The surgical removal of an individual’s uterus, known as a hysterectomy, is associated with an increased long-term risk of mental health problems— especially depression and anxiety, according to a study published in Menopause: The Journal of the North American Menopause Society.
While a cause for the link hasn’t been uncovered yet, the study’s findings could help women decide whether to opt for a hysterectomy — the second most common gynecological procedure globally — in cases where other medical alternatives are also possible.
The researchers reviewed health records logged between 1980 to 2002 of women who underwent hysterectomies, but not removal of their ovaries. Only new diagnoses of depression, anxiety, schizophrenia, dementia, and substance abuse post-hysterectomy were included. Researchers found an approximately 7% increase for depression and approximately 5% increase for anxiety among the women. They also found an even greater risk of depression — a 12% increase — for women who underwent hysterectomies between the ages 18 and 35.
Hysterectomies are often recommended by gynecologists to treat uterine fibroids, endometriosis, pelvic support problems (like uterine prolapse), abnormal uterine bleeding, chronic pelvic pain, and gynecologic cancer, according to the American College of Gynaecologists. Hysterectomies can involve the removal of a) only the uterus, b) the uterus and the cervix, and c) the uterus, cervix and the ovaries.
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According to the Indian Journal of Medical Ethics, hysterectomies are major surgeries with a mortality rate of one to two deaths per 1000 operations, and an even higher complication rate; 3-5% of hysterectomy patients require the later removal of their ovaries due to post-hysterectomy complications, as part of the blood supply to the ovaries is through the uterine artery.
In India, the prevalence of hysterectomies is also unusually high — 3.2% of women between 15 and 49 years, and 3.6% of women between 30 and 39 have had a hysterectomy, according to the fourth National Family Health Survey. India also has a history of unwarranted hysterectomies amongst young, poor women — a recent example is Maharashtra’s Beed district, where contractors were unwilling to hire women who menstruate, thus leading to women seeking out hysterectomies to be employable.
“Our study shows that removing the uterus may have more effect on physical and mental health than previously thought,” says Dr. Shannon Laughlin-Tommaso, co-author of the study and a Mayo Clinic OB-GYN, in a statement.
Laughlin-Tommaso added, “Because women often get a hysterectomy at a young age, knowing the risks associated with the procedure even years later is important.” She also stated that several other treatments for benign gynecological conditions, such aspelvic inflammatory disease and endometriosis, should take precedence over hysterectomies. “Those alternatives should be tried before going to hysterectomy, especially [for patients] at a young age.”
