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

Gibson, Carolyn J.; Joffe, Hadine; Bromberger, Joyce T.; Thurston, Rebecca C.; Lewis, Teńe T.; Khalil, Naila; Matthews, Karen A.

Obstetrical & Gynecological Survey:
doi: 10.1097/01.ogx.0000421453.14147.8a
Gynecology: Menopause

Abstract: More than 30% of women in the United States have a hysterectomy by the age of 60. A high percentage of hysterectomies (55%-80%) are accompanied by bilateral oophorectomy. Cross-sectional studies have found an association between negative mood and hysterectomy. These studies suggest that regardless of oophorectomy status, women with a hysterectomy are more distressed compared with their age-matched peers without a hysterectomy. Available data on the potential influence of hysterectomy and oophorectomy on mood are limited and mixed.

This study compared possible differences in mood symptoms over time among women who had a hysterectomy, with or without bilateral oophorectomy, and those with natural menopause. Data obtained from the Study of Women’s Health Across the Nation, a multicenter community-based prospective study, were used to examine the physical and psychological health of women undergoing the menopausal transition. Depressive symptoms were assessed annually for up to 10 years using the Center for Epidemiological Studies Depression Index score; anxiety was assessed at each visit with 4 questions. Piecewise hierarchical linear growth models were used to compare the mean rate of change in depressive and anxiety scores before and after the final menstrual period among women who had a hysterectomy with or without ovarian conservation and those undergoing natural menopause. Covariates assessed based on previously documented associations with negative mood symptoms in midlife included race, educational attainment, menopausal status, age the year before final menstrual period or surgery, and time-varying body mass index, self-rated health, use of hormone therapy, and use of antidepressants.

The analytic sample was composed of 1793 women (90.9%) who reached natural menopause, 76 women (3.9%) who had a hysterectomy with ovarian conservation, and 101 women (5.2%) who had a hysterectomy with bilateral oophorectomy. Depressive and anxiety symptoms for all women decreased in the years after final menstrual period or surgery. Hysterectomy with or without ovarian conservation had no effect on anxiety or symptoms. There was no significant difference in the mean rate of change in depressive or anxiety symptoms 5 years after final menstrual period or surgery: Depression index means were 0.72 SDs lower and anxiety symptoms were 0.67 SDs lower.

These findings show that both depressive and anxiety symptoms improve for all women over the course of the menopausal transition in the years after final menstrual period or surgery. Hysterectomy with or without ovarian conservation among women in midlife does not seem to have a lasting negative effect on mood.

© 2012 Lippincott Williams & Wilkins, Inc.