Iles S, Gath D
Baillieres Clin Obstet Gynaecol. 1989 Jun;3(2):375-89. doi: 10.1016/s0950-3552(89)80028-8.
Gynaecological complaints are often associated with psychiatric disorder. Women with psychiatric disorder are more likely to complain of excessive uterine bleeding than women without psychiatric disorder. When a woman complains of menorrhagia, yet also has a psychiatric disorder, it is important to establish which is the primary problem. If menorrhagia is primary, then any associated psychiatric disorder may be secondary to distress and fear caused by excessive menstruation. If the psychiatric disorder is primary, then psychological distress may lead a women to complain about her usual menstrual pattern or minor changes in it. If the complaint of excessive menstruation is secondary to psychiatric disorder, surgical or medical treatment of this complaint may not be justified. If the gynaecologist is to make the important distinction between complaints of menorrhagia which are primary and those which are secondary to psychiatric disorder, then he/she needs to be able to detect and assess psychiatric disorder in women who present with complaints of excessive uterine bleeding. Recent research has provided information about the relationship between the surgical treatment of menorrhagia and psychiatric disorder. Hysterectomy for menorrhagia seems to alleviate psychiatric disorder in many women who had psychiatric disorder before operation. The operation rarely induces psychiatric disorder in women who are psychiatrically well before surgery. There is no association between psychiatric disorder either before or after hysterectomy for menorrhagia and the presence of absence of demonstrable pelvic pathology. There is no evidence that those women who overestimate their menstrual blood loss have an increased likelihood of being psychiatrically disturbed after hysterectomy. However, an important determinant of psychiatric outcome after hysterectomy for menorrhagia is preoperative psychiatric status--for example, mental state before surgery, previous psychiatric history and neuroticism.
妇科疾病常常与精神障碍相关。患有精神障碍的女性比没有精神障碍的女性更有可能主诉子宫出血过多。当一名女性主诉月经过多，同时又患有精神障碍时，确定哪个是主要问题很重要。如果月经过多是主要问题，那么任何相关的精神障碍可能继发于月经过多所引起的痛苦和恐惧。如果精神障碍是主要问题，那么心理困扰可能导致女性抱怨其通常的月经模式或其中的微小变化。如果月经过多的主诉继发于精神障碍，对该主诉进行手术或药物治疗可能不合理。如果妇科医生要在原发性月经过多的主诉和继发于精神障碍的月经过多的主诉之间做出重要区分，那么他/她需要能够在出现子宫出血过多主诉的女性中检测和评估精神障碍。最近的研究提供了有关月经过多的手术治疗与精神障碍之间关系的信息。因月经过多进行子宫切除术似乎能缓解许多术前患有精神障碍的女性的精神障碍。该手术很少在术前精神状态良好的女性中诱发精神障碍。因月经过多进行子宫切除术前后的精神障碍与是否存在可证实的盆腔病理情况之间没有关联。没有证据表明那些高估自己月经量的女性在子宫切除术后出现精神障碍的可能性增加。然而，因月经过多进行子宫切除术后精神转归的一个重要决定因素是术前精神状态——例如，手术前的精神状态、既往精神病史和神经质。
