Hysterectomy and loss of fertility: implications for women's mental health.
OBJECTIVE
The objective of this study was to assess the percentage of women scheduled for hysterectomy who would have liked to have had a child or more children and associated factors.


METHODS
The study sample included 1140 premenopausal women having hysterectomy for benign indications who were interviewed before and after their surgery over the course of a 2-year follow-up period. The main outcome measures for this study were desire for a (or another) child measured preoperatively; concurrent measures of psychological distress, including anxiety, depression, anger, and confusion, and seeking of professional help for emotional problems; and psychological distress measured 12 and 24 months postoperatively.


RESULTS
Of the sample, 10.5% (n=120) answered yes to the question, "Before you were told you needed a hysterectomy, would you have wanted a (or another) child?" As compared with those who did not, those who desired a (another) child were younger; more likely to be nulliparous; waited longer before having surgery; were more likely to have an indication of endometriosis; had higher levels of depression, anxiety, anger, and confusion; and were more than twice as likely to have seen a mental health professional for anxiety or depression in the 3 months before their surgery. These differences in psychological distress persisted over the course of the 2-year follow-up period.


CONCLUSIONS
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.
Leppert
Phyllis C
PC
Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA.
Legro
Richard S
RS
Kjerulff
Kristen H
KH
D000223:Adaptation, Psychological; D000328:Adult; D000342:Affective Symptoms / Q000175:diagnosis / Q000523:psychology*; D000786:Anger; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D003221:Confusion / Q000175:diagnosis / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005298:Fertility; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000523:psychology*; D007247:Infertility, Female / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology; D017699:Pelvic Pain / Q000523:psychology; D011183:Postoperative Complications / Q000523:psychology*; D014591:Uterine Diseases / Q000523:psychology / Q000601:surgery*