Depression after hysterectomy: a comparative study

The effect of hysterectomy on sexuality and psychological changes

Every year, many women all over the world will undergo a hysterectomy, the removal of their uterus. The majority of hysterectomies are performed to treat conditions such as fibroids, heavy bleeding, endometriosis, adenomyosis and prolapse. A hysterectomy is not often a procedure that needs to be performed urgently, except in the case of cancer. Therefore, a woman considering the procedure should take time to investigate all her options, including other possible treatments. Deciding whether to have a hysterectomy can be a difficult and emotional process. Signs of depression may include severe and prolonged feelings of sadness and hopelessness; diminished interest in activities; significant weight loss or gain; insomnia; fatigue; and thoughts of death or suicide. Every person reacts differently, and reactions are a combination of emotional and physical responses. We still have much to learn about the effects of hysterectomy on sexual function. We investigated many studies published in different journals relative to this subject and we compare their results. Women are more likely to report improved sexual functioning after the surgery when their symptoms have been alleviated. A new hysterectomy procedure that 'spares' abdominal ligaments and nerves is quicker and results in less blood loss and shorter hospital stays and seems to respect the tissues more, without affecting the sexuality of the women.

Bilateral oophorectomy and depressive symptoms 12 months after hysterectomy

OBJECTIVE

This study was performed to examine whether bilateral oophorectomy is related to depressive symptoms.

STUDY DESIGN

A secondary analysis of data collected from a cohort study of 1047 premenopausal women undergoing hysterectomy with or without concomitant oophorectomy for benign indications was performed. Data on depressive symptoms, based on the Profile of Mood States survey, were collected presurgically and 12 months postoperatively.

RESULTS

The effect of bilateral oophorectomy on postoperative depressive symptoms varied, depending on the presence of baseline depressive symptoms. Bilateral oophorectomy was associated with a decrease in risk of depressive symptoms in women without baseline depressive symptoms (risk ratio [RR] 0.36 [95% confidence interval (CI), 0.17, 0.78]) and did not change significantly in those with baseline depressive symptoms (RR 1.21 [95% CI, 0.73, 2.00]).

CONCLUSIONS

Bilateral oophorectomy, in comparison with unilateral or no oophorectomy, is associated with less risk of postoperative depressive symptoms in women without baseline depressive symptoms undergoing hysterectomy.

A prospective study of 3 years of outcomes after hysterectomy with and without oophorectomy

OBJECTIVE

This study was undertaken to determine the outcomes of hysterectomy with and without conservation of the ovaries.

STUDY DESIGN

Data were collected prospectively for 3 years from 257 women undergoing hysterectomy (group 1) and 57 women undergoing hysterectomy with oophorectomy (group 2).

RESULTS

Pelvic pain, abdominal pain, and depression scores were reduced in the 3 years after hysterectomy. Twenty-one percent of the women in group 1 and 43% in group 2 regretted the loss of fertility 3 years after hysterectomy. Satisfaction with the operation was greater than 90% after 3 years in both groups. New symptoms of pelvic pain were infrequent in groups 1 (3%) and 2 (5%).

CONCLUSION

Three years after undergoing hysterectomy with and without oophorectomy, satisfaction is high although some women regret the loss of fertility.

Changes and Factors Influencing Health-related Quality of Life After Hysterectomy in Premenopausal Women with Benign Gynecologic Conditions

BACKGROUND/PURPOSE

A hysterectomy affects a woman's health. This study was performed to identify the factors that affect health-related quality of life (HRQoL) before and after hysterectomy in premenopausal women.

METHODS

This prospective follow-up study recruited 38 women (age range, 33-52 years) who underwent abdominal hysterectomy for nonmalignant causes. SF-36 and self-rated health status were used to assess HRQoL before and after hysterectomy. Data were analyzed using descriptive statistics, nonparametric tests and the generalized estimating equation method for modeling the repeatedly measured responses.

