Conclusion
The meta-analysis concluded that hysterectomy negatively impacts ovarian function, especially in women over 40. These women should closely monitor their ovarian function for early diagnosis and management of menopausal symptoms. Most women report onset of menopause symptoms at 6-12 months ost hysterectomy. Even if the ovaries are intact, their function after a hysterectomy drops.
Background
Hysterectomy is one of the most frequently performed gynecologic surgeries among premenopausal women. Many women are hesitant to undergo this procedure due to concerns about potential decreases in ovarian function. This blog explores the findings of a recent meta-analysis aimed at understanding how hysterectomy affects ovarian function.
Methods
The meta-analysis adhered to the PRISMA 2020 and AMSTAR guidelines. Researchers reviewed studies from databases such as Embase, PubMed, and Web of Science. They focused on common indicators of ovarian function, including anti-müllerian hormone (AMH), follicle stimulating hormone (FSH), inhibin B, estradiol (E2), and luteinizing hormone (LH). The analysis utilized fixed or random effect models depending on data heterogeneity, with subgroup analyses to explore variability sources.
Results
The analysis included 14 studies conducted between 1989 and 2021, encompassing 1,457 premenopausal women (760 in the hysterectomy group and 697 in the control group). Key findings showed:
• AMH Levels: Significantly lower in the hysterectomy group (WMD = -0.56, 95% CI: -0.72 to -0.39, P = 0.000).
• FSH Levels: Higher in the hysterectomy group (WMD = 2.96, 95% CI: 1.47 to 4.44, P = 0.000).
• Inhibin B Levels: Lower in the hysterectomy group (WMD = -14.34, 95% CI: -24.69 to -3.99, P = 0.000).
• LH Levels: Higher in the hysterectomy group (WMD = 4.07, 95% CI: 1.78 to 6.37, P = 0.000).
• E2 Levels: Showed a decreasing trend in the hysterectomy group, but this was not statistically significant (WMD = -17.13, 95% CI: -35.10 to 0.85, P = 0.631).
Introduction
The ovary is a core reproductive organ, responsible for producing mature oocytes for fertilization and secreting sex hormones to maintain various bodily functions. Ovarian function declines with age, marking the progression toward menopause, which can lead to conditions like vasomotor dysfunction, osteoporosis, and cardiovascular disease.
Hysterectomy is a common surgical procedure worldwide for both benign and malignant conditions, with uterine leiomyoma being a frequent indication. Despite the availability of uterus-preserving treatments like myomectomy, many women opt for hysterectomy due to concerns about recurrence rates with other treatments.
Research shows that ovarian failure can occur earlier than natural menopause following hysterectomy, with a higher incidence of severe menopausal symptoms. The interruption of ovarian blood supply due to surgery can significantly decrease ovarian function. While some studies have found elevated serum FSH levels and lower ovarian blood flow post-hysterectomy, others report no significant changes in hormone levels.
This meta-analysis aimed to clarify these conflicting results by comparing ovarian function in women who underwent hysterectomy versus those who did not.
References
1. Farquhar, C. M., Sadler, L., Harvey, S. A., & Stewart, A. W. (2005). “The association of hysterectomy and menopause: a prospective cohort study.” BJOG: An International Journal of Obstetrics & Gynaecology, 112(7), 956-962.
2. Moorman, P. G., Myers, E. R., Schildkraut, J. M., Iversen, E. S., & Wang, F. (2011). “Effect of hysterectomy with ovarian preservation on ovarian function.” Obstetrics & Gynecology, 118(6), 1271-1279.
3. Siddle, N., Sarrel, P., & Whitehead, M. (1987). “The effect of hysterectomy on the age at ovarian failure: identification of a subgroup of women with premature loss of ovarian function and literature review.” Fertility and Sterility, 47(1), 94-100.
Summary by
Dr Purity Carr
GP & Menopause Doctor
Harvey, WA
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