There has been considerable criticism in recent years concerning the high rate of hysterectomy in Europe and the USA. Now, a prospective study of women reported in the July issue of the British Journal of Obstetrics and Gynaecology (BJOG) reveals that hysterectomy is associated with an earlier onset of menopause in women who retain both ovaries by nearly four years.
It also suggests that women who retain just the one ovary after the hysterectomy undergo premature ovarian function loss over four years earlier than women who retain both ovaries after hysterectomy.
257 women who had the procedure were compared with a similar number who had not undergone hysterectomy. Over the five years of the study, 53 women (21%) from the hysterectomy group and 19 women (7%) from the comparison group became menopausal. Of the 28 women in the hysterectomy group who had had one ovary removed, 10 (36%) became menopausal during the five-year follow up period.
Prof Cynthia Farquhar, lead author says, “The findings are sufficiently robust to raise concern for women and gynaecologists. Especially given the widespread use of hysterectomy and concerns about long-term use of oestrogen replacement therapy. These results should be discussed with premenopausal women considering hysterectomy, who may then choose conservative options to control symptoms. It is important that gynaecologists should try and retain both ovaries at the time of hysterectomy.”
Mr Peter Bowen-Simpkins, RCOG says, “This study highlights yet another problem associated with hysterectomy. It presents a further worry to patients at a time when they may be reluctant to take HRT. It is important that doctors realise that for women under 50 years old who develop menopausal symptoms as a consequence of hysterectomy, that HRT is not associated with the small risks that are known about for the older woman.”
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Notes to Editor:
This study is the only research to date to report prospective data pre-operatively for five years after surgery from a group of women who have had hysterectomy with conservation of the ovaries and compare them with a group of volunteers who were menstruating regularly and who were not on hormonal contraception.
