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
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.