Hysterectomy and incidence of depressive symptoms in midlife women: the Australian Longitudinal Study on Women's Health

Wilson, Louise F.; Pandeya, Nirmala; Byles, Julie; Mishra, Gita D.

doi:10.1017/s2045796016001220

Cited by 45 publications

(42 citation statements)

References 36 publications

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“…6 However, results from a small survey in Australia showed substantial variation between practitioners' views on the age they would routinely recommend removal of both ovaries at the time of hysterectomy for benign indications, with 50% recommending removal at age 55 years. 7 Our previous research has shown associations between hysterectomy (with and without bilateral oophorectomy) and poorer physical 8 and mental 9 health. Hysterectomy has also been associated with chronic diseases such as diabetes, 10 stroke, 11 and certain cancers.…”

Section: Introductionmentioning

confidence: 98%

Hysterectomy status and all-cause mortality in a 21-year Australian population-based cohort study

Wilson

Pandeya

Byles

et al. 2019

American Journal of Obstetrics and Gynecology

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BACKGROUND: Hysterectomy is a common surgical procedure, predominantly performed when women are between 30 and 50 years old. One in 3 women in Australia has had a hysterectomy by the time they are 60 years old, and 30% have both ovaries removed at the time of surgery. Given this high prevalence, it is important to understand the long-term effects of hysterectomy. In particular, women who have a hysterectomy/ oophorectomy at younger ages are likely to be premenopausal or perimenopausal and may experience greater changes in hormone levels and a shortened reproductive lifespan than women who have a hysterectomy when they are older and postmenopausal. Use of menopausal hormone therapy after surgery may compensate for these hormonal changes. To inform clinical decisions about postsurgery management of women who have a hysterectomy prior to menopause (ie, average age at menopause 50 years), it is useful to compare women with a hysterectomy to women with no hysterectomy and to stratify the hysterectomy status by whether or not women have had a bilateral oophorectomy, or used menopausal hormone therapy. OBJECTIVE: We sought to investigate whether women who had a hysterectomy with ovarian conservation or a hysterectomy and bilateral oophorectomy before the age of 50 years were at a higher risk of premature all-cause mortality compared to women who did not have this surgery before the age of 50 years. We also sought to explore whether use of menopausal hormone therapy modified these associations. STUDY DESIGN: Women from the midcohort (born 1946 through 1951) of the Australian Longitudinal Study on Women's Health were included in our study sample (n ¼ 13,541). Women who reported a hysterectomy (with and without both ovaries removed) before the age of 50 years were considered exposure at risk and compared with women who did not report these surgeries before age 50 years. To explore effect modification by use of menopausal hormone therapy we further stratified hysterectomy status by menopausal hormone therapy use. Risk of allcause mortality was assessed using inverse-probability weighted Cox regression models. RESULTS: During a median follow-up of 21.5 years, there were 901 (6.7%) deaths in our study sample. Overall, there was no difference in all-cause mortality between women who reported a hysterectomy with ovarian conservation (hazard ratio, 0.86; 95% confidence interval, 0.72e1.02) or women who reported a hysterectomy and bilateral oophorectomy (hazard ratio, 1.02; 95% confidence interval, 0.78e1.34) and women with no hysterectomy. When stratified by menopausal hormone therapy use, women with hysterectomy and ovarian conservation before the age of 50 years were not at higher risk of all-cause mortality compared to no hysterectomy, regardless of menopausal hormone therapy use status. In contrast, among nonusers of menopausal hormone therapy only, women who reported a hysterectomybilateral oophorectomy before the age of 50 years were at a higher risk of death compared to women with no hysterectomy (hazard ratio, 1.81; 95% ...