RESULTS

Patients' attitudes toward hysterectomy and subsequent sexual activity were influenced by the surgery. All patients showed significant improvements in the physical component summary (PCS) of SF-36 (mean, 42.1-51.0), but there was no significant difference in the mental component summary (MCS). The significant improvements were found from the five repeated measurements of the self-rated health status (mean, 6.0-7.3). Hemoglobin level was the most important predictor of HRQoL before surgery. Women in employment, with more years of education and previous blood transfusion had high MCS scores after surgery.

CONCLUSION

The overall self-rated health status and PCS showed significant improvements after hysterectomy. Having had a blood transfusion, being educated and employed were positively associated with MCS score after surgery. These findings are vital for preoperative counseling for women undergoing hysterectomy.

Preoperative teaching and hysterectomy outcomes

This study used a theoretical model to determine whether an efficacy-enhancing teaching protocol was effective in improving immediate postoperative behaviors and selected short- and long-term health outcomes in women who underwent abdominal hysterectomies. The model used was the self-efficacy theory of Albert Bandura, PhD. One hundred eight patients in a 486-bed teaching hospital in the Midwest who underwent hysterectomies participated. The participation rate was 85%, and the attrition rate was 17% during the six-month study. The major finding was that participants in the efficacy-enhancing teaching group ambulated significantly longer than participants in the usual care group. This is an important finding because the most prevalent postoperative complications after hysterectomy are atelectasis, pneumonia, paralytic ileus, and deep vein thrombosis, and postoperative ambulation has been shown to decrease or prevent all of these complications. This finding could affect the overall health status of women undergoing hysterectomies.

Understanding pre- and post-hysterectomy levels of negative affect: a stress moderation model approach

Before and after hysterectomy, 60 women completed self-report questionnaires. Measures of personality (NEO-Five Factor Inventory, NEO-FFI), coping (Coping Inventory for Stressful Situations, CISS), and procedure appraisal were completed pre-operatively. Measures of depression and anxiety were completed pre- and post-operatively. Pre-op, 34% of women reported depression at clinical levels, and 29% reported clinical anxiety. The prevalence of depression fell to 8% 3-months post-op although clinical levels of anxiety persisted post-op in 22% of women. Regression analyses revealed that the principal risk factors for post-op negative affect were pre-op levels of depression and concerns about hysterectomy outcome. In assessing proposed models of post-hysterectomy outcome, structural equational modelling revealed the key position of neuroticism and extraversion, which were both directly and indirectly related to pre- and post-operative depression and anxiety. The mediating variables in this model included coping dispositions and procedure appraisal. It is concluded that the variables contained within stress moderation models provide a useful framework for understanding the processes that may lead to elevated levels of negative affect both before and after hysterectomy. Such an approach may prove beneficial for other surgical-outcome studies.

Psychological distress of conservative and nonconservative uterine surgery: a prospective study

OBJECTIVE

The aim of the present study is to evaluate the psychological reaction to conization before and after the operation compared to hysterectomy. To study the incidence of psychological stress related to conization, 60 women undergoing conization were compared to 40 women who had undergone hysterectomy.

METHOD

Psychological disease was rated in the pre- and postoperative periods using the Symptom Questionnaire (SQ). Each patient was evaluated 2 weeks before the operation, and 3, 6 and 12 months after it.

RESULTS

Both the conization and hysterectomy groups showed a significant reduction in anxiety and depression at the 3-, 6- and 12-month follow-ups compared to the preoperative period. Two weeks before surgery, 8 conization patients (19.5%) showed an anxious status, while 10 (24.3%) presented high levels of anxiety and depression. Within hysterectomy patients, the occurrence was respectively of 4 (12.9%) and 10 women (32.2%). Twelve months after surgery, of the women with preoperative depression, only four (9.7%) conization and four (12.9%) hysterectomy patients presented a negative mood status. A similar trend was present for somatic symptoms but only in the conization group, because the hysterectomy patients did not show a reduction in these symptoms from the preoperative to the postoperative period. This result could be related to the surgical menopause due to the bilateral oophoriectomy executed in more than half of the hysterectomy group.

