The association of hysterectomy and menopause: A prospective cohort study

Department of Obstetrics and Gynecology, National Women's Hospital, University of Auckland, New Zealand.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.86). 07/2005; 112(7):956-62. DOI: 10.1111/j.1471-0528.2005.00696.x
Source: PubMed

ABSTRACT To determine whether or not hysterectomy leads to an earlier onset of the menopause.
A prospective cohort study.
Gynaecology service of large urban hospital.
Premenopausal women with and without hysterectomy.
Multivariate survival analysis techniques were used to adjust for differences in initial follicle stimulating hormone (FSH) levels, body mass index, smoking and unilateral oophorectomy between the groups.
FSH levels were measured for five years following hysterectomy and compared with the comparison group. Menopause was defined as a single FSH measurement of at least 40 IU/L.
Two hundred and fifty-seven women undergoing hysterectomy were compared with 259 women who had not undergone a hysterectomy. Fifty-three women (20.6%) in the hysterectomy group and 19 women (7.3%) in the comparison group reached menopause over the five years of the study. Women in the hysterectomy group with a pre-operative FSH <10 IU/L reached menopause 3.7 years (95% CI 1.5-6.0 years) earlier than women in the comparison group independent of BMI, smoking and unilateral oophorectomy. Twenty-eight women in the hysterectomy group had unilateral oophorectomy and 10 (35.7%) of these women reached menopause over the five years of follow up. Women in the hysterectomy group with unilateral oophorectomy reached menopause 4.4 years (95% CI 0.6, 7.9 years) earlier than women with both ovaries in the hysterectomy group independent of baseline FSH, BMI and smoking.
Hysterectomy is associated with an earlier onset of menopause. Hysterectomy with unilateral oophorectomy is associated with an even earlier onset of the menopause in this study.

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Available from: Lynn Sadler, Nov 19, 2014
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    • "The effect of hysterectomy & oophorectomy upon the hormonal profile was also reported by, Moorman PG. et al. who, in agreement with our results, concluded that women undergoing hysterectomy were at significantly increased risk for ovarian failure notably those having a unilateral oophorectomy along with hysterectomy [16]. Farquhar et al. reported similar conclusions to those of this study [17]. A recent study by Hasan Toyganözü et al. reported changes in the ovarian environment after excision of the rudimentary horn in female Wistar albino rats. "
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    • "CI 1.14–2.65) in women in whom both ovaries remained [21]. Farquar et al. investigated the association between menopause and hysterectomy, and demonstrated that the onset of menopause in women who underwent hysterectomy retaining both ovaries was nearly four years earlier when compared to women with intact uteri and also that the onset of menopause in women who retained one ovary more than four years earlier than women who retained both ovaries [22]. After hysterectomy, evaluation of ovarian arterial blood flow may be helpful to predict ovarian function [23] [24]. "
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    • "However, from an endocrinological perspective, these women will continue to have circulating hormones until the time of cessation of ovarian function. b lt has been suggested that women who undergo hysterectomy alone or hysterectomy plus removal of one ovary may actually experience an earlier cessation of endocrine function in the remaining ovary or ovaries (Farquhar et al., 2005; Rocca et al., 2007; Phung et al., 2010). Therefore, the current belief of no effect of hysterectomy on ovarian function may be incorrect. "
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