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Spüntrup C, Banerjee M, Piana J, Hellmich M, Bojahr J, Bojahr B, Albus C, Noé G. The influence of persistent bleeding after supracervical hysterectomy on depressive and anxious symptoms: a prospective bicenter study. Arch Gynecol Obstet 2022; 306:127-132. [PMID: 35229204 DOI: 10.1007/s00404-022-06446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/09/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Postoperative spotting is a frequent adverse symptom after laparoscopic supracervical hysterectomy (LSH). The conical excision (eLSH) reduces the postoperative spotting rate, but data in a larger collective are still rare and inconsistent. The influence of persistent bleeding on the anxious and depressive symptoms has not been analyzed yet. METHODS 311 patients, who underwent a laparoscopic supracervical hysterectomy with conical excision (n = 163), or with straight cervical resection (n = 148) were included. Anxious and depressive symptoms and postoperative spotting were recorded before operation, at 3 month follow-up and at 1 year follow-up in both operative groups using a validated questionnaire (German version of Hospital Anxiety and Depression Scale, HADS-D) and additional questions concerning the frequency and impact of bleeding. Statistical analysis included the impairment of bleeding as well as its impact on depressive and anxious symptoms for both groups. RESULTS 11.5% after eLSH and 15.5% after LSH reported spotting after 1 year. Supracervical hysterectomy significantly improves depressive and anxious symptoms at 3 and at 12 month follow-up for both groups (p < 0.001) independent on residual spotting. Patients with a preoperative continuous bleeding showed a maximum benefit independent on operative method. CONCLUSION Laparoscopic supracervical hysterectomy has a positive effect on anxious and depressive symptoms in the short-term and intermediate-term follow-up. The conical excision of the cervical stump reduces postoperative spotting rate, but has no explicit advantage on symptoms of depression or anxiety, irrespective of residual postoperative spotting.
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Affiliation(s)
- Carolin Spüntrup
- Department of Obstetrics and Gynecology, Rheinlandklinikum Dormagen, Dormagen, Germany.
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany.
- Pelvic School Saarbrücken, Hohe Wacht 77, Saarbrücken, Germany.
| | - M Banerjee
- Department of Orthopedic Surgery and Sports Traumatology, Atos Media Park Clinic, Cologne, Germany
- University of Witten/Herdecke, Witten, Germany
| | - J Piana
- Department of Obstetrics and Gynecology, Rheinlandklinikum Dormagen, Dormagen, Germany
| | - M Hellmich
- Institute for Medical Statistics and Epidemiology, University of Cologne, Cologne, Germany
| | | | | | - C Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - G Noé
- Department of Obstetrics and Gynecology, Rheinlandklinikum Dormagen, Dormagen, Germany
- University of Witten/Herdecke, Witten, Germany
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Casarin J, Cromi A, Sgobbi B, Di Siena A, Serati M, Bolis ME, Ghezzi F. Music Therapy for Preoperative Anxiety Reduction in Women Undergoing Total Laparoscopic Hysterectomy: A Randomized Controlled Trial. J Minim Invasive Gynecol 2021; 28:1618-1624.e1. [PMID: 33549732 DOI: 10.1016/j.jmig.2021.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
STUDY OBJECTIVE To assess the superiority of a music therapy intervention (Music) vs usual care (Control) in reducing the preoperative anxiety of patients undergoing total laparoscopic hysterectomy (TLH) with nononcologic indications. DESIGN This was a 1:2 (Music vs Control) randomized controlled study. SETTING A teaching hospital. PATIENTS One hundred patients were available for the analysis: 30 and 70 in the Music and Control arms, respectively. INTERVENTIONS Perioperative music therapy pathway in patients undergoing TLH for benign disease. MEASUREMENTS AND MAIN RESULTS Anxiety was evaluated with the State-Trait Anxiety Inventory Y Form (STAI-Y) at different time points: at baseline and during preoperative, early postoperative, and late postoperative periods. Pathologic anxiety was defined as STAI-Y state >45. Postoperative pain was registered using the visual analog scale. Women in the Music arm experienced lower anxiety levels (median STAI-Y scores 38.0 vs 41.0; p = .002) during the preoperative period. STAI-Y scores did not vary significantly by intervention at each subsequent time point. A significant difference between the groups (Music vs Control) was found in the proportion of women with pathologic anxiety during the preoperative (16.7% vs 37.2%; p = .04) and early postoperative periods (0% vs 12.9%; p = .04), whereas no significant difference between the groups was registered during the late postoperative period (6.6% vs 7.1%; p = .93). Postoperative pain intensity did not significantly differ between the groups at 1, 3, and 6 hours after surgery. CONCLUSIONS Music therapy might be a viable complementary modality to usual surgical care in the gynecologic setting for its ability to significantly decrease preoperative anxiety in women undergoing TLH for benign conditions.
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Affiliation(s)
- Jvan Casarin
- Department of Obstetrics and Gynecology, Women's and Children's Del Ponte Hospital, University of Insubria, Varese, Italy (all authors).
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, Women's and Children's Del Ponte Hospital, University of Insubria, Varese, Italy (all authors)
| | - Barbara Sgobbi
- Department of Obstetrics and Gynecology, Women's and Children's Del Ponte Hospital, University of Insubria, Varese, Italy (all authors)
| | - Anna Di Siena
- Department of Obstetrics and Gynecology, Women's and Children's Del Ponte Hospital, University of Insubria, Varese, Italy (all authors)
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Women's and Children's Del Ponte Hospital, University of Insubria, Varese, Italy (all authors)
| | - Maria Elena Bolis
- Department of Obstetrics and Gynecology, Women's and Children's Del Ponte Hospital, University of Insubria, Varese, Italy (all authors)
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, Women's and Children's Del Ponte Hospital, University of Insubria, Varese, Italy (all authors)
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Saffarieh E, Ahmadi R, Pazoki R, Yousefnezhd A, Yousefi-Sharami R. The study of life expectancy in hysterectomized women in Semnan Amir Al Momenin Hospital in 2017. J Family Med Prim Care 2020; 9:826-829. [PMID: 32318428 PMCID: PMC7114009 DOI: 10.4103/jfmpc.jfmpc_783_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/17/2019] [Accepted: 12/31/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Hysterectomy as kind of surgery in which the uterus is removed, is carried out in a very high number around the world. Uterus is important because of its impact on feminism and fertility, so the exit of this important organ can lead to many physical and mental disorders. These mental disorders can affect the quality of life of patients and ultimately lead to a reduction in the hope of their lives. Materials and Methods This study was cross sectional on 50 women under hysterectomy referred to the Semnan Amir-Al-Momenin hospital in 2017, in which patients were evaluated in terms of effective subsets of life expectancy that were determined from the angle of view of miller questionnaire, and finally the data were analyzed by SPSS v. 19. Results The results showed that there is no significant difference between hope to life before and after hysterectomy in those who underwent hysterectomy. The results of our study showed that age, occupation, and education factors in patients who participated in this study did not have any meaningful relation with life expectancy after hysterectomy surgery and there was also a statistically significant correlation between the scores of hope for life before hysterectomy with the rate of education in individuals. Conclusion Hysterectomy does not affect the patients' quality of live and don't reduce the hope of living in people who underwent surgery.