CONCLUSION

In general, the results of the present study show that the conservative and nonconservative uterine surgery determines a good psychological prognosis in the short- and long-term postoperative periods.

Depressive symptoms in children after tonsillectomy

OBJECTIVE

Several cases of severe depression after tonsillectomy have been described in children, indicating psychological trauma after surgery and hospitalization. The actual prevalence of depressive symptoms after tonsillectomy is unknown and possibly underestimated. This study aims to quantify this problem by employing current diagnostic methods.

METHODS

This is a prospective study of 159 children who underwent tonsillectomy in a major Pediatric University Hospital. All patients stayed in the hospital overnight. Parents were sent questionnaires based on diagnostic criteria for depression (ICD-10) 3 weeks postoperatively. Whenever the criteria for a depressive episode were met, a telephone interview with the parents followed 3 months after the operation.

RESULTS

Some 89 questionnaires were returned (56%), revealing that 15 patients (17%), 4-16 years old, developed depressive symptomatology compared with a 4% prevalence of depression in the general child population and 10-20% in the pediatric hospital populations. No children had persisting symptoms 3 months later.

CONCLUSIONS

These results suggest that post-tonsillectomy morbidity can occasionally manifest with depressive symptoms, usually resolving spontaneously. A high index of suspicion is required by the otolaryngologist, nurses and primary care physician for early diagnosis and referral of persisting cases to a specialist. Emphasis is given to a structured preoperative psychological preparation of pediatric patients.

A prospective study of the short-term outcomes of hysterectomy with and without oophorectomy

OBJECTIVE

To determine the symptom profile and satisfaction rate for women undergoing hysterectomy with and without oophorectomy

STUDY DESIGN

Women under 46 years of age who underwent hysterectomy with (n = 266) and without oophorectomy (n = 57) were followed for six months.

RESULTS

Satisfaction was high at six months. In-hospital complication rates were 28% in Group 1 and 39% in Group 2 (p = 0.11). Pelvic pain was reported in more than half the women at six weeks. A reduction in constipation, diarrhoea, abdominal and pelvic pain, and depression was reported at six months. Quality of sexual function in women did not improve. New symptoms of pelvic pain or depression were present at six months in more than 16% to 37% of the women. Regrets about loss of fertility were increased at six months.

CONCLUSIONS

Although levels of satisfaction with the procedure of hysterectomy were high, new symptoms and regrets about the loss of fertility were commonly reported.

Women's sexual behavior, body image and satisfaction with surgical outcomes after hysterectomy: a comparison of vaginal and abdominal surgery

The aim of this study was to investigate the impact of vaginal and abdominal hysterectomy on women's sexual behavior, sexual dysfunction, body image and satisfaction with surgery. A prospective study was conducted on 90 women to evaluate the outcomes of hysterectomy. Data were collected prior to surgery, three months and two years after surgery, using self-report questionnaires. The results showed significant differences in women's sexual behavior and sexual dysfunction before and after hysterectomy, independent of the surgical procedure performed. Women in both groups reported improvements in sexual desire, sexual activity and sexual intercourse three months and two years after surgery. Sexual dysfunction such as dyspareunia, vaginismus, lack of orgasm and loss of sexual interest diminished significantly after surgery. Regression analyses revealed that postmenopausal status, severity of gynecological complaints and frequency of sexual intercourse were the most important factors for improved sexual outcomes. Women in the abdominal group were dissatisfied with their body image because of the abdominal scar, experienced more pain and had a longer period of recovery from surgery compared to women in the vaginal group. According to the results, sexual behavior alone is not an important factor in choosing vaginal or abdominal hysterectomy. However, sexual behavior was important in both groups when evaluating outcomes after hysterectomy.

Hysterectomy: what do women need and want to know?

OBJECTIVE

The purpose of this article is to describe women's experiences of hysterectomy and to identify their fears, concerns, and met as well as unmet health care needs.

