Each year about 600,000 women in the United States undergo a hysterectomy.  Somewhere between 55% and 80% of these women who also have their ovaries removed along with the uterus—a procedure known as oophorectomy.  After the removal of the ovaries, menopause follows immediately and is associated with a constellation of symptoms including hot flashes and insomnia, as well as depression and anxiety.

It has been hypothesized that women who undergo this type of abrupt menopause are more likely to have significant menopausal symptoms than women who undergo a more gradual decline in hormone levels as would occur during a natural menopause.  A new study, however, suggests that women who undergo a surgically induced menopause are no more likely to suffer from depression and/or anxiety than women who experience a natural menopause.

Using data from 1,970 women participating in the Study of Women’s Health Across the Nation (SWAN), researchers (including Dr. Hadine Joffe from the CWMH) assessed depression and anxiety symptoms annually for a period of up to 10 years.  During the 10 years of follow-up, 1,793 (90.9%) women reached a natural menopause, 76 (3.9%) reported a hysterectomy with ovarian conservation, and 101 (5.2%) reported a hysterectomy with bilateral oophorectomy.

For all three groups of women, depression scores decreased from the time of the last menstrual period to the end of the study, and at about the same rate.  Women who underwent a hysterectomy with bilateral oophorectomy did not experience more negative mood symptoms in the years after surgery than women who retained their ovaries and therefore had a more gradual decline in their hormone levels.

The results of this study should be reassuring to women who are planning to have a hysterectomy.  While women undergoing a surgically induced menopause appear to be no more likely to experience depression or anxiety symptoms than women undergoing a natural menopause, the authors remind us that all women may be vulnerable to mood and anxiety symptoms as they transition into menopause, not matter how the menopause is induced.  The good news is that these symptoms generally decline over time.

Ruta Nonacs, MD PhD

Gibson CJ, Joffe H, Bromberger JT, et al. Mood symptoms after natural menopause and hysterectomy with and without bilateral oophorectomy among women in midlife.  Obstet Gynecol. 2012; 119(5):935-41.

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