The risk of depression after removal of both ovaries (also called bilateral oöphorectomy or surgical menopause) is a major factor for women to consider when they confront medical problems that require removal of the uterus (called a hysterectomy). Many women are advised to consider having their ovaries removed when they are having the uterus removed. Sometimes removal of the ovaries is required to fully treat the condition leading to surgery, but other times it is suggested as a precaution to reduce the risk of ovarian cancer. Removal of both ovaries in a premenopausal woman results in an abrupt withdrawal of estrogen, progesterone, and testosterone. Therefore removing both ovaries (rather than just one or neither ovary) may have significant effects on mood and well-being in women.
Over the years, many studies concluded that women who had their uterus removed (some of whom also had their ovaries removed) developed depressive symptoms at a greater rate than women who did not undergo this surgery (Dennerstein et al. 2007; Farquhar et al. 2006). However, these studies had many methodological problems, including lack of assessment of women’s mood before the surgery. Therefore, it is not known if depression symptoms were related to the surgery itself, the medical condition requiring the surgery (e.g., painful conditions like endometriosis versus non-painful pre-cancerous lesions versus heavy menstrual bleeding), and/or the mood state of the women who underwent these procedures (e.g., potentially more depressed prior to surgery). It is possible that each of these factors could independently, or in combination, contribute to mood symptoms.
Recent studies investigating the effect of hysterectomy on risk of developing depressive symptoms have clarified the association between depression and surgical menopause by comparing women’s mood state pre-surgery to their mood state post-surgery. In a recent review (2007), Shifren concluded that mood and quality of life may actually improve after surgery in women who had hysterectomies for non-cancerous conditions.
One recent analysis of the large Maryland Women’s Health Study (Rohl et al. 2008) investigated the question of post-surgical depression by comparing mood state 12 months after surgery to mood state at baseline (shortly before the surgery). The investigators compared mood and well-being between groups of women who underwent surgery for pre-cancerous lesions in the cervix or uterus: those who had their uterus removed (n=614) and those who had their uterus and both ovaries removed (n=433). Approximately one-quarter of women reported pelvic pain before the surgery. The researchers found that regardless of the type of surgery (uterus and both ovaries removed or removal of uterus only), fewer women reported depressive symptoms 12 months after surgery compared to the percentage of women reporting depressive symptoms prior to surgery. In those who had both ovaries removed, 27% had depressive symptoms before surgery while only 9% had depressive symptoms after surgery; similarly, 30% of those who did not have their ovaries removed had depressive symptoms before surgery and only 15% had depressive symptoms after surgery. Post-operative depressive symptoms were reported more commonly by women who already had depressive symptoms prior to the surgery than by those who did not have depressive symptoms pre-operatively (26% versus 7%, respectively). It is notable that the overwhelming majority of women who had both ovaries removed were taking estrogen therapy at the time of the post-operative mood assessment, whereas few women who did not have both ovaries removed were receiving that treatment (83% versus 17%, respectively). As a result, it is unknown if the estrogen therapy helped their mood. Other important factors to note in this study are that the mood assessments did not evaluate for clinical depression, and that the reason for the surgery and the decision to have both ovaries removed varied based on a number of different factors.
The results of this large Maryland Women’s Health Study (Rohl et al. 2008) and the review article by Shifren (2007) suggest that removal of the uterus and, in particular, of both ovaries, do not increase the likelihood of depressive symptoms. In contrast, the proportion of women with depressive symptoms decreases after surgery, even among those who have depressive symptoms before their surgery, and does not seem to be related to removal of both ovaries. These studies provide encouraging information about mood effects of gynecologic surgery for women who require surgical removal of their uterus with or without their ovaries.
Additional research is still needed to definitively establish the association of gynecologic surgery with mood and other aspects of quality-of-life, such as sexual health. For example, we do not know the impact of these surgeries on mood for women who have been diagnosed with clinical depression prior to the operation. It would be important to monitor mood symptoms carefully in any woman with a history of mood disorders after major life events and medical illnesses, which would include hysterectomy and the medical conditions for which the surgery is indicated. However, it is hoped that such surgical interventions may be associated with improved mood because they relieve the symptoms and distress that occur because of the medical conditions that require the surgical treatment.
Hadine Joffe, MD, MSc
Erica Pasciullo, BA
References:
Dennerstein L, Guthrie JR, Clark M, Lehert P, Henderson VW. A population-based study of depressed mood in middle-aged, Australian-born women. Menopause 2004 Sep-Oct;11(5):563-8.
Farquar CM, Harvey SA, Yu Y, Sadler L, Stewart AW. A prospective study of 3 years of outcomes after hysterectomy with and without oophorectomy. Am J Obstet Gynecol. 2006 Mar;194(3):711-7.
Shifren JL, Avis NE. Surgical menopause: effects on psychological well-being and sexuality. Menopause. 2007 May-Jun;14(3 Pt 2):586-91.
Rohl J, Kjerulff K, Langenberg P, Steege, J. Bilateral oophorectomy and depressive symptoms 12 months after hysterectomy. Am J Obsetet Gynecol 2008; 199:22.e1-22.e5.
Hi! My uterus and both ovaries were removed last May 2012. I have mood swings and I experience a lot of things that I cannot explain and I hate it.
