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Hysterectomy with or without bilateral oophorectomy is the most common major surgery performed in nonpregnant U.S. women. Hysterectomy has been associated with early ovarian failure; nonetheless, ovarian preservation at time of surgery is increasingly common. In two studies, investigators addressed issues associated with hysterectomy status.
In the first study, researchers used a prospective cohort design to follow 406 women with benign disease who underwent hysterectomies with preservation of at least one ovary and 465 women with intact uteri (overall age range, 30–47). Within 5 years of follow-up, ovarian failure had occurred in 60 women who underwent hysterectomies and in 46 women in the control group (adjusted hazard ratio, 1.9). Ovarian failure occurred an estimated 1.9 years earlier in women who underwent hysterectomies than in those with intact uteri. Although HRs for nonblack women were higher than for black women, results of tests for interaction between race and hysterectomy status were not statistically significant.
The second study was a cross-sectional analysis using New York state data from 145,000 women (mean age, 48) who underwent hysterectomies for benign disease from 2001 to 2006. In all, 47% had concomitant bilateral oophorectomies. Women with family histories of breast or ovarian cancer or personal histories of breast cancer, ovarian cysts, or endometriosis were more likely to undergo oophorectomies; those who underwent vaginal or laparoscopic hysterectomies were less likely to have concurrent oophorectomies. Rates of oophorectomy fell by 8% from the first year to the last year of the study period (P for trend, <0.001). Declines in oophorectomy rates were significant whether hysterectomy was performed abdominally, vaginally, or laparoscopically; however, analysis stratified by age showed that only women who were younger than 55 were significantly less likely to undergo oophorectomy.
Moorman PG et al. Effect of hysterectomy with ovarian preservation on ovarian function. Obstet Gynecol 2011 Dec; 118:1271.
Novetsky AP et al. Trends in bilateral oophorectomy at the time of hysterectomy for benign disease. Obstet Gynecol 2011 Dec; 118:1280.
Comment
Although the first study indicates that hysterectomy without bilateral oophorectomy is associated with early ovarian failure, the data do not tell us whether the surgery itself or the underlying condition is causative. The second study shows that fewer oophorectomies are being performed in younger women who undergo hysterectomies for benign disease. As awareness of health risks associated with early menopause (osteoporosis, cardiovascular disease, and possibly neurodegenerative disease) grows, the finding that gynecologists are performing incidental oophorectomies less often is a welcome trend. Nonetheless, premenopausal women who undergo hysterectomies with ovarian preservation should be followed closely for cardiovascular risk factors and bone health.