Impact of Surgical Menopause versus Physiological Menopause on Quality of Life and Mental Health: A Cross-sectional Study in Eastern Part of India.

Menopause is the permanent cessation of menstrual cycles. This can be due to various causes, which include physiological menopause and surgical menopause. Physiological menopause is one which occurs naturally and due to the loss of ovarian activity, whereas surgical menopause occurs after the removal of the uterus and ovaries, which leads to a decline in hormonal levels. There is a risk of sexual dysfunction, adverse effects on mood, and cognitive function.[ 1 ] In physiological menopause, there is a gradual transition into menopause, whereas in surgical menopause, there is an abrupt cessation of menstruation. This menopausal transition may affect women’s quality of life due to vasomotor effects, psychosocial effects, physical quality, and sexual life. Another important aspect is mental health, which includes anxiety, depression, and stress related to these hormonal changes. Even though in menopause, there is a significant change in the quality of life and mental health, we want to compare the gradual transition which occurs in physiological menopause with the abrupt cessation in surgical menopause. Physiological and surgical menopause may have different impacts on this quality of life and mental health, and the data comparing these aspects are limited. Understanding these differences will help in the management of postmenopausal women. This study aimed to compare the quality of life and mental health in women with surgical menopause and physiological menopause.

This is a cross-sectional comparative study conducted in the Department of Obstetrics and Gynaecology at AIIMS Deoghar, Jharkhand, for 6 months from May 1, 2024, to October 31, 2024. This study was conducted after getting IEC approval (2023-141-IND-03) and informed consent was obtained from all the participants. We included all women who attained menopause either physiologically or surgically, who gave consent for participating in this study. And excluded all postmenopausal women with psychiatric disorders, currently on antipsychiatric medications, acute and chronic medical illnesses, such as uncontrolled diabetes mellitus, uncontrolled hypertension, chronic kidney disease, cardiac diseases, and malignancy and those women on hormone replacement therapy. A structured questionnaire was used for collecting data from the included participants. Basic demographic details were collected which included age, age of hysterectomy, age of physiological menopause, area of residence, reason for hysterectomy and any comorbidities. Menopause-specific quality of life questionnaire (MENQOL) is a prevalidated questionnaire used for assessing the quality of life – which includes vasomotor, psychosocial, physical and sexual domains.[ 2 ] The Hospital Anxiety Depression Scale (HADS) was used to assess the mental health of this group of postmenopausal women.[ 3 ] Data were entered and analyzed using IBM SPSS Statistics version 25, for Windows. Armonk, NY: IBM Corp. (2023) software. Data were analyzed and expressed as numbers (percentages) for categorical data and mean with standard deviations (SDs) for continuous variables and Mann–Whitney U and Chi-square tests were used for comparing the two groups. P <0.05 was considered significant.

This study included 126 women – 63 women with surgical menopause (Group 1) and 63 with physiological menopause (Group 2). The mean age of hysterectomy in surgical menopause was 35.44 years ± 8.67 and the mean age of menopause in physiological menopause was 49.84 years ± 2.24. Most common cause of hysterectomy was abnormal uterine bleeding (49.2%). Other demographic variables are mentioned in Table 1 . Demographic details A comparison of the MENQOL was done between the two groups. In the surgical menopause group, a smaller number of women were affected with vasomotor symptoms when compared to physiological menopause, but the mean scores of vasomotor symptoms, such as hot flushes (2.68 ± 0.852), night sweats (2.66 ± 1.016), and sweating (2.85 ± 1.231) in surgical menopause were higher as compared to physiological menopause [ Table 2 ]. Psychosocial symptoms were found more in the surgical menopause group. Mean values of dissatisfaction in personal life, anxiety, poor memory and depression in surgical menopause versus physiological menopause were 2.47 ± 1.518 versus 1.62 ± 0.806, 2.71 ± 1.327 versus 1.67 ± 0.747, 2.59 ± 1.317 versus 1.66 ± 1.037 and 2.61 ± 1.497 versus 1.72 ± 0.839. The median score of the psychosocial domain was 7 in the surgical menopause group versus 2 in the physiological menopause group. Comparison of frequency and scores of menopause-specific quality of life questionnaire between the two groups SD: Standard deviation The prevalence and scores of physical domains were high in surgical menopause, and the median score of physical domains in surgical menopause versus physiological menopause was 17 versus 14 [ Table 3 ]. In the sexual domain, a smaller number of women were affected by surgical menopause, and the median score was 0 in both the groups. Regarding the quality of life assessment between the two groups, surgical menopause has a bad quality of life in 58.7% versus 41.3% in the physiological menopause group. This indicates the risk of bad quality of life after surgical menopause [ Table 4 ]. Comparison of domains in both groups Quality of life between the two groups The median score of anxiety using Mann–Whitney test, according to the HADS was 3 in surgical menopause was 3 when compared to 2 in the physiological menopause group, but this was not statistically significant. The median score of depression was 6 versus 2 in surgical menopause and physiological menopause, which was statistically significant [ Table 5 ]. Category-wise distribution was done using the Chi-square test. In the category-wise distribution, significant anxiety was seen in 25.4% versus 7.9% among surgical menopause and physiological menopause. Significant depression was 27% versus 14.3% in the surgical menopause group and the physiological menopause group [ Table 6 ]. Comparison of the hospital anxiety depression scale between the two groups Mann–Whitney test Category-wise distribution between the two groups Using the Chi-square test

