According to some sources, there are as many as 600,000 hysterectomies performed annually in the US, making it the most common nonobstetrical surgical procedure among women in the US. While the procedure itself is relatively safe, allowing it to be performed in outpatient settings, little is known about the long-term effects of hysterectomies, including its risk for early menopause. To explore this possibility, Dr Patricia G Moorman, associate professor in the department of community and family medicine at Duke University, and colleagues conducted a prospective cohort study of premenopausal women aged 30 years to 47 years old. The results of the study were published in Obstetrics & Gynecology.
Moorman and colleagues looked at 406 women undergoing hysterectomy without bilateral oophorectomy and compared them with 465 women who had intact uteri. The researchers collected blood samples and questionnaires at baseline and then annually for up to 5 years. After adjusting for age, race, body mass index, smoking status, and number of pregnancies, Moorman and colleagues found a hazard ratio of 1.92 for ovarian failure in women who had hysterectomies as compared to those in the control group. After four years, they found ovarian failure in 14.8% of women who had hysterectomies and 8.0% in women in the control group. Moorman et al. found higher risk among women who had unilateral oophorectomy along with their hysterectomy as compared to those who had a hysterectomy with both ovaries left intact. While they found higher hazard ratios for non-African American women as compared to that for African American women, they failed to find statistical significance in tests for interaction between race and hysterectomy status. Using a proportional hazard ratio, Moorman and colleagues determined that the difference in time to ovarian failure between women with and without hysterectomy was approximately 1.88 years.
While their results confirm previous findings from other large prospective studies and support the long-standing hypothesis that women who undergo hysterectomy experience ovarian failure at a younger age, the causal pathways remain unclear. Moorman and colleagues reviewed one of the most prominent hypotheses; namely, that the surgery to remove the uterus compromises the blood flow to the ovaries, which might result in reduced production of hormones, which might lead to earlier ovarian failure. Another possibility, they suggested, is that the removal of the uterus allows FSH levels to increase, thereby accelerating follicular depletion, which may lead to earlier menopause. They also suggested that common indications for hysterectomy, including leiomyomas or endometriosis, may also lead to early ovarian failure.
“The major finding from our study is that women undergoing hysterectomy are at significantly increased risk for earlier ovarian failure as measured by serum FSH levels,” Moorman and colleagues wrote.
“Although it is unresolved whether it is the surgery itself or the underlying condition leading to hysterectomy that is the cause of earlier ovarian failure, it is important that physicians consider this possible sequela when discussing with patients options for treatment of benign conditions of the uterus,” they advised. “In addition, because not all women will experience overt symptoms of menopause, women who have undergone premenopausal hysterectomy may warrant closer monitoring of bone density or cardiovascular risk factors because of their possible risk of early ovarian failure.”
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Moorman PG, Myers ER, Schildkraut JM, et al. Effect of hysterectomy with ovarian preservation on ovarian function. Obstet Gynecol. 2011;118(6):1271-9.