Mood Symptoms After Natural Menopause and Hysterectomy With and Without Bilateral Oophorectomy Among Women in Midlife

Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Obstetrics and Gynecology (Impact Factor: 5.18). 05/2012; 119(5):935-41. DOI: 10.1097/AOG.0b013e31824f9c14
Source: PubMed


To examine whether mood symptoms increased more for women in the years after hysterectomy with or without bilateral oophorectomy relative to natural menopause.
Using data from the Study of Women's Health Across the Nation (n=1,970), depression and anxiety symptoms were assessed annually for up to 10 years with the Center for Epidemiological Studies Depression Index and four anxiety questions, respectively. Piece-wise hierarchical growth models were used to relate natural menopause, hysterectomy with ovarian conservation, and hysterectomy with bilateral oophorectomy to trajectories of mood symptoms before and after the final menstrual period or surgery. Covariates included educational attainment, race, menopausal status, age the year before final menstrual period or surgery, and time-varying body mass index, self-rated health, hormone therapy, and antidepressant use.
By the tenth annual visit, 1,793 (90.9%) women reached natural menopause, 76 (3.9%) reported hysterectomy with ovarian conservation, and 101 (5.2%) reported hysterectomy with bilateral oophorectomy. For all women, depressive and anxiety symptoms decreased in the years after final menstrual period or surgery. These trajectories did not significantly differ by hysterectomy or oophorectomy status. The Center for Epidemiological Studies Depression Index means were 0.72 standard deviations lower and anxiety symptoms were 0.67 standard deviations lower 5 years after final menstrual period or surgery.
In this study, mood symptoms continued to improve after the final menstrual period or hysterectomy for all women. Women who undergo a hysterectomy with or without bilateral oophorectomy in midlife do not experience more negative mood symptoms in the years after surgery.

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    • "In addition, most of these previous studies were conducted in Western countries, and cultural factors may have an influence on the reactions to hysterectomy in women from different ethnic backgrounds (Lalinec-Michaud and Engelsmann, 1989); therefore, it is essential to conduct studies among people from different cultural backgrounds. Furthermore, only a few of these studies were conducted using a nationwide population dataset, which may limit the generalizability of the results reported (Gibson et al., 2012). The National Health Insurance program of Taiwan covers most of the population, and most medical institutions (91%) in the country (Chou et al., 2013). "
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    ABSTRACT: Objective The objective of this study was to assess the risk of depressive disorders in women who underwent hysterectomy in Taiwan. Methods A retrospective study was conducted in a matched cohort of cases using the National Health Insurance Research Database of Taiwan. Database records from 1689 women who underwent hysterectomy between 2001 and 2005 were included in this study. A control group matched for age and physical comorbidity was selected from the same database (n = 6752). For all cases, medical records were tracked until the end of 2009 to identify whether a depressive disorder was diagnosed during the follow-up period. The hazard ratio (HR) for depression during the observation period was analyzed using multivariable Cox proportional-hazards models, adjusted for age, physical comorbidities, and other socioeconomic factors. Results The HR for depression was 1.78 times higher for the group that underwent hysterectomy than for the control group (adjusted HR = 1.78; 95% CI = 1.46–2.18, p < 0.001). In addition, HR for major depressive disorder in women who underwent hysterectomy was significantly higher (1.84 times) than for the control group (adjusted HR = 1.84; 95% CI = 1.23–2.74, p < 0.01). Conclusions Our study revealed that, in Taiwan, women who underwent hysterectomy had an increased risk of developing depression. Longitudinal studies to follow-up the psychological outcomes in Taiwanese women who underwent hysterectomy will be necessary to confirm our findings.
    Journal of Psychiatric Research 09/2015; 68:186-191. DOI:10.1016/j.jpsychires.2015.06.017 · 3.96 Impact Factor
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    Menopause (New York, N.Y.) 09/2012; 19(9):949-51. DOI:10.1097/gme.0b013e3182651d8d · 3.36 Impact Factor
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    ABSTRACT: Hysterectomy is one of the commonest operative procedures in the developed world, mostly occurring among premenopausal women, with contradictory results regarding post-operative psychological wellbeing. This review aims to inform practice by examining whether hysterectomy predicts depression or anxiety outcomes. We searched PubMed, EMBASE, and PsycINFO electronic databases for articles published before November 2012. Reference lists of relevant articles were hand searched, and expert opinions were sought. Refereed studies investigating an association between hysterectomy for benign (non-cancerous) conditions and post-operative symptoms of depression or anxiety were chosen for this review. Two authors independently abstracted data from original articles. Authors of relevant studies were contacted for data that could not be extracted from the published articles. Review Manager 5.1 was used throughout the meta-analysis to calculate the summary relative risks (RRs), and the weighted standardized mean difference (WstdMD), and their corresponding 95% confidence intervals (CI). A random effects model was used in data analysis and verified using a fixed effect model. Overall, hysterectomy was associated with a decreased risk of clinically relevant depression (RR = 1.69, 95% CI 1.19-2.38). Additionally, hysterectomy was associated with a decrease in standardized depression outcomes (standardized mean difference (SMD) 0.38 (95% CI 0.27-0.49)). Conversely, there was no significant association between hysterectomy and risk of clinically relevant anxiety (RR = 1.41, 95% CI 0.72-2.75). In conclusion, data from before and after studies suggest that hysterectomy for benign gynaecological conditions is not adversely associated with anxiety and may be positively rather than adversely associated with depression.
    European journal of obstetrics, gynecology, and reproductive biology 01/2013; 174(1). DOI:10.1016/j.ejogrb.2013.12.017 · 1.70 Impact Factor
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