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

Published online by Cambridge University Press: 13 February 2017 Aims. There is limited longitudinal research that has looked at the longer term incidence of depressive symptoms, comparing women with a hysterectomy to women without a hysterectomy. We aimed to investigate the association between hysterectomy status and the 12-year incidence of depressive symptoms in a mid-aged cohort of Australian women, and whether these relationships were modified by use of exogenous hormones. Methods. We used generalised estimating equation models for binary outcome data to assess the associations of the incidence of depressive symptoms (measured by the 10-item Centre for Epidemiologic Studies Depression Scale) across five surveys over a 12-year period, in women with a hysterectomy with ovarian conservation, or a hysterectomy with bilateral oophorectomy compared with women without a hysterectomy. We further stratified women with hysterectomy by their current use of menopausal hormone therapy (MHT). Women who reported prior treatment for depression were excluded from the analysis. Results. Compared with women without a hysterectomy (n = 4002), both women with a hysterectomy with ovarian conservation (n = 884) and women with a hysterectomy and bilateral oophorectomy (n = 450) had a higher risk of depressive symptoms (relative risk (RR) 1.20; 95% confidence interval (CI) 1.06–1.36 and RR 1.44; 95% CI 1.22–1.68, respectively). There were differences in the strength of the risk for women with a hysterectomy with ovarian conservation, compared with those without, when we stratified by current MHT use. Compared with women without a hysterectomy who did not use MHT, women with a hysterectomy with ovarian conservation who were also MHT users had a higher risk of depressive symptoms (RR 1.57; 95% CI 1.31–1.88) than women with a hysterectomy with ovarian conservation but did not use MHT (RR 1.17; 95% CI 1.02–1.35). For women with a hysterectomy and bilateral oophorectomy, MHT use did not attenuate the risk. We could not rule out, however, that the higher risk seen among MHT users may be due to confounding by indication, i.e. MHT was prescribed to treat depressive symptoms, but their depressive symptoms persisted. Conclusions. 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. - Type - Original Articles - Information - Copyright - Copyright © Cambridge University Press 2017 Andresen, EM, Malmgren, JA, Carter, WB, Patrick, DL (1994). Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine 10, 77–84.Google Scholar Barker, MG (1968). Psychiatric illness after hysterectomy. British Medical Journal 2, 91–95.Google Scholar Blumel, JE, Chedraui, P, Baron, G, Benitez, Z, Flores, D, Espinoza, MT, Gomez, G, Gonzalez, E, Hernandez, L, Lima, S, Martino, M, Montano, A, Monterrosa, A, Mostajo, D, Ojeda, E, Onatra, W, Robles, C, Saavedra, J, Sanchez, H, Tserotas, K, Vallejo, MS, Vallejo, C, Collaborative Group for Research of the Climacteric in Latin, A. (2014). A multicentric study regarding the use of hormone therapy during female mid-age (REDLINC VI). Climacteric 17, 433–441.CrossRefGoogle ScholarPubMed Cabness, J (2010). The psychosocial dimensions of hysterectomy: private places and the inner spaces of women at midlife. Social Work in Health Care 49, 211–226.Google Scholar Chou, PH, Lin, CH, Cheng, C, Chang, CL, Tsai, CJ, Tsai, CP, Lan, TH, Chan, CH (2015). Risk of depressive disorders in women undergoing hysterectomy: a population-based follow-up study. Journal of Psychiatric Research 68, 186–191.Google Scholar Colditz, GA, Stampfer, MJ, Willett, WC, Stason, WB, Rosner, B, Hennekens, CH, Speizer, FE (1987). Reproducibility and validity of self-reported