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Affiliation(s)
- Elham Saffarieh
- Abnormal Uterine Bleeding Research Center, Semnan University of Medical Science, Semnan, Iran
| | - Reza Ahmadi
- Psychosexual Department, Ruzbeh Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Ramin Pazoki
- Department of Parasitology, Faculty of Medicine, Education Development Center, Semnan University of Medical Science, Semnan, Iran
| | - Azadeh Yousefnezhd
- Department of Oncology and Gynecology, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Reyhaneh Yousefi-Sharami
- Department of Gynecology and Obstetrics, Kordistan University of Medical Science, Sanandaj, Iran
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Psychological outcomes after hysterectomy for benign conditions: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2013; 174:5-19. [PMID: 24398028 DOI: 10.1016/j.ejogrb.2013.12.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/27/2013] [Accepted: 12/06/2013] [Indexed: 11/23/2022]
Abstract
Hysterectomy is one of the commonest operative procedures in the developed world, mostly occurring among premenopausal women, with contradictory results regarding post-operative psychological wellbeing. This review aims to inform practice by examining whether hysterectomy predicts depression or anxiety outcomes. We searched PubMed, EMBASE, and PsycINFO electronic databases for articles published before November 2012. Reference lists of relevant articles were hand searched, and expert opinions were sought. Refereed studies investigating an association between hysterectomy for benign (non-cancerous) conditions and post-operative symptoms of depression or anxiety were chosen for this review. Two authors independently abstracted data from original articles. Authors of relevant studies were contacted for data that could not be extracted from the published articles. Review Manager 5.1 was used throughout the meta-analysis to calculate the summary relative risks (RRs), and the weighted standardized mean difference (WstdMD), and their corresponding 95% confidence intervals (CI). A random effects model was used in data analysis and verified using a fixed effect model. Overall, hysterectomy was associated with a decreased risk of clinically relevant depression (RR=1.69, 95% CI 1.19-2.38). Additionally, hysterectomy was associated with a decrease in standardized depression outcomes (standardized mean difference (SMD) 0.38 (95% CI 0.27-0.49)). Conversely, there was no significant association between hysterectomy and risk of clinically relevant anxiety (RR=1.41, 95% CI 0.72-2.75). In conclusion, data from before and after studies suggest that hysterectomy for benign gynecological conditions is not adversely associated with anxiety and may be positively rather than adversely associated with depression.
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Gibson CJ, Bromberger JT, Weiss GE, Thurston RC, Sowers M, Matthews KA. Negative attitudes and affect do not predict elective hysterectomy: a prospective analysis from the Study of Women's Health Across the Nation. Menopause 2011; 18:499-507. [PMID: 21228728 PMCID: PMC3123400 DOI: 10.1097/gme.0b013e3181f9fa35] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cross-sectional studies suggest an association between hysterectomy and negative affect. Using prospective data, we examined the associations of negative affect, attitudes toward aging and menopause, premenstrual symptoms, and vasomotor symptoms with elective hysterectomy in midlife. METHODS Data were from the Study of Women's Health Across the Nation, a multisite, community-based prospective cohort study of the menopausal transition (n = 2,818). Annually reported hysterectomy at visits 2 to 9 was verified with medical records when available (71%). Anxiety, perceived stress, depressive symptoms, attitudes toward aging and menopause, vasomotor symptoms, and premenstrual symptoms were assessed at baseline using standardized questions. Cox proportional hazards models were used to relate these variables to subsequent elective hysterectomy. Covariates included demographic variables, menstrual bleeding problems, body mass index, hormone levels, and self-rated health, also assessed at baseline. RESULTS Elective hysterectomy was reported by 6% (n = 168) of participants over an 8-year period. Women with hysterectomy were not higher in negative affect or negative attitudes toward aging and menopause compared with women without hysterectomy. Vasomotor symptoms (hazard ratio [HR], 1.44; 95% CI, 1.03-2.01; P = 0.03) and positive attitudes toward aging and menopause (HR, 1.74; 95% CI, 1.04-2.93) at baseline predicted hysterectomy over the 8-year period, controlling for menstrual bleeding problems, site, race/ethnicity, follicle-stimulating hormone, age, education, body mass index, and self-rated health. Menstrual bleeding problems at baseline were the strongest predictor of hysterectomy (HR, 4.30; 95% CI, 2.05-9.05). CONCLUSIONS In this prospective examination, negative affect and attitudes were not associated with subsequent hysterectomy. Menstrual bleeding problems were the major determinant of elective hysterectomy.
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Affiliation(s)
- Carolyn J Gibson
- Department of Psychology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Pinar G, Kurt A, Gungor T. The efficacy of preopoerative instruction in reducing anxiety following gyneoncological surgery: a case control study. World J Surg Oncol 2011; 9:38. [PMID: 21477315 PMCID: PMC3088892 DOI: 10.1186/1477-7819-9-38] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 04/08/2011] [Indexed: 11/22/2022] Open
Abstract
Background This is a quasi-experimental case control research focusing on the impact of systematic preoperative instruction on the level of postoperative anxiety in gyneoncologic patients. The population studied consists of the gyneoncologic surgery patients admitted to the Gynecologic Oncology Service at Zekai Tahir Burak Gynecology Training and Research Hospital from May to September 2010. Patients and methods Through a random sampling, 60 patients were recruited in each group. The study group was given a systematic preoperative instruction while the control group was given routine nursing care. Patients were interviewed in the postoperative period and anxiety was measured. The data-collecting tool consisted of the Individual Information Form and the State-Trait Anxiety Inventory. The collected data were analyzed by using the SPSS Program to find the frequency, the percentage, the mean and the standard variables, and the hypothesis was tested with Chi-square, variance, and t-independent test. Results It was found that the incidence rates from the post-operative anxiety score of the study group were lower than those of the control group (p < .05). The results of this research demonstrated that gyneoncologic surgery patients who were given systematic preoperative instruction felt less anxious than the ones who were given merely a routine nursing care. Conclusions Results of this study suggest that preoperative instruction programs aiming at informing gyneoncologic surgery patients at the preoperative stage should be organized in hospitals and have an essential role.
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Affiliation(s)
- Gul Pinar
- Başkent University Health Sciences Faculty, Nursing and Healthcare Services Department, Eskisehir Yolu, 20. km. Balica Campus, Cayyolu/Ankara, Turkey.
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Okunlola MA, Umuerri C, Omigbodun OO, Morhason-Bello IO, Okonkwo SN, Ojengbede OA. Pattern of mental ill health morbidities following hysterectomy for benign gynaecological disorders among Nigerian women. Int J Ment Health Syst 2009; 3:18. [PMID: 19642993 PMCID: PMC2732916 DOI: 10.1186/1752-4458-3-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 07/30/2009] [Indexed: 11/12/2022] Open
Abstract
Objective to compare the pre and post hysterectomy mental ill health (MIH) status and also, to determine whether there is any association with the surgical indication. Methodology An observational study, conducted among women scheduled for hysterectomy at the University College Hospital, Ibadan from January till June 2005. The MIH morbidities were assessed using a validated general health questionnaire (GHQ) before and after the surgery by trained research assistant. The score of 4 and above was used as the cut off. Cross tabulations were performed to detect any association and also to compare pre and post hysterectomy mental health status. The level of statistical significance was set at P < 0.05. Results Of the 50 women recruited, 45 participated in the study. The age range of the participants was 35 to 63 years with a mean of 48.6 (SD = 0.6) years. Anxiety related disorder was present in 20 (44.4%), and depression in 3 (6.7%) before hysterectomy. Post surgery, there was significant increase in those with anxiety by 6.8% and a reduction in the proportion of depressive illness by 2.3%. Uterine fibroid as a preoperative diagnosis, had significant association among those with anxiety related disorder (68.4%) and depression (10.5%). Conclusion This study suggests that mental ill health may complicates hysterectomy for benign uterine pathology among Nigerian women, and that anxiety related disorders increases after operation with the highest proportion in those with clinical diagnosis of Uterine Fibroid. We recommend adequate preoperative counseling using properly trained psychologists when affordable to minimize these morbidities.
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Affiliation(s)
- Michael A Okunlola
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria.
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Cooper R, Mishra G, Hardy R, Kuh D. Hysterectomy and subsequent psychological health: findings from a British birth cohort study. J Affect Disord 2009; 115:122-30. [PMID: 18835497 DOI: 10.1016/j.jad.2008.08.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 08/28/2008] [Accepted: 08/28/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND The association between hysterectomy and subsequent, long-term psychological health is still not well characterised. We aimed to test the association between hysterectomy and subsequent psychological health and examine variation in this association by characteristics of hysterectomy. METHODS Using data on women in the MRC National Survey of Health and Development, followed up since birth in 1946 until age 53 years (N=1790) the associations between hysterectomy and General Health Questionnaire (GHQ)-28 scores were tested. RESULTS There was no clear association between hysterectomy status and GHQ-28 score at age 53 years when grouping all hysterectomies together. However, this masked significant variation in association by characteristics of hysterectomy. In unadjusted analyses women who had undergone hysterectomy for cancer had mean GHQ-28 scores at age 53 years which were 49.0% higher (95% CI: 3.4%, 94.7%) than women who had not undergone hysterectomy. In analyses adjusted for prior psychological state and vulnerability, lifetime socioeconomic position, weight at age 26 years, smoking status and hormone replacement therapy use, women who had undergone hysterectomy before age 40 years had GHQ-28 scores 29.5% higher (95% CI: 2.7%, 56.3%) than women who had not undergone hysterectomy. CONCLUSIONS Our findings suggest that women who undergo hysterectomy at a young age are a defined group who may require more support than other women to maintain good psychological health in middle-age.