Surgical menopause results in significant impairment in the quality of life and mental health when compared to physiological menopause. This study highlights the need for counseling patients regarding the long-term adverse effects on their quality of life and mental health. Hence, follow-up of these patients is absolutely necessary, and lifestyle modification and psychological support should be given. Hormone replacement therapy should be given to those women where it is indicated. There are no conflicts of interest.

Menopause is a condition due to hormonal deficiency where there is the absence of menstrual cycles, causing the end of the reproductive stage. Naturally, it leads to physiological menopause, while surgical menopause is caused after the removal of the uterus and ovaries. Hysterectomy is done for various reasons like fibroid uterus, endometriosis, endometrial carcinoma, ovarian carcinoma, cervical carcinoma, etc. After surgical menopause, as there is a sudden loss of ovarian function, women may experience more side effects than natural menopause. In this study, we analysed the quality of life of women after surgical and physiological menopause and we found that many symptoms are more severe in the surgical menopause group than the physiological menopause. The age of menopause was much younger in surgical menopause when compared to physiological menopause in our study and they are facing these symptoms 15–20 years earlier than the physiological menopause group. In this study, we found that women after surgical menopause experienced more physical and psychosocial domain impairment than physiological menopause. In the psychosocial domain, dissatisfaction in personal life, anxiety, poor memory, and depression were more commonly affected in the surgical menopause group than the physiological menopause group. Vasomotor symptoms like hot flushes, night sweats, and sweating were higher in the surgical menopause group. These findings were similar to the findings of Ozdemir et al ., in which rates of hot flushes, sweating, poor memory, and change in sexual desire were significantly higher among the women in surgical menopause. The rates of hot flushes and sweating were 51.5% and 50.5%, respectively, among women in natural menopause and 76.5% and 78.7% among women in surgical menopause.[ 4 ] Similarly, the study by Topatan and Yıldız found that hot flushes ( P < 0.001), sleeping disturbances ( P < 0.006) and sexual problems ( P < 0.004), were found to be high in the surgical menopause group.[ 5 ] In our study, difficulty in sleeping was higher after surgical menopause (77.8%) when compared to physiological menopause (55.6%). Similarly, the study by Cho et al . found that poor quality of sleep and insomnia were more common in surgical menopause than in natural menopause.[ 6 ] In our study, quality of life was assessed using the MENQOL and found that the surgical menopause group had the bad quality of life at 58.7% versus 41.3% in the physiological menopause group. This higher poor quality of life is comparable to the study by Bhattacharya and Jha, quality of life assessed by menopause rating scale-II and the scores were higher for the surgical menopause group (mean = 29.4, SD = 6.7) than for natural menopause group (mean = 20.7, SD = 6.5), and this was statistically significant ( P < 0.0001).[ 7 ] In the study by Gümüşsoy et al . found that body image, self-esteem, and dyadic adjustment were impaired in the surgical menopause group.[ 8 ] Estrogen has a significant role in serotonergic and dopaminergic pathways, and the abrupt absence of this hormone may be the reason for these more significant emotional disturbances in these women after surgical menopause. The study by Xu et al . and Page et al . found that after surgical menopause, the incidence of depression requiring hospitalisation was high.[ 9 10 ] In our study, we found that depression (according to HADS) was more prevalent in women after surgical menopause, which was statistically significant. We also found that the median anxiety score was higher in the surgical menopause group, although the difference was not statistically significant. A large sample size is required to confirm the association of anxiety with surgical menopause. This study found that significant impairment in the psychosocial and physical domains of quality of life and a significant association with depression after surgical menopause. A comprehensive management by a multidisciplinary team is required in the management of these women after surgical menopause. Hysterectomy should be done only in patients where it is absolutely indicated, and if possible, other treatment options should be considered in all women. Strengths of this study include; that we have done a direct comparison between the two groups and have used only prevalidated tools for assessing the same. The limitations include the smaller sample size and hormonal levels were not checked in this study. Large multicentric studies are required to confirm the findings.