This has many causes, and is not only experienced by women. The level of sexual interest starts to fall, and then continuous to decline, in men and women in their middle years. While some women undoubtedly find HRT of tremendous benefit to their sexual lives, others find it little or no help at all. It is difficult to distinguish which symptoms in women are caused by lower levels of oestrogen, and which are just the effects of ageing.

How HRT can help. It is not unusual for women to feel an increased sex drive after the menopause. This is often because they no longer have an underlying worry about becoming pregnant, although the majority of women now have available much more effective contraception than their mothers and grandmothers did. However, if your sex drive has taken a plunge in your menopausal years, then HRT may help. Sometimes oestrogen alone is enough, but if loss of sex drive is coupled with a severe loss of self-confidence, your doctor may suggest you try the implant form of HRT as the male hormone, testosterone, can be incorporated into it, which may help these particular problems.

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Pain relief. An important guiding principle to remember is that when the wound is healed physical activity can do no harm; it can actually play an important part in the healing process. Pain is a good guide to wound healing and will usually indicate what is feasible. If you want to walk, try it. If it causes pain, take a rest. When you can walk easily, try a new activity requiring a little more physical exertion. While pain relief after surgery makes it more difficult to judge when the wound has healed, it has other important benefits. Jan was extremely reluctant to accept pain relief after her hysterectomy and wanted to do without painkillers if at all possible. The only problem with this approach was that it caused Jan to restrict her movements to minimise the pain. This resulted in the formation of a blood clot that settled in her leg. She was persuaded that pain relief would enable her to move about and this seemed to short-circuit further clot problems.

Thrombosis. Thrombosis, the formation of blood clots within a blood vessel, is one of the most dangerous complications of any type of surgery. The pelvis or leg are the most common sites of thrombosis after major abdominal surgery. If the thrombosis is swept along by the bloodstream, it can lodge in the lungs blocking the circulation and depriving the body of oxygen.

Lung complications. Lung complications such as pneumonia or lung collapse occur very rarely after a hysterectomy. If you have a bad cold in the days before you are due for your operation, let your doctor know so that a new time can be made. It is also important to stop smoking at least one week before surgery.

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Barbiturates were manufactured in 1912 and were used extensively for the next 60 years as a tranquillizer to calm the anxious. In a moderate dose they can be used as a hypnotic for sleeping. In an even higher dose they can be used in general anaesthesia, knocking people out completely for surgical operation.

After many years it became apparent that a lot of people abused barbiturates, becoming addicted to them, There were serious withdrawal symptoms. People who were on high doses of these pills could not stop taking them and needed a higher and higher dose to have the same desirable effect. People who were on high doses for a long time and stopped suddenly experienced serious withdrawal symptoms. Not only could they not sleep, but also they could go into convulsion and could even develop temporary psychotic illness. These pills have a narrow safety margin, and people have overdosed either accidentally or on purpose. Remember the sad cases of Marilyn Monroe and Elvis Presley?

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