10 Psychological problems and uterine bleeding

Abstract

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.