Mood Changes After Ovarian-Sparing Hysterectomy in Black Women

INTRODUCTION: Abnormal uterine bleeding (AUB) encompasses multiple conditions that can lead to pelvic pain and heavy menstrual bleeding, particularly in Black women, and may require hysterectomy. However, ovarian-sparing hysterectomy has been linked with shortened time to menopause and depressive symptoms, especially in Black women. Reduced ovarian reserve following hysterectomy has been shown to be more frequent in Black women compared to White women after hysterectomy, and independently, Black women are at higher risk for depressive symptoms during menopause. OBJECTIVE: We examined if Black women undergoing ovarian-sparing hysterectomy (OSH) experienced changes in mood and serum estradiol 1 month postoperatively. The findings could inform targeted interventions to improve quality of life and possibly predict hormone-mediated mood disorders. METHODS: Participants were Black premenopausal women, ages 30–45, with a diagnosis of uterine leiomyomas and/or AUB scheduled for OSH in an academic minimally invasive gynecology surgery program. Participants completed a screening visit to evaluate for current or past major depressive disorder (MDD). The assessment confirmed the absence of bipolar disorder, psychotic disorder, or current substance use disorder, all of which were exclusion criteria. Additionally, it was verified that participants were not taking estrogen-containing hormonal medications and did not have unstable medical conditions that could impact study endpoints. Self-reported mood assessments via the Inventory of Depression and Anxiety Symptoms (IDAS) were collected within 2 weeks of surgery and weekly through 1 month postoperatively. Serum estradiol was collected at surgery and 1 month postoperatively. Linear mixed models were used to examine the effect of time and MDD diagnosis on mood symptoms. Correlations assessed associations between change in estradiol and depressive symptoms. RESULTS: Thirty-seven patients met criteria for inclusion, of whom 12 had current or past depressive illness. Participants with a history of MDD were significantly more likely to have elevated IDAS Depression scores (β=0.27, 95% CI [0.02, 0.52], p=0.037) and IDAS Ill Temper scores (β=0.34, 95% CI [0.10, 0.58], p=0.007) across all time points. Post-hoc analyses failed to show significant differences in depression scores at individual time points, although participants with past MDD trended toward higher (worse) depression scores (35.55±10.50; no MDD history: 30.6±6.96) and Ill Temper scores (6.73±3.23; no MDD history: 5.35±1.35) compared to those without MDD at post-op week 4. Although not statistically significant, scores across IDAS Panic, Social Anxiety, and Traumatic Intrusions scales showed trends of increased scores for those with a history of MDD compared to those without. Across participants with a history of MDD, change in estradiol was correlated with change in IDAS Depression scores from screening to 4 weeks post-op (r= −0.48, p=0.028), indicating that increased depression symptoms were associated with greater decreases in estradiol. CONCLUSIONS: Black women undergoing OSH experience changes in mood symptoms postoperatively, particularly depression and ill temper, and these changes are correlated with greater decreases in estradiol in those with a history of MDD. Additional screening and interventions should be discussed to address mental health changes, particularly for patients with a history of depression. Larger longitudinal studies can help characterize how OSH can impact patients psychologically and hormonally (Figures 1 and 2).