DESIGN

Narrative data of women's hysterectomy experiences were collected via a written survey.

SETTING

Data were collected from women living in southeastern Wisconsin.

PARTICIPANTS

Participants were 102 women who had undergone hysterectomy within the previous 2 years. The mean age of the women was 43 and mean time since hysterectomy was 13 months. Eighty percent of the women had undergone both hysterectomy and oophorectomy, and 78% were taking hormone replacement therapy.

MAIN OUTCOME MEASURES

A questionnaire of women's hysterectomy needs and a demographic questionnaire were used to collect data via mail. The data from three open-ended questions were content analyzed.

RESULTS

Seven themes about women's experiences of hysterectomy were identified: (a) positive aspects, (b) hormone replacement therapy, (c) insufficient information, (d) changes in sexual feelings and functioning, (e) emotional support, (f) psychologic sequelae, and (g) feelings of loss.

CONCLUSIONS

Women wanted treatment choices, a part in decision-making, accurate and useful information at an appropriate time, provider support, and access to professional and lay support systems. The essentials for hysterectomy care are outlined and include the characteristics of care that women desire, the informational content that women want, health care systems that support patient satisfaction, and the outcomes women want.

The partner's view about hysterectomy

This prospective interview study was conducted to elucidate the psychological, social and sexual consequences of hysterectomy on the women's partners. In addition to the interviews, a check-list of psychological symptoms was used. Twenty-four partners to women who were scheduled for hysterectomy because of benign uterine diseases entered the study. The men were interviewed before hysterectomy and 12-15 months later. Approximately half of the men reacted with ambivalence towards their partners' decision to undergo hysterectomy. The main concerns of the men were possible complications related to the operation and a diagnosis of cancer. Generally, the men did not receive information from the medical staff, neither before nor after the hysterectomy. The women's symptoms before operation had a negative impact on sexual life and quality of life of the partners. Hysterectomy showed a positive effect not only on the sexual life but also on the overall quality of life of the majority of the men. In conclusion, the men in this study seem to have predominantly supportive attitudes and adequate reactions concerning their partner's hysterectomy. A decrease of their psychological symptoms postsurgery and an improvement of sexual life and overall quality of life could be observed.

Office gynecology for the primary care physician, part II: pelvic pain, vulvar disease, disorders of menstruation, premenstrual syndrome, and breast disease

Approaches to patients with pelvic pain, vulvar disease, disorders of menstruation, premenstrual syndrome, and breast diseases are addressed. In the great majority of cases, it is appropriate for the primary care physician to initiate evaluation and management of these problems. It is hoped that the brief introductions contained here suggest a diagnostic approach to each disorder and guide referral to consultants as needed.

Premenstrual tension among hysterectomized women

What is the prevalence of premenstrual tension (PMT) among women who have no uterus? Three hundred and seventeen hysterectomized women aged 28-45 years, were asked to describe their health before and after surgery. Most of the women (88%) felt that their general health improved postoperatively. There was a significant reduction in the percentage of women reporting moderate to severe PMT in all or almost all cycles: pre- versus post-hysterectomy, 56.1 versus 18.9; p < 0.001. Of the 178 women who considered PMT to have been a regular feature of their prehysterectomy menstrual cycles, 73% either lost their symptoms after surgery or felt that they were now minimal. It is concluded that the prevalence of PMT among hysterectomized women is low compared with that among women who have a uterus.

The hysterectomy experience: an ethnographic study

Women who undergo a hysterectomy typically experience preoperative symptoms that severely affect quality of life. The purpose of this study was to understand the hysterectomy experience from the informants' perspective. The research design chosen was ethnography. Research aims included (a) describing the quality of life before hysterectomy, (b) understanding the decision-making process involved in having a hysterectomy, (c) describing the knowledge base women have about hysterectomies, (d) describing concerns and fears about hysterectomies, (e) making comparisons before and 3 months after the hysterectomy, and (f) discovering what advice women give each other about hysterectomies. Ethnographic interviews were conducted and analyzed according to the Spradley method. The informants provided researchers with valuable advice for professionals caring for women who elect to undergo a hysterectomy.

