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Women awaiting hysterectomy: a qualitative study of issues involved in decisions about oophorectomy
Vanita Bhavnani1, Aileen Clarke
1Health Services Research Unit, London School of Hygiene and Tropical Medicine, UK.
Objective:
Women awaiting abdominal hysterectomy have a further decision to take--whether or not to undergo a prophylactic oophorectomy. Prophylactic oophorectomy (removal of healthy ovaries) is commonly undertaken as an adjunct to hysterectomy to prevent ovarian cancer in women who are already having a hysterectomy for menorrhagia, fibroids or severe menstrual pain. It causes an immediate 'surgical menopause'--women no longer produce endogenous oestrogens and they are advised to take hormone replacement therapy (HRT). This descriptive study was undertaken as part of a larger pilot study.
Design:
Qualitative interviewing study.
Setting:
Hospital outpatient departments in southern England.
Sample:
Women on waiting lists for hysterectomy for benign conditions.
Methods:
In-depth semi-structured interviews were undertaken with 16 women awaiting hysterectomy to examine their views of prophylactic oophorectomy, menopause and HRT use. Interviews were transcribed. Nud*ist was used to organise the data. Analysis was undertaken by two researchers working independently who then met to agree themes.
Results:
Women held treatment preferences both about the removal or retention of their ovaries and about subsequent HRT use. Many of the women did not want oophorectomy because of a dislike of a sudden menopause. Those who were planning to have an oophorectomy tended to have more severe symptoms. Some women were fearful of ovarian cancer--one woman described it as a 'silent killer'. A further theme was apparent in the discussion of ovaries as 'redundant' with further discussion of healthy versus problematic ovaries. Many women felt inadequately informed about their treatment options and were unaware of important longer term outcomes of oophorectomy such as an increased risk of osteoporosis or of coronary heart disease.
Conclusion:
It appears that many women emphasise the 'natural' when considering oophorectomy and the use of HRT. Women were uneasy both about a sudden menopause and about the risks of ovarian cancer. And although these women were all about to undergo surgery, they had experienced an apparent serious lack of information especially about long term risks and benefits on which they might base their decision.
