Hysterectomy associated with earlier onset of menopause

Hysterectomy could lead to an earlier onset of menopause in women who retain both ovaries by nearly four years, according to researchers at The University of Auckland.

A hysterectomy is an operation to remove a woman's uterus (womb). Lead researcher Professor Cindy Farquhar from the Faculty of Medical and Health Sciences says hysterectomy in pre-menopausal women is associated with the loss of ovarian function nearly four years earlier than women who do not undergo hysterectomy.

“The study also suggests that women who retain just one ovary after the hysterectomy undergo premature ovarian function loss more than four years earlier than women who retain both ovaries after hysterectomy.”

A total of 257 women who had a hysterectomy were compared with a similar number who had not had one. Over the five years of the study, 53 women (21 percent) from the hysterectomy group and 19 women (7 percent) from the comparison group became menopausal.

Of the 28 women in the hysterectomy group who had had one ovary removed, ten (36 percent) became menopausal during the five-year follow up period.

Professor Farquhar says the findings are sufficiently robust to raise concern for women and gynaecologists.

“There has been considerable criticism in recent years concerning the high rate of hysterectomy in Europe and the USA. Given the widespread use of hysterectomy and concerns about long-term use of oestrogen replacement therapy, these results should be discussed with pre-menopausal women considering hysterectomy as they may then choose conservative options to control symptoms.

“Some of the study participants regretted losing their fertility and it is important that gynaecologists discuss all concerns and options thoroughly,” she says.

Professor Farquhar says it is important that gynaecologists try and retain both ovaries at the time of hysterectomy.

The study was reported in the July issue of the “British Journal of Obstetrics and Gynaecology (BJOG)”. It is the only research to date to report prospective data pre-operatively (data collected at the time of the hysterectomy) and then every year for five years after surgery from a group of women who have had hysterectomy with conservation of both ovaries, and compare them with a group of volunteers who were menstruating regularly and who were not on hormonal contraception.

“A lot of medical research is based on retrospective data which depends on recall and memory and using data collected without a research purpose in mind. This is the longest study to date with prospective data,” says Professor Farquhar.

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