ABSTRACT

Psychological and Physiological Profiles of Post-Hysterectomy Menopausal Women Who Report Less Than Satisfactory or Satisfactory Outcomes on Hormone Replacement Therapy: A Comparative, Correlational Study by Caroline Pilcher Dott, PhD

The primary purpose of this study was to begin to determine predictors of post-hysterectomy menopausal women who will have a more difficult menopause transition to facilitate timely and appropriate management leading to a satisfactory outcome. Recent research suggests prior psychological and physiological stress may influence subsequent developmental stage transitions. The study investigated and compared two groups (n = 30 each) of outpatient post-hysterectomy menopausal women ages 30 to 60, currently on HRT (estrogen only, or estrogen-testosterone combination) reported as having less than satisfactory (Complicated Group)or satisfactory (Uncomplicated Group) menopause management outcomes. Psychological manifestations and physiological hormonal substrates of the post-hysterectomy menopausal transition were correlated and integrated, emphasizing differences between Complicated and Uncomplicated responders in occurrence and complexity of reproductive, gynecological, psychological, and abuse history events. A Background Questionnaire (BQ), and standardized measures of depression, anxiety (POMS-BI, MAACL-R), and sexual dissatisfaction (GRISS-F) were used. Serum hormone levels measured were follicle stimulating hormone (FSH) and estradiol (E₂), the primary ovarian estrogen.

Results: Complicated Group had significantly more complicated gynecological and psychological histories, and experienced significantly more abuse and more types of abuse, particularly emotional abuse and rape, than the Uncomplicated Group. The Complicated Group reported significantly more depression, anxiety, sexual dissatisfaction, unsureness, tiredness, and confusion than the Uncomplicated Group. There was a significant positive correlation between the complicatedness of the gynecological and psychological history, and between the gynecological history and anxiety. Highly significant positive correlations were found between the psychological history and anxiety and depression. Women who experienced physical, emotional, sexual abuse, or rape reported significantly more depression. Women who experienced emotional abuse or rape reported significantly more anxiety. All rape victims were Complicated responders. Women who experienced physical abuse reported significantly more sexual dissatisfaction. Significant positive correlations were found between hot flash intensity and anxiety, and between sleep disturbance and anxiety and depression. Contrary to expectations, the Complicated Group showed a significantly higher estradiol level and a significantly lower FSH level than the Uncomplicated Group due to the extremely and moderately high dosages of estradiol that the 30 Complicated women were taking to help them achieve a better outcome. Clear evidence of FSH suppression by estradiol level was demonstrated. Overall findings suggest strongly that psychological measures are important predictors of complicatedness or uncomplicatedness in terms of management and outcome at menopause. Psychological, gynecological, and abuse histories detail-specific for events and complicatedness, and determining serum FSH and estradiol levels as indicated for adequate monitoring, are strongly suggested components of the effective assessment and management of post- hysterectomy menopausal women. This work comprised part of the doctoral dissertation of Caroline P. Dott  at The Fielding Institute, Santa Barbara, CA).   (Copyright, 1998)

Dr. Caroline Dott  is available to lecture on the psychology of male and female menopause as well as issues related to the midlife-transitions of men and women.  She is particularly interested in behavioral issues affecting management level personnel at midlife and how midlife transitions effect function and performance in the workplace.   She has lectured on such related issues such as the impact of corporate downsizing on both male and female midlife executives.  She is available to travel and give seminars on the topics covered in this website both nationally and internationally.