Uterine leiomyomata (UL) are a major source of gynecologic morbidity and the primary indication for hysterectomy. Depression can cause dysregulation of the hypothalamic-pituitary-adrenal axis, which may affect the synthesis of reproductive hormones involved in UL pathogenesis. We assessed the association between depressive symptoms and UL among 15,963 premenopausal women.STUDY DESIGN:
Data were derived from the Black Women's Health Study, a prospective cohort study. In 1999 and 2005, the Center for Epidemiologic Studies Depression Scale (CES-D) was used to ascertain depressive symptoms. On biennial follow-up questionnaires from 1999 through 2011, women reported physician-diagnosed depression, antidepressant use, and UL diagnoses. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression.RESULTS:
There were 4722 incident UL cases diagnosed by ultrasound (n = 3793) or surgery (n = 929) during 131,262 person-years of follow-up. Relative to baseline CES-D scores <16, IRRs were 1.05 (95% CI, 0.98–1.13) for CES-D scores 16–24 and 1.16 (95% CI, 1.06–1.27) for CES-D scores ≥25 (P-trend = .001). IRRs for current and past physician-diagnosed depression relative to no depression were 1.15 (95% CI, 0.98–1.34) and 1.25 (95% CI, 1.13–1.39), respectively. Results persisted after further control for antidepressant use. IRRs for current and past use of antidepressants (any indication) relative to never use were 1.11 (95% CI, 0.97–1.28) and 1.32 (95% CI, 1.14–1.52), respectively.CONCLUSION:
In this cohort of black women, greater depressive symptoms were associated with UL, independent of antidepressant use, supporting the hypothesis that dysregulation of the hypothalamic-pituitary-adrenal axis increases UL risk.