Assessment of Psychological Improvements in Patients Having Successful Fistula Repair in Perimenopause Age

Abstract

Objective: To document the psychological improvements in perimenopausal women (aged 40–55 years) after undergoing surgical repair of fistula at our hospital.
Methodology: This analytical study was carried out at the Department of Obstetrics and Gynecology, Pakistan Institute of Medical Sciences (PIMS), Islamabad from April 01, 2021, to March 31, 2024. Non-probability consecutive sampling technique was employed. All women aged 40–55 years who presented for the surgical repair of fistula were included in the study. Patients who had any pre-existing history of psychiatric disorders and those who did not fall in the perimenopausal age range were excluded. The patients were managed according to established standard protocols. The pre-surgical and post-surgical assessments (performed at 06-months follow-up) evaluated the socio-demographics of the patients, their perimenopausal symptoms (vasomotor, urogenital, sexual), and the psychological outcomes (anxiety via GAD-7 scale, depression, self-esteem).
Results: There was a total of 50 women who underwent fistula repair during the study period. Most of them (94%) belonged to low-income families. The contribution of rural residents was 84%. Significant post-repair reductions were observed in anxiety (3.35± 2.7 from 9.90 ± 5.2; p<0.001), fear during intercourse (42% from 86%; p<0.001) and urinary complaints (4% from 100%; p<0.001). Insignificant improvements were observed in mood swings (p=0.26) and sleep disturbances (p=0.17).
Conclusion: Most of the anxiety and physical symptoms were alleviated by fistula repair; however residual psychological challenges persisted among a small proportion of the patients. These were influenced by menopausal transitions and socioeconomic vulnerabilities. Therefore, for ensuring complete recovery of women with fistula, an integrated post repair care is imperative. It should adequately address the mental health, hormonal deficiency, and the associated socioeconomic issues.
Keywords: Obstetric fistula, Perimenopausal, Psychological distress, Surgical repair, Anxiety, LMICs, Menopausal symptoms, Women’s health