Do ovary-sparing hysterectomies lead to early menopause?
Women who undergo an ovary-sparing hysterectomy may be at a greater risk of early onset of menopause, according to a secondary analysis from the Prospective Research on Ovarian Function study.
Published in Obstetrics & Gynecology, the findings are based on a comparison of baseline antimullerian hormone levels and absolute change and percentage change in levels of the hormone from baseline to 1 year follow-up in premenopausal women who underwent ovary-sparing hysterectomy for benign indications versus a cohort of similar age but with intact reproductive organs. Overall, the women who underwent hysterectomy but retained their ovaries entered menopause 1.9 years earlier than the reference cohort. Baseline median antimullerian hormone levels were similar in the referent group (n = 172) and the hysterectomy group (n = 148).
A year later, the hysterectomized women had a much greater median percentage decrease (-40.7% compared with -20.9%; P<.001). A higher proportion of this group also had undetectable antimullerian hormone (12.8% compared with 4.7%; P=.02), and their antimullerian hormone levels averaged 0.77 that in the reference cohort (P=.001). The differences were attenuated among white women, but were still significant among black women. Comparisons between women with a low ovarian reserve at baseline and women with a high ovarian reserve at baseline showed similar findings.
The researchers concluded that while women who underwent ovary-sparing hysterectomy had similar levels of antimullerian hormone levels at baseline, they experienced a greater percentage decrease in those levels after 1 year than the reference cohort. That suggests, the authors said, that hysterectomy may lead to ovarian damage that is unrelated to a woman’s baseline ovarian reserve.