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Medical Edge Newspaper Column from Mayo Clinic

OVARIES CAUSING POST-HYSTERECTOMY MONTHLY SYMPTOMS

DEAR MAYO CLINIC: Four years ago, I had a complete hysterectomy. What could account for the continuation of “monthly” cyclical symptoms that include breast tenderness, constipation, headaches, etc. It seems like I should experience none of these symptoms anymore. — Rochester, Minn.

ANSWER: A hysterectomy is one of the most common surgeries among women, second only to caesarean section. A complete, or total, hysterectomy involves removing the uterus and the cervix.

But for some women who undergo this procedure, the ovaries remain. These two organs, each about the size and shape of an almond, are located on either side of the uterus. They produce eggs, as well as the hormones estrogen and progesterone that regulate the monthly cycles of ovulation and menstruation.

It is these hormones, not the uterus, that produce the symptoms you are experiencing. If you still have your ovaries, you will continue to experience premenstrual symptoms because your brain, breasts, bowels and other parts of your body are still under the control of your shifting hormones. The only hormonally responsive organ removed in the hysterectomy was your uterus. Therefore, you still have all the menstrual feelings without actually having your period.

The premenstrual symptoms are likely to continue until your body goes through the natural process of menopause and your ovaries begin to make less and less estrogen and progesterone, just as they would if you had not had a hysterectomy. Because hormones are at the heart of many menopausal symptoms — such as hot flashes, vaginal changes and night sweats — you may experience those as well.

Exercising regularly, getting plenty of rest, decreasing stress, eating a healthful diet and avoiding caffeine and alcohol may help reduce some premenstrual symptoms. If your symptoms are particularly troublesome, talk to your doctor. He or she may prescribe medications to help give you some relief.

— Andrew Good, M.D., Obstetrics & Gynecology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Information on a Hysterectomy
Appointment Information

DEAR MAYO CLINIC: My daughter is five months pregnant and has developed a terrible rash. I think it is called PUPPP. Are there any medications that can help?

ANSWER: It’s not unusual to have rashes and feel itchy during pregnancy. Soaps or lotions could be irritating your daughter’s skin — even if she has used them without problems before.

Using unscented moisturizers, mild soaps and colloidal oatmeal baths (Aveeno) could help.
At the five-month mark, your daughter probably doesn’t have PUPPP, which is short for pruritic urticarial papules and plaques in pregnancy. It’s also called polymorphic eruption of pregnancy.

PUPPP, a very itchy rash, can appear in the third trimester — at 35 to 36 weeks of gestation — and can last until after the baby is born. There have been rare cases of PUPPP reported in the first and second trimesters. It starts on the stretch marks of the abdomen and can spread to the trunk and back, arms and thighs.

You can ease the itching with over-the-counter medications such as hydrocortisone lotions or antihistamines (Benadryl, others). Oatmeal baths can help. If these don’t relieve itching, a doctor might prescribe oral steroids.

PUPPP is most common in women who are pregnant with their first child. About one in 100 to 300 pregnant women deals with PUPPP. It happens more frequently with male fetuses and when the woman is expecting twins or triplets.

Doctors aren’t sure what triggers PUPPP. It’s believed that there’s a connection with the mother’s rapid weight gain and rapid growth of the fetus. While PUPPP makes the mother uncomfortable, it doesn’t indicate a health problem for the fetus.

Even so, it’s a good idea to check with a care provider about suspicious rashes or itchiness during pregnancy.

Intense itchiness without a rash can indicate a medical concern. It’s called cholestasis of pregnancy, which is a potentially serious liver problem. Other symptoms can include nausea, vomiting, loss of appetite, fatigue and jaundice. Women with these symptoms should check with their health care providers immediately.

— Mary Murry, Certified Nurse Midwife, Obstetrics and Gynecology,
Mayo Clinic, Rochester, Minn.

Additional Resources:
Information about the Department of Obstetrics
Appointment Information
More Information about Pregnancy

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.