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Affiliation(s)
- Rachel Cooper
- MRC Unit for Lifelong Health and Ageing, 33 Bedford Place, London, WC1B 5JU, UK.
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Shuster LT, Gostout BS, Grossardt BR, Rocca WA. Prophylactic oophorectomy in premenopausal women and long-term health. MENOPAUSE INTERNATIONAL 2008; 14:111-6. [PMID: 18714076 PMCID: PMC2585770 DOI: 10.1258/mi.2008.008016] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To review the data on long-term outcomes in women who underwent prophylactic bilateral oophorectomy, a common surgical procedure that has more than doubled in frequency since the 1960s. STUDY DESIGN Literature review of the published data on the consequences of prophylactic bilateral oophorectomy. Special emphasis was given to the Mayo Clinic Cohort Study of Oophorectomy and Aging. Main outcome measures Overall mortality, cardiovascular disease, cognitive impairment and dementia, parkinsonism, osteoporosis, psychological wellbeing and sexual function. RESULTS There is a growing body of evidence suggesting that the premature loss of ovarian function caused by bilateral oophorectomy performed before natural menopause is associated with several negative outcomes. In particular, studies have revealed an increased risk of premature death, cardiovascular disease, cognitive impairment or dementia, parkinsonism, osteoporosis and bone fractures, decline in psychological wellbeing and decline in sexual function. The effects involve different organs (e.g. heart, bone, or brain), and different functions within organs (e.g. cognitive, motor, or emotional brain functions). Estrogen treatment may prevent some but not all of these negative outcomes. CONCLUSION The potential adverse effects of prophylactic bilateral oophorectomy on heart health, neurological health, bone health and quality of life should be carefully weighed against its potential benefits for cancer risk reduction in women at average risk of ovarian cancer.
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Affiliation(s)
- Lynne T Shuster
- Department of Internal Medicine, Women's Health Clinic, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Persson P, Kjølhede P. Factors associated with postoperative recovery after laparoscopic and abdominal hysterectomy. Eur J Obstet Gynecol Reprod Biol 2008; 140:108-13. [PMID: 18456384 DOI: 10.1016/j.ejogrb.2008.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 01/27/2008] [Accepted: 03/22/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To determine whether the day-by-day recovery of general wellbeing was faster in women undergoing laparoscopic hysterectomy than in total abdominal hysterectomy and to analyse the association between stress coping and sick-leave and the day-by-day recovery measured as general wellbeing. STUDY DESIGN A randomised multicentre trial conducted in five hospitals in the South East of Sweden. Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study and 117 women completed the study. Fifty-five women were randomised to abdominal hysterectomy and 62 to laparoscopic hysterectomy. Day-by-day recovery of general wellbeing was measured by a visual analogue scale 1 week preoperatively, 35 days postoperatively, and during 1 week 6 months postoperatively. Stress-coping capability was measured preoperatively using a specific psychometric measurement. Sick-leave was granted with an initial period of 14 days and prolonged on patient demand with 7 days periods. Effects of operating method and stress-coping ability on the day-by-day recovery adjusted for postoperative complications and analgesics were analysed by means of analysis of variance for repeated measurements. RESULTS No significant difference was found in the day-by-day recovery of the general wellbeing between the operating methods. Stress-coping ability did significantly influence the day-by-day recovery of general wellbeing. Duration of sick-leave was associated with the occurrence of postoperative complications but not with stress-coping ability. CONCLUSIONS The day-by-day recovery of general wellbeing is not faster in laparoscopic hysterectomy than in abdominal hysterectomy. Women with high stress-coping abilities have a better outcome in general wellbeing than women with low stress-coping capacity. Identification of women with low stress-coping abilities and prevention of complications might be of benefit for improving postoperative wellbeing.
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Affiliation(s)
- Pär Persson
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynaecology Faculty of Health Sciences, University Hospital, 581 85 Linköping, Sweden.
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Elovainio M, Teperi J, Aalto AM, Grenman S, Kivelä A, Kujansuu E, Vuorma S, Yliskoski M, Paavonen J, Hurskainen R. Depressive symptoms as predictors of discontinuation of treatment of menorrhagia by levonorgestrel-releasing intrauterine system. Int J Behav Med 2007; 14:70-5. [PMID: 17926434 DOI: 10.1007/bf03004171] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
It has been shown that levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective treatment of menorrhagia. However, the discontinuation rate of LNG-IUS treatment is high, and little is known about the actual reasons intertwining it. We tested the hypothesis that depressive symptoms is the factor responsible for deciding to have a hysterectomy during LNG-IUS treatment. The participants (119 women, ages = 35-49 years) were randomly selected over a 3-year period (1994-1997) to receive the LNG-IUS or a hysterectomy for the treatment of menorrhagia. Depressive symptoms, based on Beck's Depression Inventory measured 6 months after the beginning of the treatment, were related to discontinuation of LNG-IUS use Odds Ratio (OR) = 3.70, 95% Confidence Intervals (CI) 1.55-8.82, p = .003 during a 5-year follow-up. This association was not attenuated after adjustment for other known risk factors. Our findings suggest that diagnosing and treating depression among patients having menstrual problems may improve the continuity of LNG-IUS treatment of menorrhagia.
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Affiliation(s)
- Marko Elovainio
- National Research and Development Centre for Welfare and Health , P.O Box 220, Fin 00531, Helsinki, Finland.
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Abstract
OBJECTIVE Women anticipating surgical menopause often have significant concerns regarding the effects of surgery on psychological well-being and sexuality. RESULTS The impact of hysterectomy, often with concurrent oophorectomy, on well-being and sexuality will vary depending on many factors. These include a woman's preoperative mental health and sexual function, the indications for surgery, and the specific procedure being performed. Whether or not estrogen therapy is an option also will affect a woman's postoperative symptoms and experience of surgical menopause. CONCLUSIONS The majority of research on the effects of surgical menopause shows improved psychological well-being and sexual function after hysterectomy for benign disease. Women with depression or sexual problems preoperatively are at increased risk for experiencing a worsening of mood and libido postoperatively.
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Affiliation(s)
- Jan L Shifren
- Vincent Ob/Gyn Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Ancelin ML, Scali J, Ritchie K. Hormonal therapy and depression: are we overlooking an important therapeutic alternative? J Psychosom Res 2007; 62:473-85. [PMID: 17383500 DOI: 10.1016/j.jpsychores.2006.12.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Revised: 12/11/2006] [Accepted: 12/12/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This review aimed to examine evidence for the role of hormonal changes in the onset and course of depressive symptomatology and to assess the possible future role of hormonal therapies in the treatment of depression. METHODS A Medline and PsycINFO search of the literature published between 1965 and 2006 was made of studies of depressive symptoms and hormonal treatment in women at all stages of reproductive life. RESULTS The cyclic fluctuation of gonadal steroids at menarche coincides with the beginning of gender-based differences in depression rates, which continue throughout reproductive life until menopause. Modifications in hormonal status, whether related to endogenous or exogenous exposure or to hormone deprivation, appear to be associated with affective disorder in a subgroup of women. For these women, a growing body of evidence indicates a biological pattern of vulnerability to mood disorders in response to hormonal fluctuations. This could have three major implications: that women vary in vulnerability to mood disorder when abrupt change in steroid levels occur, that these effects could be cumulative across the female life span, and that women do not arrive at menopause with equal risk of mood disorders or equal susceptibility to the effects of hormonal replacement therapy as has been assumed by current clinical research and practice. CONCLUSION While hormonal therapies could have positive effects in the treatment and prevention of depressive disorders, further research is required to differentiate hormone-responsive subgroups of women for whom specific hormonal treatments may be most beneficial. To this end, we suggest that a multifactorial model of cumulative vulnerability, which takes into account hormonal exposure throughout life, genetic vulnerability, and environmental factors, may provide better prediction of treatment response.
