child Health and Human Development and the National Institute on Aging under principal investigator Dr. Shalender Bhasin. Dr. Bhasin has received research grant support from Abbott Pharmaceuticals and Eli Lilly and Co. for investigator-initiated research unrelated to this study. Dr. Bhasin has served as a consultant to Regeneron, Merck, and Eli Lilly and Co. Dr. Huang has disclosed no relevant financial relationships.
Brigham and Women’s Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. BWH has more than 3.5 million annual patient visits, is the largest birthing center in New England and employs nearly 15,000 people. The Brigham’s medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in patient care, quality improvement and patient safety initiatives, and its dedication to research, innovation, community engagement and educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, more than 1,000 physician-investigators and renowned biomedical scientists and faculty supported by nearly $650 million in funding. For the last 25 years, BWH ranked second in research funding from the National Institutes of Health (NIH) among independent hospitals. BWH continually pushes the boundaries of medicine, including building on its legacy in transplantation by performing a partial face transplant in 2009 and the nation’s first full face transplant in 2011. BWH is also home to major landmark epidemiologic population studies, including the Nurses’ and Physicians’ Health Studies and the Women’s Health Initiative. For more information and resources, please visit BWH’s online newsroom.
What are the risks of having a hysterectomy?
No operation is free of risk. A hysterectomy is a major operation that most women undergo without experiencing complications.
If a woman is overweight, then losing weight before her hysterectomy will make the surgery easier and will reduce the likelihood of post-operative complications.
Complications do occur from time to time and these include:
heavy bleeding at the time of surgery
following surgery, infection involving the wound or bladder (cystitis) may require antibiotic treatment
surgical damage to the bladder or ureters (the narrow tubes that carry urine from the kidneys to the bladder)
an uncommon but serious complication is the development of a blood clot in the veins of the leg (venous thrombosis).
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