menopausal status in a prospective cohort study. American Journal of Epidemiology 126, 319–325.CrossRefGoogle ScholarPubMed Commonwealth Department of Health and Aged Care (1999). An Active Way to Better Health: National Physical Activity Guidelines for Adults. AGPS: Cancerra, AUST.Google Scholar Darwish, M, Atlantis, E, Mohamed-Taysir, T (2014). Psychological outcomes after hysterectomy for benign conditions: a systematic review and meta-analysis. European Journal of Obstetrics, Gynecology, and Reproductive Biology 174, 5–19.CrossRefGoogle ScholarPubMed Dennerstein, L, Guthrie, JR, Clark, M, Lehert, P, Henderson, VW (2004). A population-based study of depressed mood in middle-aged, Australian-born women. Menopause 11, 563–568.Google Scholar Dobson, AJ, Hockey, R, Brown, WJ, Byles, JE, Loxton, DJ, McLaughlin, D, Tooth, LR, Mishra, GD (2015). Cohort profile update: Australian longitudinal study on women's health. International Journal of Epidemiology 44, 1547, 1547a–1547f.Google Scholar Elson, J (2003). Hormonal hierarchy – hysterectomy and stratified stigma. Gender and Society 17, 750–770.Google Scholar Farquhar, CM, Sadler, L, Stewart, AW (2008). A prospective study of outcomes five years after hysterectomy in premenopausal women. Australian and New Zealand Journal of Obstetrics and Gynaecology 48, 510–516.Google Scholar Guthrie, JR, Dennerstein, L, Dudley, EC (1999). Weight gain and the menopause: a 5-year prospective study. Climacteric 2, 205–211.CrossRefGoogle ScholarPubMed Hammer, A, Rositch, AF, Kahlert, J, Gravitt, PE, Blaakaer, J, Sogaard, M (2015). Global epidemiology of hysterectomy: possible impact on gynecological cancer rates. American Journal of Obstetrics and Gynecology 213, 23–29.CrossRefGoogle ScholarPubMed Hehenkamp, WJ, Volkers, NA, Broekmans, FJ, de Jong, FH, Themmen, AP, Birnie, E, Reekers, JA, Ankum, WM (2007). Loss of ovarian reserve after uterine artery embolization: a randomized comparison with hysterectomy. Human Reproduction 22, 1996–2005.Google Scholar Lee, C, Dobson, AJ, Brown, WJ, Bryson, L, Byles, J, Warner-Smith, P, Young, AF (2005). Cohort profile: the Australian longitudinal study on women's health. International Journal of Epidemiology 34, 987–991.Google Scholar Moorman, PG, Myers, ER, Schildkraut, JM, Iversen, ES, Wang, F, Warren, N (2011). Effect of hysterectomy with ovarian preservation on ovarian function. Obstetrics and Gynecology 118, 1271–1279.Google Scholar Nahas, E, Pontes, A, Traiman, P, NahasNeto, J, Dalben, I, De Luca, L (2003). Inhibin B and ovarian function after total abdominal hysterectomy in women of reproductive age. Gynecological Endocrinology 17, 125–131.Google Scholar National Health and Medical Research Council (2001). Australian Alcohol Guidelines: Health Risks and Benefits. Endorsed October 2001. Commonwealth of Australia: Canberra, AC.Google Scholar Parker, WH (2010). Bilateral oophorectomy versus ovarian conservation: effects on long-term women's health. Journal of Minimally Invasive Gynecology 17, 161–166.Google Scholar Parker, WH, Jacoby, V, Shoupe, D, Rocca, W (2009). Effect of bilateral oophorectomy on women's long-term health. Womens Health (Lond Engl) 5, 565–576.Google Scholar Payne, JL, Palmer, JT, Joffe, H (2009). A reproductive subtype of depression: conceptualizing models and moving toward etiology. Harvard Review of Psychiatry 17, 72–86.Google Scholar Phipps, AI, Buist, DS (2009). Validation of self-reported history of hysterectomy and oophorectomy among women in an integrated group practice setting. Menopause 16, 576–581.Google Scholar Redburn, JC, Murphy, MF (2001). Hysterectomy prevalence and adjusted cervical and uterine cancer rates in England and Wales. BJOG: An International Journal of Obstetrics