Hysterectomy with ovarian preservation risks later ovarian failure
MedWire News: Women who undergo hysterectomy with ovarian preservation face an almost twofold increased risk for ovarian failure relative to similar aged women with an intact uterus, study results show.
It remains unclear whether it is the surgery itself or the underlying condition leading to hysterectomy that is the cause of early ovarian failure.
Nevertheless, "it is important that physicians consider this possible sequela when discussing with patients options for treatment of benign conditions of the uterus," say study author Patricia Moorman (Duke University Medical Center, Durham, North Carolina, USA) and colleagues.
It is estimated that up to 40% of women will have a hysterectomy during their lives.
Although uterine artery embolization, endometrial ablation, or progestin-releasing intrauterine devices are increasingly used for treating common indications for hysterectomy, such as leiomyomas and dysfunctional uterine bleeding, hysterectomy rates remain high.
The majority of women who have premenopausal hysterectomies retain at least one ovary because of evidence that the physical and psychologic benefits derived from keeping the ovaries outweigh the risk for ovarian pathology, including cancer.
"Although it is clear that most women do not lose ovarian function in the short-term after hysterectomy without bilateral oophorectomy, there has long been suspicion that these women are at increased risk for early ovarian failure," Moorman et al comment.
To address this theory, the researchers conducted a prospective cohort study among women aged 30 to 47 years undergoing hysterectomy without bilateral oophorectomy (n=406) and women with intact uteri (n=465) from the Prospective Research on Ovarian Function (PROOF) study.
Blood samples and questionnaire data were obtained at baseline and annually for up to 5 years. Ovarian failure was defined as follicle-stimulating hormone levels of 40 international units/L or higher.
Ovarian failure occurred in 60 of the women with hysterectomy and 46 of the women in the control group. Women undergoing hysterectomy were at nearly a twofold increased risk for ovarian failure compared with women with intact uteri (hazard ratio [HR]=1.92).
The proportional hazards model further estimated that 14.8% of women with hysterectomies experienced ovarian failure after 4 years of follow up compared with 8.0% of the women in the control group.
Risk for ovarian failure was highest for women who had a unilateral oophorectomy along with their hysterectomy (HR= 2.93), but also it was significantly increased for women who retained both ovaries (HR=1.74).
"Because not all women will experience overt symptoms of menopause, women who have undergone premenopausal hysterectomy may warrant closer monitoring of bone density or cardiovascular risk factors because of their possible risk of early ovarian failure," Moorman et al comment in the journal Obstetrics and Gynecology.
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By Andrew Czyzewski