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Affiliation(s)
- Min Chung-Park
- Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, CA, USA
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Flory N, Bissonnette F, Amsel RT, Binik YM. The Psychosocial Outcomes of Total and Subtotal Hysterectomy: A Randomized Controlled Trial. J Sex Med 2006; 3:483-91. [PMID: 16681474 DOI: 10.1111/j.1743-6109.2006.00229.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Current controversies involve the adverse effects of hysterectomy on women's psychosocial functioning and whether subtotal as opposed to total hysterectomy mitigates these effects. AIM To investigate the psychosocial effects of hysterectomy by examining sexual, pain, and psychological outcomes of total vs. subtotal hysterectomy in a randomized controlled trial. METHODS Patients suffering from benign gynecological conditions were randomly assigned to one of two groups: (i) total hysterectomy, that is, laparoscopic assisted vaginal hysterectomy (TOT, N = 32); or (ii) subtotal hysterectomy, that is, supracervical laparoscopic hysterectomy (SUB, N = 31). Both groups were premenopausal and underwent hysterectomy without concurrent oophorectomy. Two premenopausal control groups: (i) minor gynecological surgery (SURG-CON, N = 30); and (ii) healthy nonsurgical controls (NORM-CON, N = 40), were also tested. All surgical groups were assessed 2-3 weeks before surgery and then 6-7 months afterward; the nonsurgical control group was assessed at the time of recruitment and 6-7 months later. OUTCOME MEASURES Assessments included semistructured interviews, standardized questionnaires, and standardized gynecological examinations. RESULTS For the TOT group, sexual drive, arousal, and sexual behavior significantly improved postoperatively. For the SUB group, sexual behavior and overall sexual functioning significantly improved. For both TOT and SUB groups, unprovoked pain in the abdomen and pain in the abdomen during gynecological examinations was significantly reduced. For both TOT and SUB groups, overall psychological functioning did not significantly change postoperatively. Although between 3% and 16% of women undergoing hysterectomy reported adverse changes in psychosocial well-being after surgery, similar percentages of women in the control groups reported such effects. CONCLUSIONS Hysterectomy resulted in a consistent reduction in abdominal pain, some improvement in sexual functioning, but no change in overall psychological functioning. There was no evidence supporting the idea that subtotal hysterectomy produced more favorable psychosocial outcomes than total hysterectomy nor was there any evidence that either type of hysterectomy resulted in adverse effects.
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Affiliation(s)
- Nicole Flory
- Department of Behavioral Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.
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Carr E, Brockbank K, Allen S, Strike P. Patterns and frequency of anxiety in women undergoing gynaecological surgery. J Clin Nurs 2006; 15:341-52. [PMID: 16466484 DOI: 10.1111/j.1365-2702.2006.01285.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Within a gynaecological surgical setting to identify the patterns and frequency of anxiety pre- and postoperatively; to identify any correlation between raised anxiety levels and postoperative pain; to identify events, from the patients' perspective, that may increase or decrease anxiety in the pre- and postoperative periods. BACKGROUND It is well documented that surgery is associated with increased anxiety, which has an adverse impact on patient outcomes. Few studies have been conducted to obtain the patient's perspective on the experience of anxiety and the events and situations that aggravate and ameliorate it. METHOD The study used a mixed method approach. The sample consisted of women undergoing planned gynaecological surgery. Anxiety was assessed using the State Trait Anxiety Inventory. Trait anxiety was measured at the time of recruitment. State anxiety was then assessed at six time points during the pre- and postoperative periods. Postoperative pain was also measured using a 10 cm visual analogue scale. Taped semi-structured telephone interviews were conducted approximately a week after discharge. RESULTS State anxiety rose steadily from the night before surgery to the point of leaving the ward to go to theatre. Anxiety then increased sharply prior to the anaesthetic decreasing sharply afterwards. Patients with higher levels of trait anxiety were more likely to experience higher levels of anxiety throughout their admission. Elevated levels of pre- and postoperative anxiety were associated with increased levels of postoperative pain. Telephone interviews revealed a range of events/situations that patients recalled distressing them and many were related to inadequate information. CONCLUSION This study found higher rates of anxiety than previously reported and anxiety levels appeared raised before admission to hospital. This has important clinical and research implications. RELEVANCE TO CLINICAL PRACTICE Patients with high levels of anxiety may be identified preoperatively and interventions designed to reduce anxiety could be targeted to this vulnerable group. Patient experiences can inform the delivery of services to meet their health needs better.
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Affiliation(s)
- Eloise Carr
- Bournemouth University, Institute of Health and Community Studies, Bournemouth, Dorset, UK
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Abstract
Acute onset of surgical menopause rarely complicates a woman's psychological state. Although most women with acute surgical menopause have associated menopausal symptoms, few psychological consequences have been reported. This article presents the case report of a woman who developed immediate postoperative symptoms of severe anxiety that significantly impacted her quality of life. Physiological and psychological changes associated with surgical menopause and hormone replacement therapy are also discussed.
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Affiliation(s)
- Min Chung-Park
- Department of Obstetrics and Gynecology, Naval Medical Center-San Diego, 34800 Bob Wilson Drive, St 5, San Diego, CA 92134, USA.
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Ceausu I, Shakir YA, Lidfeldt J, Samsioe G, Nerbrand C. The hysterectomized woman. Maturitas 2006; 53:201-9. [PMID: 16368473 DOI: 10.1016/j.maturitas.2005.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Revised: 04/01/2005] [Accepted: 04/04/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To delineate the health profile of hysterectomized women and to assess whether women who have undergone hysterectomy have a different health profile even before surgery. MATERIAL AND METHODS The WHILA project covers all women (n = 10,766) aged 50-60, living in the Lund area and are based on questionnaires and personal interviews tied to laboratory examinations. RESULTS 6917 women (64.2%) had complete questionnaires and laboratory tests, 800 were hysterectomized (11.6%). Logistic regression analysis revealed that hysterectomized women had more "dizziness" 1.40 (1.19-1.66), "nervous problems" 1.29 (1.07-1.56), "backache" 1.37 (1.16-1.62), "joint problems" 1.29 (1.09-1.52), "eye problem" 1.20 (1.02-1.42) and "headache" 1.17 (1.00-1.37). For both somatic (5.22 versus 4.49 mean value, p < 0.001) and psychological (4.19 versus 3.86 mean value, p = 0.002) symptoms, the number was higher in hysterectomized women. Logistic regression analysis revealed that among hysterectomized women university education was less common odds ratios 0.73 (95% confidence interval 0.58-0.91) as well as working full time 0.76 (0.62-0.93). A higher body weight at the age 25, 1.01 (1.001-1.02) as well as a weight gain of more than 5 kg during the last 5 years 1.27 (1.07-1.50), elevation of serum triglycerides 1.29 (1.16-1.44), high-density (HDL) 1.44 (1.14-1.80) and low-density lipoprotein (LDL) cholesterol 1.11 (1.02-1.21) as well as the bone density 1.08 (1.00-1.17). Hysterectomized women had a lower age at giving first birth (p < 0.001), shorter interval between menstrual periods (p < or = 0.001) and less frequent amenorrhic episodes (p < 0.05). The hysterectomized women used IUD to a lesser extent (p < 0.05) but used hormone therapy (HT) (p < 0.001) and utilized health care services (p < 0.001) more often. CONCLUSIONS Long after surgery, several somatic and psychological symptoms were still more common in hysterectomized women. A low frequency of amenorrhic episodes and lower age at giving first birth, concomitant with a higher body weight already at age 25 may imply that women who end up hysterectomized have a specific health profile long before as well as long after surgery.
