From the Guidelines
A hysterectomy does not directly cause mental health problems in women, though some women may experience emotional changes following the procedure. Research shows that most women who have hysterectomies for benign conditions actually report improved mental health and quality of life afterward 1. However, some women may experience temporary mood changes due to hormonal fluctuations, especially if the ovaries are removed (oophorectomy) along with the uterus, which can trigger surgical menopause. Symptoms might include mood swings, anxiety, or depression.
Key Considerations
- Women with pre-existing mental health conditions may be more vulnerable to emotional difficulties after surgery.
- The psychological response to hysterectomy varies widely among individuals and depends on many factors including age, reason for surgery, support systems, and pre-existing mental health.
- If you're experiencing persistent mental health issues following a hysterectomy, it's essential to speak with your healthcare provider.
Treatment Options
- Hormone replacement therapy if your ovaries were removed, as it has a more beneficial risk/benefit profile for women who have had a hysterectomy 1.
- Counseling, or in some cases, antidepressant medications.
- Non-pharmacological approaches such as cognitive-based therapy, yoga, acupuncture, or auriculotherapy may also be beneficial for managing menopausal symptoms and improving mental health 1.
From the Research
Mental Health Outcomes After Hysterectomy
- The relationship between hysterectomy and mental health outcomes in women is complex and has been studied extensively 2, 3, 4, 5, 6.
- A systematic review and meta-analysis found that hysterectomy was associated with a decreased risk of clinically relevant depression, but no significant association with anxiety 2.
- Another study found that the majority of retrospective studies reported an adverse psychological outcome after hysterectomy, but prospective studies showed that the incidence of depressed mood is higher even before hysterectomy 3.
- A study on the effect of psychological care on women who underwent hysterectomy found that psychological care decreased anxiety and increased positive body perception 4.
- A study on the implications of hysterectomy on women's mental health found that women who desired a child or more children before hysterectomy had higher levels of depression, anxiety, anger, and confusion 5.
- A cohort study found that women who underwent hysterectomy with ovarian conservation had an increased long-term risk of de novo depression and anxiety, especially when performed in women who are younger 6.
Factors Influencing Mental Health Outcomes
- Age at hysterectomy: younger age at hysterectomy is associated with an increased risk of de novo depression and anxiety 6.
- Desire for a child or more children: women who desired a child or more children before hysterectomy had higher levels of depression, anxiety, anger, and confusion 5.
- Indication for hysterectomy: the association between hysterectomy and mental health outcomes did not vary significantly by indication 6.
- Psychological care: psychological care given to women before and after hysterectomy can decrease anxiety and increase positive body perception 4.
Implications for Clinical Practice
- Psychological care should be part of routine nursing care for women undergoing hysterectomies 4.
- The issue of loss of fertility should be discussed candidly with women considering hysterectomy, and those who express ambivalence, sadness, or regret at the loss of future childbearing options may benefit from further exploration of fertility-sparing treatments 5.
- Women who undergo hysterectomy should be monitored for de novo mental health conditions, especially depression and anxiety 6.