The psychological outcome of hysterectomy

The objective of this study is to review the published literature on psycho logical outcome of hysterectomy and oophorectomy for non-malignant indicati ons. 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 se arches of the relevant references in the literature identified by the elect ronic search. The published studies on the psychological outcome of hystere ctomy have been selected to identify the incidence, possible causes and ris k 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 adv erse psychological outcome after hysterectomy. However, all prospective stu dies showed that the incidence of depressed mood is higher even before hyst erectomy, owing to pre-existing psychiatric illness and personality and psy chosocial problems, as a result of the emotional response to gynecological symptoms or as a manifestation of associated ovarian failure. Hence, the th erapeutic effects of hysterectomy include improvement of mood in some but n ot all patients, unless proper case selection, psychiatric evaluation and p reoperative counselling are arranged. An early detection of ovarian failure after hysterectomy, the initiation of hormone replacement therapy (HRT) im mediately after surgery in perimenopausal women and in those undergoing oop horectomy, as well as regular follow-ups to ensure long-term compliance wit h HRT, would also improve the psychological outcome. In conclusion hysterectomy itself is not the cause of any adverse psycholog ical outcome. Psychological symptoms actually improve in the majority of wo men, with the relief of distressing gynecological symptoms and the correcti on of ovarian hormone deficiency, but hysterectomy may not be of any benefi t in women with prior psychiatric illness and those with personality and ps ychosocial problems.