This study assessed change in mood symptoms after surgical menopause relative to natural menopause. We found that both depressive and anxiety symptoms generally improved over the course of the menopausal transition for all women, with no effect of hysterectomy status on this change. Our results suggest that compared to natural menopause, hysterectomy with or without ovarian conservation among women in midlife does not have a lasting negative impact on mood.
These results are consistent with studies examining mood symptoms over a short follow-up period after hysterectomy; some studies, though not all, suggest that mood symptoms improve after surgery. (5
) In contrast to our data suggesting a continual decline in symptoms over time, Rocca et al. showed an increased long-term risk of de novo
anxiety and depressive symptoms among women with hysterectomy with bilateral oophorectomy a median of 24 years post-surgery. (7
) However, mood symptoms and their timing in that study were assessed retrospectively from women interviewed years or decades after surgery, and may have been subject to retrospective reporting biases. Women in that study also experienced hysterectomy at a variety of ages, while this investigation examines only women with hysterectomy during midlife and prior to the onset of natural postmenopause. Health and mental health risks of oophorectomy may be limited to younger women who have not already begun to experience hormonal changes related to the progression to natural menopause. (13
Additional findings about annually measured hormone therapy and antidepressant use are worth mentioning. Use of hormone therapy was concurrently associated with lower levels of anxiety and depressive symptoms. Hormones were used at some point over the observation by the majority of participants, and as expected, were particularly common among women with a hysterectomy and oophorectomy. Excluding women who reported post-final menstrual period or surgery hormone therapy use did not affect the trajectory of changes in depressive or anxiety symptoms, suggesting that while hormone therapy was associated with improvements in mood, it did not account for the general lack of relationship seen between mood trajectories post-surgery and hysterectomy status. Antidepressant or anxiolytic use was strongly and consistently concurrently related to higher anxiety and depressive symptoms, which may highlight the need for clinicians to appropriately monitor treatment efficacy among patients in midlife presenting with mood symptoms.
Several limitations of this study should be noted. These results are based on assessment of anxiety and depressive symptoms, and may not be generalizable to populations with anxiety and depressive disorders. Women who chose to participate in this study and continue to participate in annual visits may differ from women in the general population, and women who reported hysterectomy during the observed period may differ from women with a hysterectomy in the general population. In a survey of 15,160 women screened for study participation, women with prior hysterectomy were more often African American, less educated, older, separated/widowed/divorced, multiparous, current or past smokers, and religious. (14
) Thus, the remaining sample of eligible women tended to differ on those potential risk factors for hysterectomy than the sample contacted for survey and eligibility. (8
Despite these limitations, the study also had considerable strengths. A large, well-characterized, multi-ethnic population-based sample of women in midlife was used, providing information about symptom experience among women from diverse backgrounds. Data were collected over an eleven-year period, allowing for observations across a range of participant ages and stages in the menopausal transition. This study was unique in prospectively evaluating mood and hysterectomy status, providing information on the influence of elective hysterectomy with and without bilateral oophorectomy on depressive and anxiety symptoms over time while accounting for mood symptoms prior to surgery. The comparison of these trajectories to those of naturally postmenopausal women offers needed information not only on the effects of oophorectomy over hysterectomy alone, but also how these differ from general trends experienced over the natural menopausal transition.
Overall, the results of this study should provide reassurance to women and their clinicians about the progression of depressive and anxiety symptoms in women both before and after menopause. Clinicians should be aware that negative mood symptoms generally decline over time over the course of the menopausal transition, (15
) suggesting that anxiety and depressive symptoms should improve as women enter the postmenopausal years. Lasting effects on both anxiety and depressive symptoms do not appear to be necessary considerations when evaluating decisions surrounding ovarian conservation.