Hysterectomy and psychiatric disorder: are the levels of psychiatric morbidity falling?

Abstract

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.

Psychiatric morbidity after hysterectomy

“…The level of psychiatric morbidity in this study is lower than other study done in Bangladesh." But it is consistent with other studies done in western world 12 ' 13 . This study could not reveal whether hysterectomy itself led to psychiatric morbidity or not, as this study did not measure psychiatric morbidity before hysterectomy and as per history, all the patients were psychologically unremarkable before the operation.…”

Hormonal therapy and depression: Are we overlooking an important therapeutic alternative?

“…Maintaining the ovaries of premenopausal women who have had a hysterectomy may protect against subsequent mood disorder [68,70] although hysterectomy may also cause premature ovarian failure. Being the result of prolonged heavy periods, chronic pelvic pain, and severe MRD, depressed mood is, however, also observed in women before hysterectomy [71][72][73][74]. Hysterectomy may thus improve mood, except for women with preexisting psychiatric illness or predisposing personality problems, in whom depressed mood may persist or re-occur in response to the stress associated with surgery [72,74].…”

Psychiatric morbidity following endometrial ablation and its association with genuine menorrhagia

“…It may be that women with high levels of psychological morbidity are more likely to present for surgery for reasons other than heavy periods, and the fact that a large proportion of women (higher than the community prevalence) were cases both before and after surgery is relevant here. Work supporting this 49 suggests that over time in one locality, the fall in the proportion of referred women having psychological morbidity was apparently as a result of local general practitioners becoming more aware of mental health issues for women and adapting referral practices. Previous studies also suggest that surprisingly high numbers of women with low or normal loss present in outpatients with the complaint of heavy periods 58 -60 .…”

“…It is therefore likely that realigning illness representations or attributions about menstruation may have some psychological benefits. It would seem that in Switzerland such an approach has reduced hysterectomy rates 63 and Gath et al's work 49 in Oxford suggests that referral patterns and clinical approaches can change.…”