and Gynaecology 108, 388–395.Google Scholar Rocca, WA, Grossardt, BR, Geda, YE, Gostout, BS, Bower, JH, Maraganore, DM, de Andrade, M, Melton, LJ III (2008). Long-term risk of depressive and anxiety symptoms after early bilateral oophorectomy. Menopause 15, 1050–1059.Google Scholar Rositch, AF, Nowak, RG, Gravitt, PE (2014). Increased age and race-specific incidence of cervical cancer after correction for hysterectomy prevalence in the United States from 2000 to 2009. Cancer 120, 2032–2038.Google Scholar Sarrel, PM, Sullivan, SD, Nelson, LM (2016). Hormone replacement therapy in young women with surgical primary ovarian insufficiency. Fertility and Sterility 106, 1580–1587.Google Scholar Soares, CN (2014). Mood disorders in midlife women: understanding the critical window and its clinical implications. Menopause 21, 198–206.Google Scholar Twisk, JWR (2013). Applied Longitudinal Data Analysis for Epidemiology. A Practical Guide, 2nd edn. Cambridge University Press: Cambridge, UK.Google Scholar Whiteman, MK, Staropoli, CA, Benedict, JC, Borgeest, C, Flaws, JA (2003). Risk factors for hot flashes in midlife women. Journal of Womens Health (Larchmt) 12, 459–472.CrossRefGoogle ScholarPubMed World Health Organisation Consultation on Obesity (1999). Obesity: Preventing and Managing the Global Epidemic: Report of a WHO Consultation. WHO: Geneva (CHE).Google Scholar Worsley, R, Bell, RJ, Gartoulla, P, Davis, SR (2016). Low use of effective and safe therapies for moderate to severe menopausal symptoms: a cross-sectional community study of Australian women. Menopause 23, 11–17.Google Scholar Xiangying, H, Lili, H, Yifu, S (2006). The effect of hysterectomy on ovarian blood supply and endocrine function. Climacteric 9, 283–289.Google Scholar Yelland, LN, Salter, AB, Ryan, P (2011). Performance of the modified Poisson regression approach for estimating relative risks from clustered prospective data. American Journal of Epidemiology 174, 984–992.CrossRefGoogle ScholarPubMed Zou, G (2004). A modified poisson regression approach to prospective studies with binary data. American Journal of Epidemiology 159, 702–706.Google Scholar - 52 - Cited by Cited by Crossref Citations Dohbit, Julius Sama Foumane, Pascal Nkwabong, Elie Kamouko, Christelle Ogolong Tochie, Joel Noutakdie Otabela, Bernard and Mboudou, Emile 2017. Uterus preserving surgery versus hysterectomy in the treatment of refractory postpartum haemorrhage in two tertiary maternity units in Cameroon: a cohort analysis of perioperative outcomes. BMC Pregnancy and Childbirth, Vol. 17, Issue. 1, Harnod, Tomor Chen, Weishan Wang, Jen-Hung Lin, Shinn-Zong and Ding, Dah-Ching 2018. Hysterectomies Are Associated with an Increased Risk of Depression: A Population-Based Cohort Study. Journal of Clinical Medicine, Vol. 7, Issue. 10, p. 366. Gazzuola Rocca, Liliana Smith, Carin Y. Bobo, William V. Grossardt, Brandon R. Stewart, Elizabeth A. Laughlin-Tommaso, Shannon K. and Rocca, Walter A. 2019. Mental health conditions diagnosed before bilateral oophorectomy: a population-based case-control study. Menopause, Vol. 26, Issue. 12, p. 1395. Gava, Giulia Orsili, Isabella Alvisi, Stefania Mancini, Ilaria Seracchioli, Renato and Meriggiola, Maria Cristina 2019. Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy. Medicina, Vol. 55, Issue. 10, p. 668. Sheyn, David Bretschnieder, C. Emi Mahajan, Sangeeta T. El-Nashar, Sherif Billow, Megan and Ninivaggio, Cara S. 2019. Comparison of 30-day Complication Rates between Laparoscopic Myomectomy and Total Laparoscopic Hysterectomy for the Treatment of Uterine Leiomyoma in Women Older Than Age 40. Journal of Minimally Invasive Gynecology, Vol. 26, Issue. 