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Affiliation(s)
- Iuliana Ceausu
- Department of Obstetrics and Gynecology, Lund University Hospital, Sweden
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Flory N, Bissonnette F, Binik YM. Psychosocial effects of hysterectomy: literature review. J Psychosom Res 2005; 59:117-29. [PMID: 16198184 DOI: 10.1016/j.jpsychores.2005.05.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Accepted: 05/18/2005] [Indexed: 01/23/2023]
Abstract
OBJECTIVES With the development of less invasive treatments, the suitability of hysterectomy as a treatment for benign symptoms is being reevaluated. This paper critically and comprehensively reviews the psychosocial outcomes of hysterectomy in areas of sexuality, pain, and psychological functioning. METHODS Medline, Pub Med, and PsychLit were searched for studies and reviews pertaining to the psychosocial outcomes of hysterectomy. Over 100 studies and reviews, in English, French, and German language, published in the past 30 years were included. Controversial theories and empirical evidence are discussed in the domains of sexuality, pain, and psychological well-being. Special attention is devoted to design, sampling, and measurement issues as well as different surgical approaches with regard to hysterectomy-oophorectomy. RESULTS While hysterectomy appears to reduce pain, there do not appear strong psychosexual or psychosocial effects. Nonetheless, there may be a subgroup of women (10-20%) who report negative psychosocial outcomes such as reduced sexual interest, arousal, and orgasm, as well as elevated depressive symptoms and impaired body image. CONCLUSIONS More research is necessary to establish which patients may benefit most and which may not. Directions for future research are discussed.
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Affiliation(s)
- Nicole Flory
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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Aziz A, Brännström M, Bergquist C, Silfverstolpe G. Perimenopausal androgen decline after oophorectomy does not influence sexuality or psychological well-being. Fertil Steril 2005; 83:1021-8. [PMID: 15820815 DOI: 10.1016/j.fertnstert.2004.12.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2004] [Revised: 12/08/2004] [Accepted: 12/08/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether oophorectomy during the perimenopause, with the associated decline in ovarian androgens, affects sexual function and psychological well-being negatively. DESIGN Prospective, observational study comparing sexuality and psychological well-being in women after hysterectomy only (HYST) vs. hysterectomy and concomitant oophorectomy (HYST+BSO). SETTING University hospital and district general hospital. PATIENT(S) Three hundred sixty-two perimenopausal women scheduled for elective hysterectomy on benign indication were recruited and 323 (89%) completed the 1-year follow-up (217 in the HYST group and 106 in the HYST+BSO group). INTERVENTION(S) The patients were evaluated preoperatively and 1 year after surgery. Postoperatively, estrogen replacement therapy was recommended to all women in the HYST+BSO group and to HYST group subjects with climacteric symptoms. MAIN OUTCOME MEASURE(S) Sex steroids (T, androstenedione, DHEA-S, and E(2)) and sex hormone-binding globulin (SHBG) were measured. Free androgen index and free E(2) index were calculated. Sexuality (McCoy's Female Sex Questionnaire) and psychological well-being (Psychological General Well-Being Index) were evaluated. RESULTS(S) Preoperatively, no hormonal differences were found between the two groups. At 1-year follow-up, all sex steroid levels and indices were decreased and SHBG was increased in the HYST+BSO group. Ovarian sex steroids were decreased in the HYST group, whereas DHEA-S and SHBG were unaltered. Sexuality was unaltered in the HYST+BSO group, whereas decreased scores were found in 3 of 14 sexual variables in the HYST group. Psychological well-being was improved in both groups. There were no correlations between the observed changes (data 1 year after surgery, compared with preoperative data) in androgen levels and index and the observed changes in any aspect of sexuality or psychological well-being. CONCLUSION(S) Hormonal changes after oophorectomy in conjunction with perimenopausal hysterectomy do not significantly change postoperative (1-year) sexual or psychological well-being.
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Affiliation(s)
- Adel Aziz
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Göteborg University, Borås Hospital, 501 82 Borås, Sweden.
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Ellström MA, Åström M, Möller A, Olsson JH, Hahlin M. A randomized trial comparing changes in psychological well-being and sexuality after laparoscopic and abdominal hysterectomy. Acta Obstet Gynecol Scand 2003. [DOI: 10.1034/j.1600-0412.2003.00216.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Donoghue AP, Jackson HJ, Pagano R. Understanding pre- and post-hysterectomy levels of negative affect: a stress moderation model approach. J Psychosom Obstet Gynaecol 2003; 24:99-109. [PMID: 12854394 DOI: 10.3109/01674820309042807] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Before and after hysterectomy, 60 women completed self-report questionnaires. Measures of personality (NEO-Five Factor Inventory, NEO-FFI), coping (Coping Inventory for Stressful Situations, CISS), and procedure appraisal were completed pre-operatively. Measures of depression and anxiety were completed pre- and post-operatively. Pre-op, 34% of women reported depression at clinical levels, and 29% reported clinical anxiety. The prevalence of depression fell to 8% 3-months post-op although clinical levels of anxiety persisted post-op in 22% of women. Regression analyses revealed that the principal risk factors for post-op negative affect were pre-op levels of depression and concerns about hysterectomy outcome. In assessing proposed models of post-hysterectomy outcome, structural equational modelling revealed the key position of neuroticism and extraversion, which were both directly and indirectly related to pre- and post-operative depression and anxiety. The mediating variables in this model included coping dispositions and procedure appraisal. It is concluded that the variables contained within stress moderation models provide a useful framework for understanding the processes that may lead to elevated levels of negative affect both before and after hysterectomy. Such an approach may prove beneficial for other surgical-outcome studies.
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Affiliation(s)
- A P Donoghue
- Department of Psychology, University of Melbourne
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Vuorma S, Rissanen P, Aalto AM, Kujansuu E, Hurskainen R, Teperi J. Factors predicting choice of treatment for menorrhagia in gynaecology outpatient clinics. Soc Sci Med 2003; 56:1653-60. [PMID: 12639582 DOI: 10.1016/s0277-9536(02)00199-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this prospective study was to investigate factors predicting choice of treatment for excessive menstrual bleeding, with special emphasis on women's pre-treatment preference. A cohort of women with heavy menstruation and their treatment process in gynaecology outpatient clinics were followed-up for 1yr. A total of 383 35-54-yr-old women attending 14 Finnish hospitals participated. They completed a questionnaire before their first outpatient clinic visit, and postal follow-ups were conducted 3 and 12 months later. Information on treatment(s) during the follow-up was taken from medical records and questionnaires. The choice between hysterectomy and conservative treatments, and fulfillment of pre-treatment preference were the main outcome measures. During the 1-yr follow-up, 51% (n=196) of the women underwent hysterectomy and nine were still awaiting it, 12% (n=44) had a minor surgical procedure, 11% (n=41) had oral medication, 9% (n=33) used a hormonal intrauterine system, and nine women changed preventive method. Forty-two women (11%) reported having had no treatment. Data on previous treatments suggested that conservative treatment modalities were under-used. Most of the treatment decisions were made within the first 3-month period. Women's pre-treatment preference was the strongest predictor of chosen treatment. Unemployment, irregular periods and anxiety decreased the probability of a decision for hysterectomy, while pelvic pain and inconvenience due to bleeding increased it. The treatment plan accorded with pre-treatment preference in 72% of the women preferring hysterectomy and in 74% of those preferring a conservative option.
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Affiliation(s)
- Sirkku Vuorma
- STAKES, National Research and Development Centre for Welfare and Health, 00531, Helsinki, Finland.
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Baldaro B, Gentile G, Codispoti M, Mazzetti M, Trombini E, Flamigni C. Psychological distress of conservative and nonconservative uterine surgery: a prospective study. J Psychosom Res 2003; 54:357-60. [PMID: 12670614 DOI: 10.1016/s0022-3999(02)00394-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of the present study is to evaluate the psychological reaction to conization before and after the operation compared to hysterectomy. To study the incidence of psychological stress related to conization, 60 women undergoing conization were compared to 40 women who had undergone hysterectomy. METHOD Psychological disease was rated in the pre- and postoperative periods using the Symptom Questionnaire (SQ). Each patient was evaluated 2 weeks before the operation, and 3, 6 and 12 months after it. RESULTS Both the conization and hysterectomy groups showed a significant reduction in anxiety and depression at the 3-, 6- and 12-month follow-ups compared to the preoperative period. Two weeks before surgery, 8 conization patients (19.5%) showed an anxious status, while 10 (24.3%) presented high levels of anxiety and depression. Within hysterectomy patients, the occurrence was respectively of 4 (12.9%) and 10 women (32.2%). Twelve months after surgery, of the women with preoperative depression, only four (9.7%) conization and four (12.9%) hysterectomy patients presented a negative mood status. A similar trend was present for somatic symptoms but only in the conization group, because the hysterectomy patients did not show a reduction in these symptoms from the preoperative to the postoperative period. This result could be related to the surgical menopause due to the bilateral oophoriectomy executed in more than half of the hysterectomy group. CONCLUSION In general, the results of the present study show that the conservative and nonconservative uterine surgery determines a good psychological prognosis in the short- and long-term postoperative periods.