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Section: Introductionmentioning

confidence: 98%

Hysterectomy status and all-cause mortality in a 21-year Australian population-based cohort study

Wilson

Pandeya

Byles

et al. 2019

American Journal of Obstetrics and Gynecology

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“…The same findings were observed for the comorbidities. Our findings and the results of another study [ 12 ] suggest that once a hysterectomy is performed on a woman, early-premenopausal hormone therapy might not be beneficial for improving her psychological health.…”

Section: Discussionmentioning

confidence: 51%

“…These operations had a joint effect on the increased risk of depression. Although ovarian conservation at hysterectomy might be beneficial for a lowering the risk of developing subsequent depression, the results of ours and other studies revealed that both women underwent a hysterectomy with ovarian conservation and those underwent a hysterectomy with oophorectomy would have an increased risk of depression [ 12 , 14 ]. The results imply that hysterectomy itself would be a predisposing factor for developing depression, with or without oophorectomy.…”

Section: Discussionmentioning

confidence: 91%

“…One study suggested that post-hysterectomy symptoms might be a continuation of patients’ pre-surgery depression, anxiety, or hostility [ 11 ]. Another study discovered that women who underwent a hysterectomy (regardless of whether or not they underwent a bilateral oophorectomy) had a higher risk of developing new depressive symptoms in the postoperative follow-up period that could not be explained by the patients’ lifestyles or socioeconomic factors [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Hysterectomies Are Associated with an Increased Risk of Depression: A Population-Based Cohort Study

Harnod

Chen

Wang

et al. 2018

JCM

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Using the National Health Insurance Research Database of Taiwan, we investigated whether undergoing a hysterectomy increases the risk of depression. A total of 7872 patients aged 30–49 years who underwent a hysterectomy from 2000 to 2013 were enrolled as the hysterectomy group. The comparison group was randomly selected from women who had never undergone a hysterectomy and was four times the size of the hysterectomy group. We calculated adjusted hazard ratios and 95% confidence intervals (CIs) for depression [The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 296.2, 296.3, 300.4, 311] in these cohorts after adjusting for age, comorbidities, oophorectomy, and hormone therapy. The overall incidence of depression was 1.02 and 0.66 per 100 person-years in the hysterectomy and comparison cohorts, respectively, yielding an adjusted hazard ratio of 1.35 (95% CI = 1.22–1.50) for depression risk. When we stratified patients by age, comorbidities, oophorectomy, and hormone use, hysterectomy increased the risk of depression. Hysterectomy, oophorectomy, and post-surgery hormone use were associated with an increased risk of depression when they occurred alone, but conferred a greater risk if they were considered jointly. Hysterectomy would be a predisposing factor for increased risk of subsequent depression. Our findings provide vital information for patients, clinicians, and the government for improving the treatment strategy in the future.

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“…Some studies have examined the association between depression and hysterectomy with or without oophorectomy, obtaining mixed results [70,71,72,73]. A study by the Australian Longitudinal Study on Women’s Health, which enrolled 5336 women, detected an elevated risk of depressive symptoms, 20% higher in women with hysterectomy and ovarian conservation and 44% higher in women with hysterectomy without ovarian conservation compared to controls (women without hysterectomy) [74].…”

Section: The Influence Of Menopausal Transition and Menopause Hormmentioning

confidence: 99%

Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy

et al. 2019

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During the menopausal transition, which begins four to six years before cessation of menses, middle-aged women experience a progressive change in ovarian activity and a physiologic deterioration of hypothalamic-pituitary-ovarian axis function associated with fluctuating hormone levels. During this transition, women can suffer symptoms related to menopause (such as hot flushes, sleep disturbance, mood changes, memory complaints and vaginal dryness). Neurological symptoms such as sleep disturbance, “brain fog” and mood changes are a major complaint of women transitioning menopause, with a significant impact on their quality of life, productivity and physical health. In this paper, we consider the associations between menopausal stage and/or hormone levels and sleep problems, mood and reduced cognitive performance. The role of estrogen and menopause hormone therapy (MHT) in cognitive function, sleep and mood are also discussed.

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Hysterectomy and incidence of depressive symptoms in midlife women: the Australian Longitudinal Study on Women's Health

Abstract: Women with a hysterectomy (with and without bilateral oophorectomy) have a higher risk of new incidence of depressive symptoms in the longer term that was not explained by lifestyle or socio-economic factors.

Cited by 45 publications

References 36 publications

Hysterectomy status and all-cause mortality in a 21-year Australian population-based cohort study

Hysterectomy status and all-cause mortality in a 21-year Australian population-based cohort study

Hysterectomies Are Associated with an Increased Risk of Depression: A Population-Based Cohort Study

Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy

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