6, p. 1076. Wilson, Louise F. Pandeya, Nirmala Byles, Julie and Mishra, Gita D. 2019. Hysterectomy status and all-cause mortality in a 21-year Australian population-based cohort study. American Journal of Obstetrics and Gynecology, Vol. 220, Issue. 1, p. 83.e1. Eid, Rand S. Lieblich, Stephanie E. Wong, Sarah J. and Galea, Liisa A.M. 2020. Ovarian status dictates the neuroinflammatory and behavioral consequences of sub-chronic stress exposure in middle-aged female mice. Neurobiology of Stress, Vol. 12, Issue. , p. 100199. Choi, Hyo Geun Rhim, Chae Chun Yoon, Ji Young and Lee, Suk Woo 2020. Association between hysterectomy and depression: a longitudinal follow-up study using a national sample cohort. Menopause, Vol. 27, Issue. 5, p. 543. Laughlin-Tommaso, Shannon K. Satish, Anisha Khan, Zaraq Smith, Carin Y. Rocca, Walter A. and Stewart, Elizabeth A. 2020. Long-term risk of de novo mental health conditions after hysterectomy with ovarian conservation: a cohort study. Menopause, Vol. 27, Issue. 1, p. 33. Kotsopoulos, Joanne Gronwald, Jacek Lubinski, Jan McCuaig, Jeanna Lynch, Henry T. Neuhausen, Susan L. Foulkes, William D. Weitzel, Jeffrey N. Senter, Leigha Tung, Nadine Eng, Charis Karlan, Beth Sun, Ping and Narod, Steven A. 2020. Does preventive oophorectomy increase the risk of depression in BRCA mutation carriers?. Menopause, Vol. 27, Issue. 2, p. 156. Madueke-Laveaux, Obianuju Sandra Elsharoud, Amro and Al-Hendy, Ayman 2021. What We Know about the Long-Term Risks of Hysterectomy for Benign Indication—A Systematic Review. Journal of Clinical Medicine, Vol. 10, Issue. 22, p. 5335. Lycke, Kathrine Dyhr Kahlert, Johnny Damgaard, Rikke Mogensen, Ole and Hammer, Anne 2021. Trends in Hysterectomy Incidence Rates During 2000–2015 in Denmark: Shifting from Abdominal to Minimally Invasive Surgical Procedures. Clinical Epidemiology, Vol. Volume 13, Issue. , p. 407. Pizova, N. V. Pizov, N. A. and Pizov, A. V. 2021. Perimenopausal period and mood disorders. Meditsinskiy sovet = Medical Council, p. 230. Kim, Hyewon Kim, Yuwon Fava, Maurizio Mischoulon, David Shin, Myung-Hee Lee, Dong-Yun and Jeon, Hong Jin 2021. Increased risk of depression before and after unilateral or bilateral oophorectomy: A self-controlled case series study using a nationwide cohort in South Korea. Journal of Affective Disorders, Vol. 285, Issue. , p. 47. Bimonte-Nelson, H. A. Bernaud, V. E. and Koebele, S. V. 2021. Menopause, hormone therapy and cognition: maximizing translation from preclinical research. Climacteric, Vol. 24, Issue. 4, p. 373. Poliart, Aline Kirakoya-Samadoulougou, Fati Ouédraogo, Mady Collart, Philippe Dubourg, Dominique and Samadoulougou, Sékou 2021. Using geographically weighted Poisson regression to examine the association between socioeconomic factors and hysterectomy incidence in Wallonia, Belgium. BMC Women's Health, Vol. 21, Issue. 1, Goudarzi, Fatemeh Khadivzadeh, Talat Ebadi, Abbas and Babazadeh, Raheleh 2021. Iranian Women's Self-concept after Hysterectomy. Iranian Journal of Nursing and Midwifery Research, Vol. 26, Issue. 3, p. 230. Musial, Natalie Ali, Zinnia Grbevski, Jennifer Veerakumar, Ashan and Sharma, Priya 2021. Perimenopause and First-Onset Mood Disorders: A Closer Look. Focus, Vol. 19, Issue. 3, p. 330. Remes, Olivia Mendes, João Francisco and Templeton, Peter 2021. Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature. Brain Sciences, Vol. 11, Issue. 12, p. 1633. Hickey, Martha Moss, Katrina M. Brand, Alison Wrede, C. David Domchek, Susan M. Meiser, Bettina Mishra, Gita D. and Joffe, Hadine 2021. What happens after menopause? (WHAM): A prospective controlled study of depression and anxiety up to 12 months after premenopausal risk-reducing bilateral salpingo-oophorectomy. Gynecologic Oncology, Vol. 161, Issue. 2, p. 527.