Does Ovary-Sparing Hysterectomy Affect Subsequent Ovarian Function?

Summary and Comment |
April 21, 2016

Does Ovary-Sparing Hysterectomy Affect Subsequent Ovarian Function?

  1. Robert W. Rebar, MD

Study indicates that ovarian reserve declines faster in women who have undergone hysterectomy than in those with intact reproductive tracts.

  1. Robert W. Rebar, MD

Whether to perform bilateral oophorectomy at the time of hysterectomy for benign disease has long been debated. Data support sparing the ovaries because of several negative consequences associated with oophorectomy, including increased risks for cardiac and neurologic disease, cancer mortality, and overall mortality. But does hysterectomy alone affect ovarian function? Investigators conducted a prospective cohort study among racially diverse women and compared those undergoing ovary-sparing hysterectomy for benign disease with women whose reproductive organs were intact. The original analysis showed that women undergoing hysterectomy entered menopause at least 1.9 years sooner than the referent cohort. In this secondary analysis, levels of antimüllerian hormone (AMH; an indicator of ovarian reserve) were assessed at baseline compared with 1 year after hysterectomy in 117 women, and at baseline compared with 1 year later in 129 referent women; baseline AMH levels were also compared between groups.

The median percentage 1-year decrease in AMH levels was greater in the hysterectomy group than in the referent group (–40.7% vs. –20.9%; P<0.001); also, 12.8% of women in the hysterectomy group versus 4.7% in the referent group had undetectable AMH levels 1 year after baseline (P<0.02). These differences were not significant when white women were analyzed independently, but remained significant among black women.

Comment

This analysis was complicated by the fact that AMH levels were not normally distributed and more women in the hysterectomy group had irregular menses at baseline. Still, the data confirm that women undergoing ovary-sparing hysterectomy experience menopause at earlier ages and suggest that hysterectomy can damage the ovaries (most likely through diminished ovarian blood flow). Thus, even seemingly benign procedures can have unexpected consequences — and gynecologists and their patients should factor these observations into their decision making about hysterectomy.

Editor Disclosures at Time of Publication

  • Disclosures for Robert W. Rebar, MD at time of publication Grant / Research support Religious, Ethical and Cultural Impacts on the Delivery of Reproductive Healthcare: A Program for InterProfessional Education (RECIPE; Co-Principal Investigator) from the Association of Professors of Gynecology (APGO) Education Foundation Editorial boards Contraception (Deputy Editor); EndoText (Section Editor); Clinical OB/GYN Alert (Associate Editor) Leadership positions in professional societies American Society for Reproductive Medicine (Member Practice Committee)

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