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Negative attitudes and affect do not predict elective hysterectomy: a prospective analysis from the Study of Women's Health Across the Nation

Gibson, Carolyn J. MPH1; Bromberger, Joyce T. PhD2; Weiss, Gerson E. MD3; Thurston, Rebecca C. PhD4; Sowers, MaryFran PhD5; Matthews, Karen A. PhD1,2

doi: 10.1097/gme.0b013e3181f9fa35
Original Articles

Objective: Cross-sectional studies suggest an association between hysterectomy and negative affect. Using prospective data, we examined the associations of negative affect, attitudes toward aging and menopause, premenstrual symptoms, and vasomotor symptoms with elective hysterectomy in midlife.

Methods: Data were from the Study of Women's Health Across the Nation, a multisite, community-based prospective cohort study of the menopausal transition (n = 2,818). Annually reported hysterectomy at visits 2 to 9 was verified with medical records when available (71%). Anxiety, perceived stress, depressive symptoms, attitudes toward aging and menopause, vasomotor symptoms, and premenstrual symptoms were assessed at baseline using standardized questions. Cox proportional hazards models were used to relate these variables to subsequent elective hysterectomy. Covariates included demographic variables, menstrual bleeding problems, body mass index, hormone levels, and self-rated health, also assessed at baseline.

Results: Elective hysterectomy was reported by 6% (n = 168) of participants over an 8-year period. Women with hysterectomy were not higher in negative affect or negative attitudes toward aging and menopause compared with women without hysterectomy. Vasomotor symptoms (hazard ratio [HR], 1.44; 95% CI, 1.03-2.01; P = 0.03) and positive attitudes toward aging and menopause (HR, 1.74; 95% CI, 1.04-2.93) at baseline predicted hysterectomy over the 8-year period, controlling for menstrual bleeding problems, site, race/ethnicity, follicle-stimulating hormone, age, education, body mass index, and self-rated health. Menstrual bleeding problems at baseline were the strongest predictor of hysterectomy (HR, 4.30; 95% CI, 2.05-9.05).

Conclusions: In this prospective examination, negative affect and attitudes were not associated with subsequent hysterectomy. Menstrual bleeding problems were the major determinant of elective hysterectomy.

From the Departments of 1Psychology and 2Epidemiology and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; 3Department of Obstetrics, Gynecology, and Women's Health, UMDNJ-New Jersey Medical School, Newark, NJ; 4Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; and 5Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI.

Received June 2, 2010; revised and accepted August 25, 2010.

Funding/support: Carolyn J. Gibson was supported by Cardiovascular Behavioral Medicine training grant NIH T32 HL 007560.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Carolyn J. Gibson, MPH, Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15213. E-mail:

©2011The North American Menopause Society