All of us will go through menopause and a third of women will have a hysterectomy by the age of 60. Do either or both increase the occurrence of negative mood, (hereafter to be used to connote depressive and anxiety symptoms)? Well what a coincidence that you ask! An article in the May issue of the Journal Obstetrics and Gynecology titled “Mood Symptoms After Natural Menopause and Hysterectomy With and Without Bilateral Oophorectomy among Women in Midlife” deals with this subject. (Yes it’s a long title… and by the way, bilateral oophorectomy means removal of both ovaries.)
The article is based on data from the “Study of Women’s Health Across the Nation” which followed 1,970 women between the ages of 42 and 52 for up to 10 years. During this period, the presence and/or absence of depressive symptoms was assessed by trained interviewers with a 20-item depressive symptom scale on a yearly basis. The women’s anxiety was assessed with 4 questions (and no, they had nothing to do with those of the Passover Hagadah) asking about the number of days in the two weeks prior to their visit that the woman had “irritability or grouchiness”, were “feeling tense or nervous”, felt “heart pounding or racing” or “felt fearful with no reason”. The researchers then assessed whether the women had had a hysterectomy and if so, with or without an oophorectomy. Now, if you want to know the exact numbers while anticipating the results (hopefully, with no great nervousness or pounding heart), here they are:
A total of 1,793 women reached natural menopause, 76 had had a hysterectomy with ovarian conservation and 101 women had a hysterectomy and bilateral oophorectomy. The participants were followed for up to 10 years after baseline. (There was an interesting disclaimer that was put in the study whilst describing results…for an unknown reason the women at the New Jersey site, all 131, were not included in the final results due to “reasons unrelated to scientific integrity”. As a former New Jersey-ite I had to wonder why?)
The researchers found that depressive symptoms declined before the final menstrual period or surgery and continued to decline after both. Moreover, regardless of whether the ovaries were conserved or removed, hysterectomy status has no effect on depressive symptoms initially or later. And anxiety scores did not change significantly in the years leading up to the final menstrual period or surgery, but they decreased during the period after the onset of menopause or surgery. Once more, regardless of whether the ovaries were conserved, hysterectomy had no effect on anxiety symptoms at the first annual visit or in the years that followed.
Now, for the caveats; which in this study are huge. Firstly, the study was limited to women in mid-life close to the onset on natural menopause. We know that there can be significant health and mental risks subsequent to oophorectomy in younger women who have not already begun to experience the hormonal changes of menopause. In general early surgical menopause has been associated with significant mood changes, bone loss, possibly increased risk of heart disease and early onset of Alzheimer’s.) Secondly, and this is a big one… The authors stated that the “use of hormone therapy was associated with lower levels of anxiety and depressive symptoms. Hormones were used at some point by the majority of participants and, as expected, were particularly common among women with a hysterectomy.” but when they excluded the women who after menopause or hysterectomy with oophorectomy did not use hormone therapy, the trajectory of depressive or anxiety symptoms was not changed. Their final conclusion was that lasting effects on both anxiety and depressive symptoms do not need to be a major consideration for deciding whether to keep the ovaries during a hysterectomy.
I realize this was a somewhat confusing article with lots of facts that are first stated and then discussed with a scientific “there were exceptions and additional factors”. I, too, sometimes wonder why certain studies are published. Does this one mean that we should take hormones to preclude mood symptoms during or subsequent to menopause, after a mid-life hysterectomy or removal of the ovaries or not? As usual the answer has to be geared to the individual woman and requires consultations with her physician. But what I think it does say is that no matter what we do, once we go through the menopause transition, whatever mood changes we experience at that time, won’t get worse in the years to come.