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: 3.45). 07/2005; 112(7):956-62. DOI: 10.1111/j.1471-0528.2005.00696.x
Source: PubMed


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.

Download full-text


Available from: Lynn Sadler, Nov 19, 2014
25 Reads
  • Source
    • "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. "
    International Journal of Clinical and Experimental Medicine 06/2015; 8(6):9403-9411. · 1.28 Impact Factor
    • "Information on hysterectomy and oophorectomy status was also obtained through self-administered questionnaires. We considered women surgically post-menopausal if they had had a hysterectomy and/or uni-or bilateral oophorectomy before reaching natural menopause (Cooper and Thorp, 1999; Hardy and Kuh, 1999; Farquhar et al., 2005; Yasui et al., 2012). Women with missing or incomplete questionnaire data on menstruation status were classified as premenopausal when they were younger than 46 years, as perimenopausal when they were between 46 and 55 years of age, and as post-menopausal when they were older than 55 years at enrollment in which case they were excluded from the present analysis because of lack of information on age at menopause. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Do women who have diabetes before menopause have their menopause at an earlier age compared with women without diabetes? Although there was no overall association between diabetes and age at menopause, our study suggests that early-onset diabetes may accelerate menopause. Today, more women of childbearing age are being diagnosed with diabetes, but little is known about the impact of diabetes on reproductive health. We investigated the impact of diabetes on age at natural menopause (ANM) in 258 898 women from the European Prospective Investigation into Cancer and Nutrition (EPIC), enrolled between 1992 and 2000. Determinant and outcome information was obtained through questionnaires. Time-dependent Cox regression analyses were used to estimate the associations of diabetes and age at diabetes diagnosis with ANM, stratified by center and adjusted for age, smoking, reproductive and diabetes risk factors and with age from birth to menopause or censoring as the underlying time scale. Overall, no association between diabetes and ANM was found (hazard ratio (HR) = 0.94; 95% confidence interval (CI) 0.89-1.01). However, women with diabetes before the age of 20 years had an earlier menopause (10-20 years: HR = 1.43; 95% CI 1.02-2.01, <10 years: HR = 1.59; 95% CI 1.03-2.43) compared with non-diabetic women, whereas women with diabetes at age 50 years and older had a later menopause (HR = 0.81; 95% CI 0.70-0.95). None of the other age groups were associated with ANM. Strengths of the study include the large sample size and the broad set of potential confounders measured. However, results may have been underestimated due to survival bias. We cannot be sure about the sequence of the events in women with a late age at diabetes, as both events then occur in a short period. We could not distinguish between type 1 and type 2 diabetes. Based on the literature, an accelerating effect of early-onset diabetes on ANM might be plausible. A delaying effect of late-onset diabetes on ANM has not been reported before, and is not in agreement with recent studies suggesting the opposite association. The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l'Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ) and Federal Ministry of Education and Research (BMMF) (Germany); Ministry of Health and Social Solidarity, Stavros Niarchos Foundation and Hellenic Health Foundation (Greece); Italian Association for Research on Cancer (AIRC) and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); ERC-2009-AdG 232997 and Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health (Norway); Health Research Fund (FIS), Regional Governments of Andalucía, Asturias, Basque Country, Murcia (no. 6236) and Navarra, ISCIII RETIC (RD06/0020) (Spain); Swedish Cancer Society, Swedish Scientific Council and Regional Government of Skåne and Västerbotten (Sweden); Cancer Research UK, Medical Research Council, Stroke Association, British Heart Foundation, Department of Health, Food Standards Agency, and Wellcome Trust (UK). None of the authors reported a conflict of interest. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email:
    Human Reproduction 03/2015; 30(6). DOI:10.1093/humrep/dev054 · 4.57 Impact Factor
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to evaluate ovarian function with longitudinal changes in serum levels of anti-mullerian hormone (AMH), follicle stimulating hormone (FSH) and estradiol (E2) after total abdominal hysterectomy (TAH) with ovarian conservation. In this prospective longitudinal study, a total of 29 women, aged 39 to 48 years, suffering from uterine pathologies underwent TAH with ovarian conservation. Their serum AMH, FSH and E2 levels were measured at baseline, at the first month and the third month after TAH. There was a statistically significant decrease in AMH serum levels between the baseline and the first postoperative month; the values were 0.22 (0.16-1.49) ng/mL and 0.18 (0.04-0.52) ng/mL, respectively. However, significant differences were not seen for serum levels of FSH and E2 when baseline and one-month values were compared. In addition, no statistically significant differences were detected between the baseline and third-month serum AMH, FSH and E2 levels. The study demonstrated that TAH affects ovarian function temporarily.
    Advances in Clinical and Experimental Medicine 09/2014; 23(5):821-5. DOI:10.17219/acem/37259 · 1.10 Impact Factor
Show more