You may find it difficult to deal with some of the emotional or physical effects of a hysterectomy, a major surgical procedure that involves removal of the uterus. Some women experience a loss of sexual or reproductive identity, while others find the recovery process stressful. Depression can be a serious and debilitating condition and may be related to the surgical removal of your ovaries, with or without a hysterectomy.
Progesterone and its Effects
Progesterone is classified as a sex hormone, along with estrogen. Both progesterone and estrogen work in your body to regulate your menstrual cycle. Estrogen signals the cells in the lining of your uterus to grow and new blood vessels to form in case they are needed for a pregnancy. Progesterone signals your ovaries when it is time to release the egg and allow ovulation to take place. Progesterone is also a key component of pregnancy, because its production in the ovary tells the body to maintain the pregnancy and prevents contractions of the uterus. In breast tissue, progesterone begins to prime the tissue for potential milk production while at the same time inhibiting the actual manufacturing of milk. When labor begins, levels of both estrogen and progesterone decline significantly, allowing for uterine contractions and the eventual birth of the infant. The drop in progesterone also removes the block in the milk process so production can begin.
Depression
Depression can be a significant factor affecting every aspect of your life. According to the Diagnostic and Statistical Manual of Mental Disorders, depression requires at least five out of nine symptoms. One of these must be persistent depressed mood or a loss of interest or pleasure in living. The remaining criteria include sleep disorder, appetite loss or appetite, fatigue or loss of energy, too much or too little energy, trouble concentrating or trouble making decisions, low self-esteem or guilt, and recurrent thoughts of death or suicide.
Hysterectomy Types
A hysterectomy is one of the most common surgical procedures performed by gynecologists, with approximately 600,000 women undergoing a hysterectomy every year in the United States. A hysterectomy is the removal of the uterus, composed of a hollow body and the cervix at the bottom, which allows passage of menstrual blood and the birthing of infants. On each side of the uterus are your fallopian tubes, which carry eggs from an ovary to the uterus for a possible pregnancy to implant. Near the ends of the tubes are the ovaries, which supply eggs during ovulation and secrete estrogen and progesterone.
A hysterectomy is can be performed for various conditions, such as symptoms related to fibroids. These usually benign growths of fibrous tissue in the uterus can cause heavy bleeding. A hysterectomy can also be performed for uncontrolled bleeding after a delivery and uterine cancer. The procedure can be done in various combinations. A total hysterectomy includes the body of the uterus and the cervix. A partial or supra cervical hysterectomy only removes the body of the uterus, leaving the cervix in your body. A hysterectomy does not include removal of the ovaries or fallopian tubes, but removal of the ovaries can be done along with a hysterectomy. Discussion with your physician is recommended, because there are risks and benefits with each procedure.
Depression and Hysterectomy
Conditions that directly lower the levels of your progesterone and estrogen will have an effect on your mood. The period following a birth, for example, causes marked drops in hormone levels and an increase in depression. Menopause is also associated with a drop in hormones and elevations in mood disorders. R. Lazenberger et al. showed that increased levels of progesterone prevent proper functioning of serotonin, a brain chemical that is believed to affect mood. Many anti depressants work by increasing levels of serotonin.
A hysterectomy will not yield decreases in progesterone unless the ovaries are also removed and is not likely to respond to progesterone treatment. If your ovaries are also removed, it is likely that you will have mood symptoms as well as symptoms associated with menopause. Surgical removal of the ovaries will put you in surgical menopause, so you may experience mood alterations as well as hot flashes and vaginal dryness. Depression associated with a hysterectomy and treatment alternatives should be discussed with your physician.
References
- "Southern Medical Journal"; Postpartum Depression: An Essential Overview for the Practitioner; Sarah Breese McCoy; 2011
- "Neuroendocrinology"; Progesterone Level Predicts Serotonin-1A Receptor Binding in the Male Human Brain; R. Lazenberger et al.; 2011
- "Behavioral Medicine: A Guide for Clinical Practice"; Mitchel Feldman; 2007
- "Endocrine Physiology"; Patricia Molina; 2009
- "Williams Gynecology"; J.O. Schorge; 2009
- Cleveland Clinic: Perimenopause, Menopause and Depression
