Removing the ovaries during hysterectomy among women who are at a low-risk for ovarian cancer has been linked to an increased risk of heart disease, neurological disease, and death.1 To avoid these consequences, performing ovary-sparing hysterectomies when possible is becoming more common. And yet, women who have ovary-sparing hysterectomies may still be at a higher risk for early menopause, according to a secondary analysis from the Prospective Research on Ovarian Function (PROOF) study.1
In the original report, the PROOF study found that premenopausal women who underwent ovary-sparing hysterectomy for treatment of noncancerous conditions experienced menopause 1.9 years earlier than women of similar age but who had reproductive organs—including both ovaries—that remained intact.1
To reexamine the link between hysterectomy and ovarian function, researchers from the Mayo Clinic and Duke University conducted a secondary analysis.1 In each group of women, they looked at antimüllerian hormone levels (a marker of ovarian reserve) at baseline and then the absolute change and percentage change in the hormone levels between baseline and a 1-year follow-up.
Results published in Obstetrics & Gynecology showed that median antimüllerian hormone levels were similar between the hysterectomy group (148 women) and the comparative group (172 women) at baseline.1 But at 1-year follow-ups, hysterectomized women had a significant decrease in antimüllerian hormone (-40.7% versus -20.9%) and a higher proportion had levels that were undetectable (12.8% versus 4.7%). Women who underwent hysterectomy also had antimüllerian hormone levels that averaged 0.77 of that observed in the comparative group. These differences were weaker among white women but were still significant among black women. Similar results were seen among women with low or high ovarian reserves at baseline.
The researchers concluded that although women undergoing hysterectomy have similar antimüllerian hormone levels at baseline, they experience a greater percentage decrease in levels after 1-year in comparison to women whose reproductive organs remain intact. This suggests, “hysterectomy may lead to ovarian damage that is unrelated to baseline ovarian reserve.”1
Results from other studies have aligned with these findings, showing that women who have ovary-sparing hysterectomies reach menopause on an average of 1.9-4 years earlier than women with intact reproductive organs.1
Why does this occur? The authors explain that hysterectomy could disrupt ovarian blood flow or remove hormone signals from the uterus, resulting in the speeding up of follicular depletion and earlier menopause. “In essence, after surgery, a woman’s ovarian age may be advanced to that of a woman with a naturally diminished ovarian pool of similar, lower antimüllerian hormone levels.”1
ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer and Editor, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community.
- Trabuco, E., Moorman, P., Algeciras-Schimnich, A., et al. (2016). Association of ovary-sparing hysterectomy with ovarian reserve. Obstet Gynecol, May; 127(5): 819-827.