Mental health conditions diagnosed before bilateral oophorectomy: a population-based case-control study.

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 (REP http://www.rochesterproject.org). 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. VIDEO SUMMARY:: http://links.lww.com/MENO/A458.

A longitudinal investigation of psychological disorders in patients prior and subsequent to a diagnosis of ovarian cancer.

This longitudinal study investigated levels of anxiety and depression in women who underwent clinical investigations to diagnose a possible ovarian cancer. Women completed the Hospital Anxiety and Depression Scale (HADS), prior to clinical investigations (Time 1), after receiving diagnostic results (Time 2) and at 3 months follow-up (Time 3). Thirty women completed the assessments at Time 1 and Time 2, and 22 women were re-assessed at Time 3. The majority of the sample (56%) scored as a case of anxiety prior to clinical investigations. A significant decrease in anxiety and depression across time was found. Levels of anxiety and depression between women with a subsequent cancer diagnosis and women with a benign result were not significantly different. This study showed that clinical investigations are a highly anxiety-provoking event. In addition, the diagnosis of cancer did not significantly elevate or maintain levels of anxiety and depression compared to a benign diagnosis.

Depressive symptoms among young breast cancer survivors: the importance of reproductive concerns.

Breast cancer diagnosis and treatment can negatively impact fertility in premenopausal women and influence reproductive planning. This study investigates whether concerns about reproduction after breast cancer treatment were associated with long-term depressive symptoms. Participants include 131 women diagnosed with early-stage breast cancer at age 40 or younger participating in the Women's Healthy Eating and Living (WHEL) Survivorship Study. Participants were enrolled an average of 1.5 years postdiagnosis and depressive symptoms were monitored 6 times throughout the average additional 10 year follow-up period. Detailed recall of reproductive concerns after treatment was collected an average of 12 years postdiagnosis. Multilevel regression was used to evaluate whether mean long-term depressive symptoms differed as a function of reproductive concerns and significant covariates. Multilevel regression identified greater recalled reproductive concerns as an independent predictor of consistent depressive symptoms after controlling for both social support and physical health (B = 0.02, SE = 0.01, P = 0.04). In bivariate analyses, being nulliparous at diagnosis and reporting treatment-related ovarian damage were both strongly associated with higher reproductive concerns and with depressive symptoms. Reported reproductive concerns after breast cancer treatment were a significant contributor to consistent depressive symptoms. Younger survivors would benefit from additional information and support related to reproductive issues.

Hysterectomy and women satisfaction: total versus subtotal technique.

INTRODUCTION: The impact of different surgical procedures on women's satisfaction after hysterectomy is a topical issue. The aim of this study was to investigate the impact of sub-total and total hysterectomy on women's satisfaction, evaluated with questionnaire assessment of sexual activity, body image, and health status. MATERIALS AND METHODS: A prospective, randomized, non-blind study was conducted. In the study period of 3 years, 105 women were enrolled and completed the questionnaires [EuroQol (EQ-5D), body image scale (BIS), sexual activity questionnaire] 2 weeks before and 1 year after surgery. RESULTS: Both total and sub-total hysterectomy resulted with improvements in the women's sexual satisfaction (1 year after surgery), but no statistically significant differences were reached between the two groups. A highly significant difference (P < 0.001) in the perception of the body image between total and sub-total hysterectomy, at 1 year after surgery, was underlined. The health-related quality of life resulted significantly better in the "sub-total hysterectomy" group 1 year after surgery (P < 0.05). CONCLUSION: Considering these results, why should a total hysterectomy be performed, if the women's satisfaction seems to be higher using the sub-total technique? In our opinion, the woman undergoing hysterectomy for benign conditions must be counseled regarding the differences between the two techniques and, when possible, a choice must be offered to the woman.

Consequences and treatment of ovarian failure after total body irradiation for leukaemia.

OBJECTIVE: To assess the incidence and severity of physical and psychosexual symptoms in young women due to ovarian failure caused by total body irradiation for leukaemia and the women's response to hormone treatment. DESIGN: Postal questionnaire and interview. SETTING: Leukaemia unit of oncology hospital. PATIENTS: Consecutive series of 46 English speaking women who had developed ovarian failure after total body irradiation and bone marrow transplantation as treatment for leukaemia. RESULTS: Of the 36 responders, 33 reported some symptoms, vaginal dryness being the most common (29). This profoundly affected sexual function. Although 22 women had had sexual intercourse within six months after treatment, 16 were less interested in and 18 experienced difficulties with sexual intercourse. Anxieties about sterility, femininity, and appearance were common and reduced self confidence. Almost half reported that they had changed their social habits and restricted their social activities. Treatment seemed effective in abolishing symptoms in 24 women, but vaginal dryness remained a problem in three. Two women failed to respond and intercourse remained impossible. CONCLUSIONS: Such patients are vulnerable and access to gynaecologists and endocrinologists soon after treatment would be valuable. The optimal treatment regimen and the long term benefits of treatment have yet to be established.

[Comparative multidimensional analysis of the personality traits of patients with different forms of gynecologic pathology]. / Sravnitel'nyi mnogomernyi analiz lichnostnykh osobennostei bol'nykh s raznymi formami ginekologicheskoi patologii.

The personality characteristics of gynecological patients with hormonal dysfunction versus hormone dependent pathology were compared, using a factorial analysis of answers to 377 questions of the Russian modified variant of MMPI and a cluster analysis of intergroup subdivisions. A group of patients with uterine myoma (UM) differed considerably from all the others in relation to six "varimax" factors. A new factor scale was elaborated which makes it possible to differentiate a group of patients with UM from both healthy women and other gynecological patients. The results obtained are discussed in the light of the hypothesis about the psychosomatic nature of UM. The factor scale presented may be utilized for detecting a group of high risk for UM development.