Khastgir G, Studd J
Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, London, United Kingdom.
Menopause. 1998 Summer;5(2):113-22.
The incidence of depressed mood is high in women before hysterectomy. This finding is usually the effect of prolonged heavy periods, chronic pelvic pain, and severe premenstrual syndrome that warrant the surgical treatment. The therapeutic effects of hysterectomy thus include both the cure of physical symptoms and improvement of mood. However, in women with preexisting psychiatric illness or predisposing personality problems, depressed mood may persist or occur with the stress of hysterectomy. Hysterectomy is commonly performed in the perimenopausal age but also results in a premature ovarian failure. Thus, ovarian hormone deficiency following hysterectomy may be responsible for the negative effect on mood. The cyclical nature of such hormone-related depressed states often remains unrecognized in the absence of menstruation; without routine endocrinologic monitoring the need for estrogen replacement following hysterectomy is often missed. Associated bilateral oophorectomy results in the depletion of endogenous androgens, which also has a significant effect on mood. Estrogen plus testosterone replacement following hysterectomy with or without bilateral oophorectomy has been shown to reduce the incidence of depressed state. The compliance with hormone replacement following hysterectomy is high in the absence of withdrawal bleeding and the depressant effect of progestins on mood. Therefore, a practice of regular endocrinologic monitoring following hysterectomy to detect the need for estrogen replacement and a near-routine replacement of combined estrogen and testosterone following bilateral oophorectomy should be adopted to reduce the incidence of posthysterectomy depression.
子宫切除术前女性抑郁情绪的发生率较高。这一发现通常是长期月经过多、慢性盆腔疼痛和严重经前综合征的结果，这些情况需要进行手术治疗。因此，子宫切除术的治疗效果包括身体症状的治愈和情绪的改善。然而，对于已有精神疾病或具有易患人格问题的女性，抑郁情绪可能会持续存在，或因子宫切除术的压力而出现。子宫切除术通常在围绝经期进行，但也会导致卵巢早衰。因此，子宫切除术后的卵巢激素缺乏可能是对情绪产生负面影响的原因。在没有月经的情况下，这种与激素相关的抑郁状态的周期性往往未被认识到；如果没有常规的内分泌监测，子宫切除术后雌激素替代治疗的必要性常常被忽视。相关的双侧卵巢切除术会导致内源性雄激素的耗竭，这对情绪也有显著影响。子宫切除术后无论是否进行双侧卵巢切除术，补充雌激素加睾酮已被证明可降低抑郁状态的发生率。在没有撤退性出血和孕激素对情绪的抑制作用的情况下，子宫切除术后激素替代治疗的依从性较高。因此，应采用子宫切除术后定期进行内分泌监测以发现雌激素替代治疗的必要性，并在双侧卵巢切除术后近乎常规地补充雌激素和睾酮联合制剂，以降低子宫切除术后抑郁症的发生率。
