Hysterectomy tied to increased risk for bipolar disorder

  • Shen YC & al.
  • Depress Anxiety
  • 26 Apr 2019

  • International Clinical Digest
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Takeaway

  • Women undergoing hysterectomy appear at greater risk for developing bipolar disorder.
  • Endometriosis and hormone therapy may add to the risk.

Why this matters

  • The role of hormonal fluctuations on emergence of bipolar disorder is unclear.

Study design

  • 4337 women who underwent hysterectomy and 17,348 nonhysterectomy control patients from the National Health Insurance Research Database of Taiwan.
  • Mean follow-up, 7.93 years.
  • Funding: Taiwan Ministry of Health and Welfare Clinical Trial Center and others.

Key results

  • Bipolar disorder incidence significantly higher with hysterectomy than without (5.82 and 2.04 per 10,000 person‐years, respectively; P<.0001>
  • In multivariate analysis, hysterectomy was associated with significantly higher risk for bipolar disorder (adjusted incidence rate ratio [aIRR], 2.19; 95% CI, 1.94-2.49).
    • Incidence was higher with endometriosis (aIRR, 3.17; 95% CI, 2.83-3.56) and use of conjugated estrogens (Premarin; aIRR, 4.22; 95% CI, 3.71-4.80).
  • Bipolar incidence was lower in nonhysterectomy control patients who received estradiol (aIRR, 0.28; 95% CI, 0.20-0.40) or conjugated estrogens (aIRR, 0.69; 95% CI, 0.58-0.83).
  • Patients who underwent hysterectomy with oophorectomy had a higher bipolar incidence than the hysterectomy-only group (aIRR, 1.85; 95% CI, 1.50-2.29).

Limitations

  • Retrospective analysis.

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