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Letter to the Editor: "Hysterectomy Uniquely Impacts Spatial Memory in a Rat Model: A Role for the Nonpregnant Uterus in Cognitive Processes".

Iread with interest the recent manuscript by Koebele et al. (1). This novel set of experiments opens the door to an intriguing possibility: the uterus may communicate with the brain independent of the ovaries. The implications of such a possibility are fascinating because the uterus is typically thought of as an endocrine target but not a hormone source. Nonetheless, the article would have been improved if the authors had included a discussion of alternative explanations for their findings. In particular, it is well established that surgery itself is associated with cognitive changes, a fact we encounter frequently on our inpatient psychiatric consultation service when called to assess postsurgical patients. All wounds, including sterile surgical wounds, result in a cascade of inflammatory responses with clear potential for effects on cognition [reviewed in Saxena and Maze (2)]. Although Koebele et al. (1) used a sham surgery condition, it is unclear whether this condition adequately controlled for the variability of inflammation that would be expected in a comparison of surgeries with different amounts of tissue destruction, such as ovariectomy or hysterectomy. Future research in this area is needed and will be strengthened by the development and implementation of models that account for this confounding variable.