Psychiatric disorders may be linked to unnecessary oophorectomies

Study identifies multiple mental health conditions associated with an increased risk of unnecessary bilateral oophorectomies, despite nonmalignant indications

Undergoing a hysterectomy, especially in conjunction with removal of the ovaries, can take a major toll on a woman's mental health. A new study, however, turns the tables on this relationship and investigates the psychiatric symptoms that may prompt a woman to undergo an oophorectomy, even after confirmation of a nonmalignant diagnosis. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

Although multiple studies have previously been conducted to investigate the effects of hysterectomy with or without concurrent bilateral oophorectomy on mental health outcomes, this new study out of the Mayo Clinic is the first to identify psychiatric conditions before a bilateral oophorectomy. The Mayo Clinic's efforts in this area date back to 2016 when it reported study results that showed a higher frequency of depression, anxiety, and substance abuse occurring before the date of bilateral oophorectomy compared with controls. In 2017, the Mayo Clinic additionally reported an association between adverse childhood or adult experiences and the risk of bilateral oophorectomy.

In this latest study, researchers sought to determine whether various psychiatric symptoms directly or indirectly influence a woman's decision to undergo an oophorectomy, even if there were no threat of malignancy. The researchers identified several psychiatric conditions that were associated with an increased risk of undergoing surgery. These included mood disorders, bipolar disorders, anxiety disorders, schizophrenia, personality disorders, dissociative disorders, and somatoform disorders, among others. Although mood and anxiety disorders were the most frequently cited, somatoform and personality disorders proved to have the greatest association.

Given the increased desire throughout the medical industry to develop more conservative treatment and prevention strategies in the future, the study's researchers believe that these results provide valuable insight regarding the relationship between mental health and gynecologic health and how addressing certain emotional issues could lead to alternative, nonsurgical treatment plans.

Abstract

OBJECTIVE:

We studied eight mental health conditions diagnosed before bilateral oophorectomy performed for nonmalignant indications.

METHODS:

We identified 1,653 premenopausal women who underwent bilateral oophorectomy for a nonmalignant indication in Olmsted County, Minnesota, during a 20-year period (1988-2007). Each woman was matched by age (±1 year) to one population-based control who had not undergone bilateral oophorectomy before the index date (age range: 21-49 years). Both cases and controls were identified using the records-linkage system of the Rochester Epidemiology Project. For eight mental health conditions, we calculated odds ratios (ORs) and their 95% confidence intervals (95% CIs) adjusted for race, education, and income using conditional logistic regression.

RESULTS:

Pre-existing mood disorders, anxiety disorders, and somatoform disorders were associated with increased risk of bilateral oophorectomy in overall analyses. These associations were also significant in women ≤45 years of age at index date. Personality disorders were associated with increased risk only in overall analyses and adjustment disorders only in women 46 to 49 years of age. Some of the associations were significantly different across strata by age at index date and by indication. There was also a linear trend of increasing adjusted ORs from 1.55 (95% CI 1.31-1.83) for one mental health condition to 2.19 (95% CI 1.40-3.41) for three or more conditions (trend P < 0.001).

CONCLUSIONS:

We identified several mental health conditions that were associated with bilateral oophorectomy for nonmalignant indications. Awareness of these associations may guide women and physicians in future decision-making and limit unindicated bilateral oophorectomies. 

Reference

Gazzuola Rocca L, Smith CY, Bobo WV3, Grossardt BR, Stewart EA, Laughlin-Tommaso SK, Rocca WA.  Mental health conditions diagnosed before bilateral oophorectomy: a population-basedcase-control study. Menopause. 2019 Aug 30. doi: 10.1097/GME.0000000000001413. [Epub ahead of print] 

Content created 25 September 2019