Psychiatric morbidity following endometrial ablation and its association with genuine menorrhagia.

Objective: To explore the relation between pre-operative psychiatric morbidity, menstrual blood loss and psychiatric outcome in women receiving endometrial ablation for heavy periods.

Design: A prospective cohort study.

Setting: The menorrhagia clinic at Leeds General Infirmary.

Population: One hundred and twenty consecutive women referred to the Clinic for endometrial ablation.

Methods: Psychiatric interview and actual menstrual blood loss measurements at presentation pre-operatively and one year post endometrial ablation.

Main Outcome Measure: Psychiatric status using the semi-structured interview, Present State Examination, with measurement of menstrual blood loss.

Results: Endometrial ablation was performed on 92 women. Of the 87 women evaluated 51 (59%) had clinically significant psychiatric symptoms, mainly depression and anxiety. Psychiatric morbidity fell to 21.8% at one year after endometrial ablation. Women with the best psychiatric outcome (6% post-operative psychiatric morbidity) were those with genuine menorrhagia (> or =80 mL) and low psychiatric morbidity pre-operatively. Those who fared worst (39% post-operative psychiatric morbidity) were women with high pre-operative psychiatric morbidity and low menstrual blood loss. Of seven women with very low losses [mean 19 mL (SD 17)] who did not proceed to surgery after counselling, six (86%) had significant psychiatric morbidity.

Conclusions: Pre-operative psychiatric status and menstrual blood loss are predictors of outcome of surgery for women with reported heavy periods.