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Affiliation(s)
- Bruno Baldaro
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, Italy.
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Wright B, Gannon MJ, Greenberg M, House A, Rutherford T. Psychiatric morbidity following endometrial ablation and its association with genuine menorrhagia. BJOG 2003. [DOI: 10.1046/j.1471-0528.2003.02199.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vuorma S, Teperi J, Hurskainen R, Aalto AM, Rissanen P, Kujansuu E. Correlates of women's preferences for treatment of heavy menstrual bleeding. PATIENT EDUCATION AND COUNSELING 2003; 49:125-132. [PMID: 12566206 DOI: 10.1016/s0738-3991(02)00069-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This cross-sectional survey investigated factors associated with treatment preferences of women with menorrhagia. Women (n = 474) aged 35-54 years referred to gynaecology out-patient clinics for menorrhagia were mailed a self-administered questionnaire before their first clinic visit. The main outcome measure was treatment preference. Hysterectomy and conservative treatment (combined with no treatment) were favoured equally often. In a multivariate analysis, completed family size (P = 0.003), menstrual pain (P = 0.02), irregular periods (P = 0.03), and higher age (P = 0.04) predicted hysterectomy preference, as did lower education level (P = 0.001), gynaecologist consultations (P = 0.002), and unemployment (P = 0.03). The psychological factors assessed were not associated with treatment preference. In conclusion, rational considerations regarding stage of reproductive life and severity of symptoms were linked to women's treatment preferences. However, education, employment status and use of specialists' services guided women's preferences even more powerfully than menstrual symptoms and burden caused by them. Doctors should pay more attention to motivating women for a trial of conservative treatment since only half of the women reported previous treatment for their menstrual problem.
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Affiliation(s)
- Sirkku Vuorma
- STAKES, National Research and Development Centre for Welfare and Health, PO Box 220, 00531 Helsinki, Finland.
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Sterling KM, Vogelzang RL, Chrisman HB, Worthington-Kirsch RL, Machan LS, Goodwin SC, Andrews RT, Hovsepian DM, Smith SJ, Bonn J. V. Uterine fibroid embolization: management of complications. Tech Vasc Interv Radiol 2002; 5:56-66. [PMID: 12098108 DOI: 10.1053/tvir.2002.124728] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Fortunately, the number of complications reported after uterine fibroid embolization (UFE) is extremely low. Angiographic mishap or drug reaction are probably more common than purely UFE-related complications. However, the possibility of infection or necrosis of the uterus, with their significant attendant morbidity, is a sobering reminder that embolotherapy can have a powerful impact on the target organ(s). Knowledge of the expected time course for symptom resolution and the often confusing imaging findings shortly after UFE are critical for avoiding unnecessary delay in surgical intervention or, perhaps more important, an inappropriate rush to surgery when antibiotics alone will suffice. Other complications include alteration of uterine physiology, which may disrupt sexual function, and menstrual irregularity and even premature menopause.
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Affiliation(s)
- Keith M Sterling
- Vascular and Interventional Section, Mallinckrodt Institute of Radiology, 510 S Kingshighway Boulevard, St. Louis, MO 63110, USA
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Postoperative Fatigue Negatively Impacts the Daily Lives of Patients Recovering From Hysterectomy. Obstet Gynecol 2002. [DOI: 10.1097/00006250-200201000-00011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Khastgir G, Studd J. Patients' outlook, experience, and satisfaction with hysterectomy, bilateral oophorectomy, and subsequent continuation of hormone replacement therapy. Am J Obstet Gynecol 2000; 183:1427-33. [PMID: 11120506 DOI: 10.1067/mob.2000.107734] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our purposes were to investigate patients' opinions of hysterectomy, bilateral oophorectomy, and hormone replacement therapy and to evaluate whether their outlook and experience influenced the overall satisfaction and continuation of hormone replacement therapy. STUDY DESIGN We conducted a questionnaire survey of 200 patients before and 2 years after hysterectomy with or without bilateral oophorectomy. Postoperatively all patients received long-term estradiol and testosterone replacement. The inquiries of patients' views included (1) preoperative awareness of indication and outlook, (2) postoperative recovery, symptom relief, and experiences with hormone replacement therapy, (3) perceived benefits and problems, (4) changes in physical well-being, psychologic state, and sexual activity, (5) continuation of hormone replacement therapy, and (6) overall satisfaction. RESULTS The outlook toward hysterectomy, bilateral oophorectomy, and hormone replacement therapy was positive in 77.4%, 87.1%, and 76.3%, respectively. The experience was positive in the majority, with a satisfactory postoperative recovery (70.6%), complete symptom relief (77.9%), and minimal side effects with hormone replacement therapy (5.2%). The benefits included improved physical well-being (79.9%), lower depressive symptoms (32.0%), and better sexuality (31.4%). The continuation rate of hormone replacement therapy was 97.4%, and overall satisfaction was positive in 88.7% of patients. The independent predictors of satisfaction were outlook toward hysterectomy and incomplete symptom relief. CONCLUSION The outcome of hysterectomy, bilateral oophorectomy, and hormone replacement therapy was satisfactory to most patients.
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Affiliation(s)
- G Khastgir
- Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, United Kingdom
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Lai AC, Goodwin SC, Bonilla SM, Lai AP, Yegul T, Vott S, DeLeon M. Sexual dysfunction after uterine artery embolization. J Vasc Interv Radiol 2000; 11:755-8. [PMID: 10877421 DOI: 10.1016/s1051-0443(07)61635-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- A C Lai
- Department of Radiological Sciences, UCLA Medical Center, Los Angeles, California 90095, USA
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Abstract
The objective of this study is to review the published literature on psychological outcome of hysterectomy and oophorectomy for non-malignant indications. The relevant publications over the past 30 years until the end of 1997 were identified by a MEDLINE computer search. This was followed by hand searches of the relevant references in the literature identified by the electronic search. The published studies on the psychological outcome of hysterectomy have been selected to identify the incidence, possible causes and risk factors of psychological morbidity, and the measures that can be adopted to improve the outcome. The study showed that the majority of retrospective studies reported an adverse psychological outcome after hysterectomy. However, all prospective studies showed that the incidence of depressed mood is higher even before hysterectomy, owing to pre-existing psychiatric illness and personality and psychosocial problems, as a result of the emotional response to gynecological symptoms or as a manifestation of associated ovarian failure. Hence, the therapeutic effects of hysterectomy include improvement of mood in some but not all patients, unless proper case selection, psychiatric evaluation and preoperative counselling are arranged. An early detection of ovarian failure after hysterectomy, the initiation of hormone replacement therapy (HRT) immediately after surgery in perimenopausal women and in those undergoing oophorectomy, as well as regular follow-ups to ensure long-term compliance with HRT, would also improve the psychological outcome. In conclusion hysterectomy itself is not the cause of any adverse psychological outcome. Psychological symptoms actually improve in the majority of women, with the relief of distressing gynecological symptoms and the correction of ovarian hormone deficiency, but hysterectomy may not be of any benefit in women with prior psychiatric illness and those with personality and psychosocial problems.
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Affiliation(s)
- G Khastgir
- Department of Obstetrics and Gynaecology, Imperial College of Science, Technology and Medicine, Chelsea and Westminster Hospital, London, UK
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Williams RD, Clark AJ. A qualitative study of women's hysterectomy experience. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 2000; 9 Suppl 2:S15-25. [PMID: 10714742 DOI: 10.1089/152460900318731] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of this qualitative study was to elicit women's perceptions of their experiences with hysterectomy, oophorectomy, and surgical menopause. Focus group and individual interviews were used to obtain data from a sample of southern urban women who had had hysterectomies for benign reasons. Of the 38 women who participated, 22 were African American and 16 were Caucasian, the mean age was 48 years, and most were low to middle income. Findings revealed that biophysical, psychosocial, and spiritual domains were important in the decision to have a hysterectomy. For many, the choice to have a hysterectomy was a last resort and was viewed as a technique that could relieve a myriad of symptoms. Although most participants described the hysterectomy experience as positive, they expressed a variety of concerns from diagnosis through recovery. Participants expressed a need for information about women's gynecological health for themselves and their male partners. African American women expressed a need for change in attitudes and beliefs in the black community about women undergoing hysterectomy. Many spouses, brothers, uncles, and other African American male friends were nonsupportive, and a few women revealed that they had not told a new partner about the surgery. The findings have implications for women's healthcare providers. Provider training and education are needed that integrate biophysical care of women with the psychological, sociological, and spiritual domains. Efforts must be directed to the community to enlighten men and families about hysterectomy by dispelling myths and providing current health information related to women's gynecological health and alternatives to, indications for, and types of hysterectomy.
