Original articleHysterectomy and loss of fertility: Implications for women's mental health
Introduction
Hysterectomy is one of the most commonly performed operative procedures in the industrialized world and occurs most frequently during the childbearing years [1], [2]. Because hysterectomy is usually an elective procedure performed as treatment for symptoms associated with benign gynecologic disorders, it is generally assumed that premenopausal women having hysterectomy have completed childbearing and are reconciled to the loss of fertility that hysterectomy entails. However, in a recent 3-year prospective study, 6% of premenopausal women having hysterectomy for benign indications indicated regret at their loss of fertility before surgery that increased after surgery, reaching a peak of 30% 2 years after hysterectomy [3]. Unfortunately, we know very little about the psychological impact of regret at loss of fertility as a result of this surgical procedure. In contrast, there are numerous studies on women's sadness and regret at the loss of fertility after bilateral tubal ligation [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]. These two life situations are not identical as one involves a conscious decision on the part of the woman and her partner to limit childbearing, whereas the other involves sterility that is the consequence of treatment for a disease. In addition, unlike tubal sterilization, hysterectomy is irreversible. Several studies found that hysterectomy improves quality of life and decreases psychiatric symptoms among women overall [16], [17], [18], [19]. However, those studies did not specifically address the issue of psychological repercussions of loss of fertility. Thus, physicians and their patients cannot rely on information obtained from studies on sadness and regret after tubal ligation or on quality-of-life studies after hysterectomy as a guide for assessing the emotional impact of the loss of fertility as a result of hysterectomy on an individual woman and her family. Despite the frequency of hysterectomy in the United States and in countries throughout the world, we know little about the psychological correlates of regret of loss of fertility among premenopausal women having hysterectomy or how such regret may affect long-term psychological functioning after surgery.
As part of a large-scale, longitudinal, and prospective study on the outcomes and effectiveness of hysterectomy, we asked women about their childbearing desires before surgery and measured psychological functioning before and after surgery over the course of a 2-year follow-up period. This provided a unique opportunity to measure desire for further childbearing among premenopausal women having hysterectomy for benign indications and to assess the concurrent and long-term psychological correlates of this desire.
Section snippets
Methods
We analyzed the responses of more than 1000 premenopausal women to specific questions pertaining to their desire for a (another) child. Women were interviewed in person in their homes shortly before undergoing hysterectomy. Responses were analyzed in relation to a variety of factors such as age, race, and number of children, education, income, and measures of mental health as measured by the Profile of Mood States (POMS) [20]. The objectives of our analysis were to determine the variables most
Results
In response to the question, “Before you were told that you needed a hysterectomy, would you have wanted a (another) child?,” 120 women (10.5%) responded yes, 980 (86.0%) responded no, 40 (3.5%) responded maybe, and 11 women said they did not know (counted as missing data).
The women who answered yes and maybe in response to the question, “Before you were told that you needed a hysterectomy, would you have wanted a (another) child?,” were younger than those who said no, as shown in Table 1.
Discussion
In this study, we found that among women of childbearing age having hysterectomy, 14% indicated that they either definitely or perhaps would have liked to have had a child or more children. In addition, these women were significantly younger and more likely to be nulliparous and psychologically distressed at the time of hysterectomy as compared with those who were certain that they did not want a child or more children. These results are consistent with those of research publications that
Acknowledgments
This research was supported by grant HS0685 from the Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD, USA, and the Intramural Research Program of the Reproductive and Biology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
References (31)
- et al.
A prospective study of 3 years of outcomes after hysterectomy with and without oophorectomy
Am J Obstet Gynecol
(2006) - et al.
Risk factors for tubal sterilization regret, detectable before surgery
Contraception
(1996) - et al.
Psychosexual adjustment following sterilization: a prospective study on Chinese women
J Psychosom Res
(1997) - et al.
Requesting information about and obtaining reversal after tubal sterilization: findings from the US Collaborative Review of Sterilization
Fertil Steril
(2000) - et al.
Risk factor for tubal ligation: regret and psychological effects. Impact of Beck Depression Inventory
Contraception
(2005) Menopausal symptoms and psychological distress in women with and without tubal sterilization
Psychosomatics
(2004)- et al.
Effectiveness of hysterectomy
Obstet Gynecol
(2000) Subfecundity and anxiety in a nationally representative sample
Soc Sci Med
(2003)- et al.
Pregnancy outcomes after treatment for fibromyomata: uterine artery embolization versus laparoscopic myomectomy
Am J Obstet Gynecol
(2004) - et al.
Patient satisfaction and disease specific quality of life after uterine artery embolization
Am J Obstet Gynecol
(2004)