Hysterectomized women with ovarian conservation report more severe climacteric complaints than do normal climacteric women of similar age

OBJECTIVE

Our purpose was to compare the severity of typical climacteric complaints (vasomotor complaints and vaginal dryness) and 21 other complaints, considered atypical for the climacteric, in women with and without a uterus.

STUDY DESIGN

A cross-sectional population questionnaire survey was sent to all women aged 39 through 60 years in Ede, the Netherlands. Subjects were 986 hysterectomized women (one or both ovaries present) and 5636 normal women (uterus and both ovaries present). Statistical analysis was performed by cross tabulations, chi 2 analysis, analysis of variance, meta-analysis of variance, and ratios.

RESULTS

Hysterectomized women, especially those aged 39 to 41 years, report significantly more vasomotor complaints, vaginal dryness, and atypical complaints than do normal climacteric women of the same age. The higher prevalence of typical climacteric complaints in hysterectomized women largely explains their higher level of atypical complaints.

CONCLUSION

Physicians should be alert to typical climacteric complaints after hysterectomy with ovarian conservation, especially in young women, because the literature indicates that hysterectomized women with ovarian conservation are overrepresented with regard to osteoporosis, cardiovascular disease, osteoarthritis, depression, and sexual problems.

Decrease of depression during stroke and amputation rehabilitation

Clinical observation had suggested that mild depression occurs after admission for acute medical treatment and then decreases during further hospitalization for rehabilitation treatment. The Geriatric Depression Scale (GDS) was given on admission and discharge to 14 stroke and 17 amputee rehabilitation patients. Each of the two groups showed decreasing GDS scores from beginning to end of the rehabilitation admission. Suggested reasons included: (1) the gradually diminishing effects of stroke and amputation as life crises during the 1-2 month admission, (2) effects of physical improvement on mood and affect, (3) milieu effects of the medical ward, and (4) tendencies for all psychopathology scale scores to decrease on retest.

A comprehensive education and support program for women experiencing hysterectomies

Women undergoing hysterectomies require special education and emotional support. A new comprehensive program of nursing interventions helps assist women in coping with hysterectomies. Nurses, combining their skills in gynecologic and mental-health nursing, conduct presurgery classes, provide information and support during hospitalization, and offer a postdischarge support group to hysterectomy patients. This article includes descriptions of the program's development process, class content, and ways in which continuity of care is provided.

Cultural factors and reaction to hysterectomy

The role of cultural background in the etiology of depressive symptoms associated with hysterectomy has been rarely explored. However, the increasing interest in the transcultural aspects of psychiatry in the last decade gives a particular relevance to this subject. In the current study, 152 women underwent hysterectomy in a downtown hospital of a large city. The population under study consisted of women of various ethnic backgrounds, French Canadian (35%), English Canadian (29%), European (22%) and other (14%). The women completed the Zung self-rating depression scale (SDS) before the operation and six times after during a one year period. They also answered two questionnaires, the first before the operation and the last one a year after. These questionnaires explored the presence of fears, misconceptions, the attitudes toward the operation, the satisfaction regarding medical care and the general pre- and post-operative adjustment. English Canadian women reported the lowest scores on the SDS; they had few misconceptions and fears. They had the best post-operative adjustment of the three groups. French Canadian women showed intermediate scores on the SDS and expressed more misconceptions and feelings of mutilations pre-operatively. Women of European origin showed the highest scores on the SDS at all observations, expressed more regrets about the operation and had a more difficult post-operative adjustment than the other two groups. This study suggests that cultural factors may contribute to the reaction to hysterectomy in women of different ethnic backgrounds. Education, the type of society: patriarchal versus matriarchal, the emphasis on the women's reproductive ability in a particular culture, are among other factors that seem to play an important role.