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Affiliation(s)
- R D Williams
- Department of Graduate Studies, School of Nursing, University of Alabama, Birmingham 35294-1210, USA
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Khastgir G, Studd J, Catalan J. Is there a hormonal basis to hysterectomy-related depression? BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1999; 106:620-2. [PMID: 10428514 DOI: 10.1111/j.1471-0528.1999.tb08357.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G Khastgir
- Department of Obstetrics and Gynaecology, Imperial College School of Medicine, Chelsea and Westminster Hospital, London
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37
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Stabinsky SA, Einstein M, Breen JL. Modern treatments of menorrhagia attributable to dysfunctional uterine bleeding. Obstet Gynecol Surv 1999; 54:61-72. [PMID: 9891301 DOI: 10.1097/00006254-199901000-00025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Menorrhagia (excessive uterine bleeding) affects some 20 percent of the women of reproductive age worldwide. The following review describes known and theorized etiologies of the disorder, followed by a discussion of treatment options that are currently in use as well as those on the horizon. There is much interest internationally in decreasing hysterectomy rates, particularly for those women with abnormal bleeding and anatomically normal uteri. It is these women who are the focus of this paper. Pharmacotherapy and surgery are the mainstay treatments for such patients with menorrhagia secondary to dysfunctional uterine bleeding. Most commonly, hormonal and nonhormonal medications are followed by dilatation and curettage, and ultimately, in many cases, hysterectomy. Endometrial ablation techniques have been evolving since the 1980s in response to the need for an efficacious, safer, and more cost-effective alternatives to hysterectomy. Hysteroscopic ablation achieves these goals but is difficult technically and requires significant additional training even for otherwise skilled and experienced gynecologists. The current decade has seen the development of many innovative approaches to performing endometrial ablation. These methods are intended to be much simpler to perform with less risk than electrosurgical or laser endometrial ablation. The final section of this article presents the published data to date on these new technologies, which should (in their refined state) revolutionize the treatment of menorrhagia secondary to dysfunctional uterine bleeding.
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Abstract
AbstractObjectives: The aims of the audit were to monitor the activities of the liaison clinic over a 12 month period, to establish the number of attenders and non-attenders and to evaluate whether the service was meeting the needs of patients with perinatal disorders.Method: The Coombe Women's Hospital is one of three maternity hospitals in Dublin and had 6,452 deliveries and 5,273 inpatient gynaecological procedures performed in 1994. The charts of all the patients who were given an appointment for the psychiatric clinic between January 1 and December 31, 1994 were reviewed.Results: Fifty-six patients attended the clinic over the 12 month period, 38(68%) of whom were new referrals to the service. Twenty-two patients were antenatal, 20 were postnatal and 14 patients were attending the gynaecology department. Seventeen patients (30%) who were referred to the clinic failed to attend for their first appointment. Forty-one (73%) patients had sufficient symptomatology to make an ICD-10 diagnosis. Medication was prescribed for 58% of those who attended. Four patients were referred to their catchment area service for inpatient care: six patients were referred to their catchment area service for further outpatient care as they had psychiatric illnesses which predated their pregnancies.Conclusions: The number of patients referred to the liaison service with postnatal depression is remarkably less than that anticipated and there is a high rate of defaulting among first attenders. Various recommendations are made to improve the effectiveness of the service.
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Marchant-Haycox S, Liu D, Nicholas N, Salmon P. Patients' expectations of outcome of hysterectomy and alternative treatments for menstrual problems. J Behav Med 1998; 21:283-97. [PMID: 9642573 DOI: 10.1023/a:1018721117588] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patients can influence treatment to the extent of securing surgery in the absence of medical need, but their expectations of effects of surgery are poorly understood. Interviews with 26 patients presenting menstrual problems without confirmed pathology were used to construct a questionnaire to measure expectations of effects of treatment. Principal-components analysis of responses of 200 similar patients identified six discrete areas in which improvement was expected, including general well-being, menstrual function, and physical symptoms. Expectations of harm were nonspecific and unidimensional. Component-based scale scores showed that patients who anticipated hysterectomy expected more benefit, but also more harm, than those anticipating conservative procedures. In study 2, these different expectations were largely replicated in patients who were randomly allocated to provide their expectations of specific procedures. Patients' uniquely positive expectations of hysterectomy may help to explain its frequent use in the absence of pathology.
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Abstract
Older persons are the fastest growing segment of the American population, and older women significantly outnumber men. The health status of older women is influenced by disease and psychosocial factors. Comprehensive geriatric assessment is a tool which takes into account the many aspects of health and provides a framework for developing individualized goals of care. Cardiovascular disease, osteoporosis, hormonal treatment, urinary incontinence, mental health, sexuality, substance abuse, cancer and exercise are discussed.
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Affiliation(s)
- E L Cobbs
- Health Care Sciences, George Washington University, Washington, DC, USA
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41
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Abstract
Hysterectomy is a popular operation that has a number of complications associated with it. The most common are hemorrhage, infection, and injuries to adjacent organs. Unintended major surgical procedures and second operations occur in approximately 4% of patients undergoing hysterectomy. Laparoscopic hysterectomy is a controversial new procedure that has both advocates and detractors. In skilled hands, the complication rate of laparoscopic hysterectomy does not exceed that of traditional hysterectomy methods. At the present time, there is a growing consensus that removal of the uterus only does not lead to an increase in psychosexual morbidity. It also appears that hysterectomy procedures have little, if any, effect on lower urinary tract function.
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Affiliation(s)
- W J Harris
- East Tennessee State University, Quillen College of Medicine, Johnson City, USA
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Affiliation(s)
- M J Naughton
- Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, USA.
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Lambden MP, Bellamy G, Ogburn-Russell L, Preece CK, Moore S, Pepin T, Croop J, Culbert G. Women's sense of well-being before and after hysterectomy. J Obstet Gynecol Neonatal Nurs 1997; 26:540-8. [PMID: 9313184 DOI: 10.1111/j.1552-6909.1997.tb02157.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To describe women's perceived sense of well-being before and after hysterectomy by examining a broad array of outcomes experienced by women undergoing hysterectomies for benign conditions. DESIGN Prospective, descriptive. SETTING A regional tertiary care facility in central Texas. PARTICIPANTS One hundred seventy-eight women presenting for hysterectomies for nononcologic reasons who completed all three periods of data collection. MAIN OUTCOME MEASURES Subjects completed a questionnaire assessing information pertinent to their current gynecologic health and the SF-36 Health Survey before surgery and of 4 and 11 months after surgery. The women also completed the Zung Self-Rating Depression Scale preoperatively and at 4 months postoperatively. Additional demographic and medical information was extracted from the medical record. RESULTS In the initial period after surgery, the patients experienced an improved health status. In addition, the women reported on improvement in their psychologic well-being, including less depression and improved sexual functioning. Relationships with others also improved after the surgery. CONCLUSIONS Outcomes for these women undergoing hysterectomy for nononcologic reasons were generally positive. This information is vital for preoperative counseling by nurses of women contemplating or about to undergo this surgery.
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Affiliation(s)
- M P Lambden
- Children's Health Center, Scott and White Clinic, Temple, TX 76508, USA
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44
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Ryan MM. Hysterectomy: social and psychosexual aspects. BAILLIERE'S CLINICAL OBSTETRICS AND GYNAECOLOGY 1997; 11:23-36. [PMID: 9155934 DOI: 10.1016/s0950-3552(97)80048-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Studies of the psychological and sexual outcome of hysterectomy have often arrived at conflicting conclusions and this has resulted in some confusion among health professionals as well as among women themselves. This situation should cause concern, since the incidence of this surgery is high in most countries of the western world. The confusion about outcome arises out of the methodological problems that plagued earlier research. Some of the more recent studies using prospective design, standardized measures and appropriate statistical analysis have not implicated hysterectomy with increased psychological or sexual disorders. However, both before and after hysterectomy in samples studied, the rate of psychological disorder was higher than would have been expected in a normal population, although a clearer picture has emerged from the most recent study. In this paper, risk factors are identified, and the need to include women's own evaluation of the procedure is emphasized.