I had hysterectomy 2 1/2 years ago, with cervix removal. I had precancerous cervical cells so this is why i did this. I was already on anti depressants for 8 years. Two years later I have just had my ovaries removed! I don’t feel more depressed after surgery an I’m taking livial 2 weeks before op.
I was diagnosed bipolar 2 in 2005 after I had a severe manic episode while taking antidepressant. I went in to psych hosp aug 2012 rediagnosed bipolar 1 seroquel 400XR seroquel 100mg bedtime lexapro 10mg and klonopin 2mg a day….Im 37 and getting a hystrectomy in 3 weeks, deciding on whether to keep ovaries or not?? Need some advice. I have PMDD so I’m thinking that removing everything would be the way to go. I mean I already have mood swings, depression hence bipolar so what difference would being thrown into menopause make to a bipolar person?
Hi robin, I wonder were u diagnosed with bi polar due to mood swings from diseased ovaries or hormone fluctuation? I went through similar but having ovaries removed if they are healthy I think would be a mistake. I wish you every blessing. Jo
My uterus and both ovaries were removed in 2010. As a result, my mental and physical health has slowly declined. I’m depressed. I feel flat and empty inside. I have debilitating anxiety. I’m an artist and writer, but my creativity dried up. I have no sex drive. My diabetes and other conditions have worsened. I’ve aged rapidly. At 52, I seem like an elderly woman.
My depression has hurt all of my relationships, including my relationship with my husband.
My uterus had to go, because I had a disease that caused severe pain, but I also had my doctor remove my ovaries as I hoped it would put an end to my PCOS, severe PMS, and menopause symptoms. Now, I regret having my ovaries removed as it didn’t get rid of my PCOS, which is a lifelong hormonal condition, and I’m sure that my I shortened my lifespan. I think I will be lucky if I make it to 60.
I had my hysterectomy with ovaries removal (total) almost two weeks ago due to breast cancer and precancerous cell and cyst on my ovaries. Since surgery, I find myself crying for no reson and unable to control it. I am 51.
We don’t have a lot of data on what happens immediately after a total hysterectomy in terms of mood. However, there is a dramatic reduction in the levels of hormones afterward. This can result in sleep disruption and severe vasomotor symptoms (hot flashes and night sweats). We also know from other conditions — PMDD and postpartum depression — that this rapid fall in hormone levels can be a potent trigger for mood and anxiety disorders.
I would recommend that you speak with your GYN or primary care provider to determine if you might benefit from some type of intervention.
Women can suffer from depression as they enter into the menopause, but there are many treatments available and you might want to talk to your GYN or primary care provider about depression treatment.
I had a hysterectomy for massive fibroids at age 53 years in 2016, and a bilateral oophorectomy at the same time (my mum died of ovarian cancer).
I experienced a post-surgical menopause 6 weeks after the surgery – mostly hot flushes, vaginal dryness, dry skin etc.. and (unexpected) overheating while trekking a year later.
(No history of pregnancy, but I seem very sensitive to oestrogen in OC pills – it led to nausea).
Apart from topical vaginal oestrogen I didn’t do anything specific to address symptoms in the early years post-op.
However/then, 3 years after the op, mood swings, anxiety and depressions appeared unexpectedly, although in context with other life stresses linked with getting older.
and I am now trialling hormone replacement (and any accompanying risk of breast cancer) with effect. Progesterone may turn out to be the key hormone linked to my mood shifts.
Is this relative “delay” in mood change known to occur in some women, with/without oophorectomy?
I do wonder whether, if I had adopted hormone replacement earlier this might this have prevented the mood changes from occurring??
Most women experience mood changes and the worst menopausal symptoms immediately after oophorectomy. There is some data to suggest that estrogen replacement therapy may prevent depression from emerging during the perimenopause; however, your situation is a bit unusual.
I had a partial hysterectomy in 2006 (ovaries left). 3-4 years ago serious pain led to left ovary being removed. Turns out it and the tube were covered in polyps and scar tissue. About 6wks to 2 months ago I began to have stomach and pain on my right side. A CT revealed that my appendix needed to be removed. I asked for my right ovary to be checked. Well it ended up being removed. (Back history I had been told I was done with menopause as a blood test showed levels that showed I was done, I didn’t have a lot of symptoms as I am Bi Polar and a lot of my symptoms could have masked the menopause) so the right ovary was found to have been a working one, eggs had been moving I guess and become encapsulated and granulated etc… so it was removed. SO my question is, was there a small amount of estrogen being produced? I am crying a lot now.. its been 16 days since the surgery, don’t care about much. still hurt…. can anyone advise…
A hysterectomy ruined my life. I snap and get angry over things where I would have handled them calmly before, and this is in addition to the night sweats, vaginal dryness, etc.
I was not allowed estrogen because of the cancer effects.
It has been 21 yrs since my hysterectomy and to this day I regret it. I have to use Premarin cream vaginally to stop the bleeding and pain from being so dry. I was divorced and now I’m alone in my 60’s because of the hysterectomy changing me.
We are sorry to hear that you had such an unfortunate experience with hysterectomy. Because of the significant after effects of hysterectomy when it is accompanied by removal of the ovaries, it is usually reserved for situations where there are no other options.
For women who cannot use estrogen replacement therapy because of cancer risk, it may be possible to manage some of the symptoms using other non-hormonal treatments.
https://womensmentalhealth.org/posts/position-paper-non-hormonal-treatments-for-vasomotor-symptoms/
Ruta Nonacs, MD PhD