SynopsisThis paper compares the findings of three studies carried out at intervals over the years 1975–1990. The three studies were concerned with different issues, but each study examined psychiatric morbidity among women undergoing hysterectomy for menorrhagia of benign origin.In all three studies levels of psychiatric morbidity were measured before the operation and 6 months after the operation. Psychiatric morbidity was measured with the Present State Examination (PSE) (Wing et al. 1974), and with established self-report questionnaires. Levels of psychiatric morbidity fell significantly across the three studies. In Study 1, the proportions of psychiatric cases were 58% before hysterectomy and 26% after; in Study 2, 28% before and 7% after; and in Study 3, 9% before and 4% after.The decline in psychiatric morbidity was not associated with demographic and social characteristics, previous psychiatric history, family psychiatric history, the nature of the women's menstrual complaints, or the women's understanding and expectations of the operation.In Study 3 anti-menorrhagic drugs were prescribed twice as frequently as in the two previous studies; while the prescribing of psychotropic medication was significantly higher in Study 1 than in Study 2 or Study 3. The implications of these findings are discussed.

A total of 201 women were interviewed four weeks before elective interval tubal sterilisation, of whom 190 (94-5%) were assessed again six months postoperatively and 193 (96 0%) 18 months postoperatively. Before sterilisation the prevalence of psychiatric morbidity as measured by the present state examination was 104% (21 patients), no greater than might be expected in a general population sample; six months after the operation the prevalence was significantly reduced to 4-7% (nine patients); and 18 months postoperatively it had returned almost to the preoperative value (9-3%; 18 patients). Postoperative psychosexual disturbance was rare, only 3% of patients reporting reduced enjoyment of sexual intercourse at either follow-up. Considerable regret was reported by only five patients (2-6%) six months after the operation and by eight (4 1%) 18 months after the operation; however, some dissatisfaction was reported by 15 patients (7-9%) at six months and 21 patients (10-9%) at 18 months. Postoperative psychiatric disturbance and dissatisfaction were largely associated with preoperative psychiatric disturbance.Thus there was no evidence that elective interval sterilisation increased the risk of psychiatric disturbance up to 18 months after the operation.

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