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Affiliation(s)
- M M Ryan
- Royal Australian College of Obstetricians and Gynaecologists, East Melbourne, Victoria, Australia
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Thornton EW, McQueen C, Rosser R, Kneale T, Dixon K. A prospective study of changes in negative mood states of women undergoing surgical hysterectomy: the relationship to cognitive predisposition and familial support. J Psychosom Obstet Gynaecol 1997; 18:22-30. [PMID: 9138203 DOI: 10.3109/01674829709085565] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Levels of anxiety and depression were documented by questionnaire response from a sample of 89 women who were to undergo surgical hysterectomy 3 weeks later. Fifty-four per cent (n = 48) of the sample reported anxiety and 26% (n = 23) reported depression at clinical levels during the preoperative period, with an additional number (n = 16 anxiety; n = 19 depression) at borderline status. Despite an overall significant postoperative reduction of negative mood states, clinical levels of anxiety were found in a substantial minority of women both 2 (24%) and 6 months (31%) after surgery. Levels of depression at these times were respectively 13% and 11% of the sample which provided postoperative information. These data confirm previous reports of high levels of negative mood states in patients referred for surgical hysterectomy. However, analyses of individual profiles of change confirm that there was a beneficial outcome for the large majority of the women, with 83% of those with clinical levels of anxiety showing improved status. Regression analyses indicated that postoperative outcomes with respect to negative affect could be predicted from preoperative status, and the data provide some support for the hypothesis that for a minority of women, negative mood states co-presented with gynecological symptoms may not be attenuated by surgery. Both dispositional resilience and familial cohesiveness were entered as significant variables in regression models examining postoperative status, although they provided only a limited increase to the postoperative variance prediction from measure of preoperative levels of affect. Preoperative mood status was found to be inversely related to an intrapersonal dimension of 'dispositional resilience' and to 'family cohesiveness'. It is suggested that measurement of preoperative mood status to family cohesiveness and dispositional resilience may provide useful adjunctive measures in attempts to identify women at risk of reporting an unsatisfactory surgical outcome.
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Affiliation(s)
- E W Thornton
- Department of Psychology, University of Liverpool, UK
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Alexander DA, Naji AA, Pinion SB, Mollison J, Kitchener HC, Parkin DE, Abramovich DR, Russell IT. Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects. BMJ (CLINICAL RESEARCH ED.) 1996; 312:280-4. [PMID: 8611783 PMCID: PMC2349907 DOI: 10.1136/bmj.312.7026.280] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To compare in psychiatric and psychosocial terms the outcome of hysterectomy and endometrial ablation for the treatment of dysfunctional uterine bleeding. DESIGN Prospective randomised controlled trial. SETTING--Obstetrics and gynaecology department of a large teaching hospital. SUBJECTS 204 women with dysfunctional bleeding for whom hysterectomy would have been the preferred treatment were recruited over 24 months and randomly allocated to hysterectomy (99 women) or to hysteroscopic surgery (transcervical resection (52 women) or laser ablation (53 women). MAIN OUTCOME MEASURES Mental state, martial relationship, psychosocial and sexual adjustment in assessments conducted before the operation and one month, six months, and 12 months later. RESULTS Both treatments significantly reduced the anxiety and depression present before the operation, and there were no differences in mental health between the groups at 12 months. Hysterectomy did not lead to postoperative psychiatric illness. Sexual interest after the operation did not vary with treatment. Overall, 46 out of 185 (25%) women reported a loss sexual interest and 50 out of 185 (27%) reported increased sexual interest. Marital relationships were unaffected by surgery. Personality and duration of dysfunctional uterine bleeding played no significant part in determining outcome. CONCLUSIONS Hysteroscopic surgery and hysterectomy have a similar effect on psychiatric and psychosocial outcomes. There is no evidence that hysterectomy leads to postoperative psychiatric illness.
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Affiliation(s)
- D A Alexander
- Department of Mental Health, Medical School, University of Aberdeen
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Abstract
What is the prevalence of premenstrual tension (PMT) among women who have no uterus? Three hundred and seventeen hysterectomized women aged 28-45 years, were asked to describe their health before and after surgery. Most of the women (88%) felt that their general health improved postoperatively. There was a significant reduction in the percentage of women reporting moderate to severe PMT in all or almost all cycles: pre- versus post-hysterectomy, 56.1 versus 18.9; p < 0.001. Of the 178 women who considered PMT to have been a regular feature of their prehysterectomy menstrual cycles, 73% either lost their symptoms after surgery or felt that they were now minimal. It is concluded that the prevalence of PMT among hysterectomized women is low compared with that among women who have a uterus.
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Affiliation(s)
- V Braiden
- Medical Research Council of New Zealand
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48
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Clarke A, Black N, Rowe P, Mott S, Howle K. Indications for and outcome of total abdominal hysterectomy for benign disease: a prospective cohort study. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1995; 102:611-20. [PMID: 7654638 DOI: 10.1111/j.1471-0528.1995.tb11398.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To describe the indications for total abdominal hysterectomy for women with nonmalignant disease and to determine the immediate (initial ten days) and medium term outcome. DESIGN A prospective cohort study. SETTING Three district general hospitals in shire counties, two in outer London and one London teaching hospital. SUBJECTS Three hundred and sixty-six women undergoing total abdominal hysterectomy (with or without other procedures) for nonmalignant disease. INTERVENTIONS Self-completed patient questionnaires before and ten days, six weeks and three months after surgery. Data extracted from patients' hospital case notes. MAIN OUTCOME MEASURES Complications plus change in symptoms, urinary and bowel function, general health status, sexual function, activities of daily living and quality of life. RESULTS The principal indications were bleeding, pain or both. Symptoms were severe enough to be socially debilitating and have a major impact on lifestyle. Otherwise, the women were in good health. During the first ten post-operative days the women suffered more pain, urinary discomfort, constipation and a reduction in their ability to perform activities of daily living. Urinary (25%) and wound (25%) infections were the commonest complications. At the same time, significant improvements in psychological health occurred. By six weeks, the principal symptoms had resolved for 95% of the women and early adverse effects on urinary and bowel function had settled. This was reflected in improvements in health status and quality of life including sexual activity. Despite this, these changes did not meet the pre-operative expectations of some women. CONCLUSIONS Most women reported substantial benefits from hysterectomy. However, women should be warned about early, transient adverse effects. These findings can serve as a benchmark for nonexperimental evaluations of the effectiveness of new treatment modalities.
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Affiliation(s)
- A Clarke
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
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Abstract
Women who undergo a hysterectomy typically experience preoperative symptoms that severely affect quality of life. The purpose of this study was to understand the hysterectomy experience from the informants' perspective. The research design chosen was ethnography. Research aims included (a) describing the quality of life before hysterectomy, (b) understanding the decision-making process involved in having a hysterectomy, (c) describing the knowledge base women have about hysterectomies, (d) describing concerns and fears about hysterectomies, (e) making comparisons before and 3 months after the hysterectomy, and (f) discovering what advice women give each other about hysterectomies. Ethnographic interviews were conducted and analyzed according to the Spradley method. The informants provided researchers with valuable advice for professionals caring for women who elect to undergo a hysterectomy.
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50
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Abstract
Alternatives to endometrial ablation include re-education of the 20% or more women complaining of menorrhagia whose blood loss is normal, less than 35 ml, and the use of an increasing variety of drugs to find an effective regime with minimal side effects. Endometrial resection is an effective treatment, particularly in the short term. Laparoscopic and vaginal hysterectomy have advantages over endometrial resection in the long term, avoiding failure and retreatment for menorrhagia. Hysteroscopic, laparoscopic and open myomectomy are more suitable in treating fibroids of significant size, although these techniques may be used with endometrial resection to avoid hysterectomy. Myoma reduction may become a less morbid alternative to myomectomy.
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Affiliation(s)
- C Wood
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
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