Emotional Factors in Gynecology

Psychological problems and uterine bleeding

Gynaecological complaints are often associated with psychiatric disorder. Women with psychiatric disorder are more likely to complain of excessive uterine bleeding than women without psychiatric disorder. When a woman complains of menorrhagia, yet also has a psychiatric disorder, it is important to establish which is the primary problem. If menorrhagia is primary, then any associated psychiatric disorder may be secondary to distress and fear caused by excessive menstruation. If the psychiatric disorder is primary, then psychological distress may lead a women to complain about her usual menstrual pattern or minor changes in it. If the complaint of excessive menstruation is secondary to psychiatric disorder, surgical or medical treatment of this complaint may not be justified. If the gynaecologist is to make the important distinction between complaints of menorrhagia which are primary and those which are secondary to psychiatric disorder, then he/she needs to be able to detect and assess psychiatric disorder in women who present with complaints of excessive uterine bleeding. Recent research has provided information about the relationship between the surgical treatment of menorrhagia and psychiatric disorder. Hysterectomy for menorrhagia seems to alleviate psychiatric disorder in many women who had psychiatric disorder before operation. The operation rarely induces psychiatric disorder in women who are psychiatrically well before surgery. There is no association between psychiatric disorder either before or after hysterectomy for menorrhagia and the presence of absence of demonstrable pelvic pathology. There is no evidence that those women who overestimate their menstrual blood loss have an increased likelihood of being psychiatrically disturbed after hysterectomy. However, an important determinant of psychiatric outcome after hysterectomy for menorrhagia is preoperative psychiatric status--for example, mental state before surgery, previous psychiatric history and neuroticism.

Psychiatric disorder and gynaecological symptoms in middle aged women: a community survey

In a community survey 521 women aged 35-59 were selected at random from all patients registered in two groups practices. They were interviewed at home and assessed by means of standardised psychiatric measures and detailed gynaecological inquiry. Levels of psychiatric morbidity were found to be within the expected range for such a sample. Both psychiatric morbidity and the personality dimension of neuroticism were significantly associated with gynaecological symptoms, including dysmenorrhoea and premenstrual tension, some symptoms of excessive menstruation, and flushes and sweats but not disappearance of menstruation for over six months. Current psychiatric state was significantly associated with recent adverse life events and with indices of psychiatric vulnerability (neuroticism and previous psychiatric history), suggesting possible aetiological links with gynaecological symptoms. The findings of this study have implications for the management of gynaecological complaints in general practice.

Post-hysterectomy adaptation: a review and report of two follow-up studies

Hysterectomy, its indications and its consequences for later health, have been prominent topics in recent psychiatric, gynaecological and lay literature. This study describes the results of two recent surveys, one of 216 women less than 45 years old who had a hysterectomy for non-malignant conditions at a major Sydney hospital. These women were interviewed on the seventh to tenth postoperative day. One hundred and ninety-four were then followed up by questionnaire 13 months later. In a later study carried out at a hospital on the outskirts of Sydney, 100 out of 146 women responded to a follow-up questionnaire approximately one year after their operations. These studies and their relevance to recent similar studies are discussed in terms of post-hysterectomy adaptation and prognostic factors associated with poor psychiatric outcome.

Abdominal pain of unknown etiology

The influence of age, sex, duration of symptoms, and exploratory laparotomy on prognosis of adult patients with abdominal pain of unknown etiology was assessed in a retrospective review. Patients with incomplete diagnostic evaluation were excluded. Of the sixty-four patients studied, forty-six were female. Lack of improvement of symptoms in the follow-up period was 67% in females and 22% in males (p less than 0.05). Younger patients tended to have higher improvement rates. Of the patients whose duration of symptoms was less than fourteen days, 65% were improved and 25% were subsequently diagnosed, as compared with 14 and 9%, respectively, of those whose symptoms had been present for more than ninety days (p less than 0.05). Laparotomy did not influence rate of improvement and established a diagnosis in only one of twenty-three patients explored. It is concluded that few of these patients are likely to benefit from laparotomy, especially adult females whose symptoms have been present for more than three months.