Menopausal Symptoms After Ovarian-Sparing Hysterectomy in Black Women

INTRODUCTION: Abnormal uterine bleeding (AUB) encompasses multiple conditions that can lead to pelvic pain and heavy menstrual bleeding, particularly in Black women, and may require hysterectomy. However, ovarian-sparing hysterectomy has been linked with shortened time to menopause and depressive symptoms, especially in Black women. Reduced ovarian reserve following hysterectomy has been shown to be more frequent in Black compared to White women after hysterectomy, and independently, Black women are at higher risk for depressive symptoms during menopause. OBJECTIVE: We examined if Black women undergoing ovarian-sparing hysterectomy (OSH) experienced changes in menopausal symptoms and serum estradiol 1 month postoperatively. The findings could inform targeted interventions to improve quality of life and possibly predict hormone-mediated mood disorders. METHODS: Participants were Black premenopausal women aged 30–45 diagnosed with uterine leiomyomas and/or abnormal uterine bleeding (AUB), scheduled for outpatient surgery in a minimally invasive gynecology surgery program. They underwent screening for current or past major depressive disorder (MDD) and confirmed the absence of bipolar disorder, psychotic disorders, or substance use disorders, which were exclusion criteria. Additionally, participants were not on estrogen-containing medications and had no unstable medical conditions affecting study outcomes. Self-reported menopausal symptoms were assessed using the Greene Climacteric Scale (GCS) within 2 weeks of surgery and weekly for 1 month postoperatively. Serum estradiol levels were measured at surgery and 1 month later. Linear mixed-effects models analyzed the impact of time and past MDD diagnosis on menopausal symptoms, along with correlations between age and symptoms. RESULTS: 37 participants (mean age 41.32, SD 4.94) were included in these analyses, of whom 12 had a history of MDD. Age was not significantly associated with menopausal symptoms 1 week postsurgery (r= −0.13, p>0.05), indicating that older participants did not experience greater symptom severity. There was no significant difference between preoperative (M 8.64, SD 10.06) and 4-week postoperative GCS scores (M 8.04, SD 10.05), t(27)=−0.35, p>0.05. However, a prior diagnosis of MDD was associated with increased menopausal symptoms on the GCS at all study time points, although this effect did not reach statistical significance (β=0.19, 95% CI [−0.03, 0.41], p=0.08). Specifically, total scores 4 weeks postoperatively were 11.11 ± 10.08 for those with a history of MDD, compared to 6.58 ± 9.97 for those without. Estradiol levels did not show a statistically significant difference between the time of surgery (M 114.41, SD 85.77) and four weeks postoperatively (M 105.34, SD 94.61), t(49.06)=0.37, p>0.05. Furthermore, there was no significant difference in the change of estradiol levels between participants with a history of MDD and those without, t(7.08)=−0.46, p>0.05. CONCLUSIONS: This study highlights the complex relationship between OSH and menopausal symptoms in Black women with AUB and/or fibroids. While preoperative estradiol levels did not correlate significantly with symptom severity, a history of MDD appeared to influence the development of menopause-related symptoms, warranting a need for further investigation. These findings underscore the need for tailored approaches in managing postoperative menopausal symptoms and the importance of considering psychiatric history in preoperative counseling for this population (Figures 1 and 2).