Psychoemotional disorders and quality of life in women after hysterectomy with combination and single-component drug therapy

Aim. To evaluate the effect of combination treatment with an antidepressant and menopausal hormone therapy (MHT) on social and psychological adaptation, women’s health, and quality of life of patients after hysterectomy in the short- and long-term postoperative periods compared to MHT monotherapy.

Material and methods. 136 women with emotional disorders after hysterectomy were examined, randomly divided into 2 groups. The main group included 74 (54.4 %) women who were prescribed 17β-estradiol in combination with vortioxetine. The control group consisted of 62 (45.6 %) patients who received MHT only (17β-estradiol). The Hospital Anxiety and Depression Scale (HADS), Beck’s Depression Inventory (BDI), Hamilton Depression Rating Scale 17 (HDRS-17), and the Women’s Quality of Life questionnaire developed at V. I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology were used in the study. To evaluate the severity of menopausal disorders, the modified menopausal index was used.

Results. BDI score in the main patient group after 3 months was 3.82 ± 2.47 (p < 0.05) corresponding to the absence of clinically pronounced depression. In the comparison group, baseline BDI score corresponded to moderate depression and amounted to 13.06 ± 3.19; after therapy it decreased to mild depression with a value of 7.82 ± 3.51 (p < 0.05). After 12 months of MHT in combination with vortioxetine in the main group, baseline HDRS-17 score of 12.34 ± 1.95 decreased to 2.82 ± 1.69; in the comparison group, depression was initially characterized as moderate, and it significantly decreased 12.82 ± 1.98 to 5.80 ± 3.08 (p < 0.05). In the main group, 63 (85.1 %) patients gave a “good” assessment of their quality of life after a year, 7 (9.4 %) gave a “satisfactory” assessment, and 4 (5.5 %) gave a “poor” assessment of their quality of life. In the control group, 41 (66.2 %) patients gave a “good” assessment, 14 (22.6 %) gave “satisfactory” assessment, and 7 (11.2 %) gave “bad” assessment. One month after the hysterectomy, 39 (52.8 %) and 32 (51.7 %) patients in the main and control groups, respectively, showed signs of anxiety and depression. After 6 months, clinical manifestations of mixed anxiety-depressive disorder were detected in 21 (28.3 %) patients in the main and 22 (35.4 %) patients in control group, and 1 year later in 13 (17.5 %) and 18 (29 %), respectively.

Conclusion. The combined use of antidepressants and MHT after hysterectomy promotes restoration of the psychoemotional wellbeing and physical activity, significantly accelerates the recovery period after surgery, and improves overall quality of life.