Robert W. Rebar, MD reviewing Trabuco EC et al. Obstet Gynecol 2016 Apr 4.

Study indicates that ovarian reserve declines faster in women who have undergone hysterectomy than in those with intact reproductive tracts.

Whether to perform bilateral oophorectomy at the time of hysterectomy for benign disease has long been debated. Data support sparing the ovaries because of several negative consequences associated with oophorectomy, including increased risks for cardiac and neurologic disease, cancer mortality, and overall mortality. But does hysterectomy alone affect ovarian function? Investigators conducted a prospective cohort study among racially diverse women and compared those undergoing ovary-sparing hysterectomy for benign disease with women whose reproductive organs were intact. The original analysis showed that women undergoing hysterectomy entered menopause at least 1.9 years sooner than the referent cohort. In this secondary analysis, levels of antimüllerian hormone (AMH; an indicator of ovarian reserve) were assessed at baseline compared with 1 year after hysterectomy in 117 women, and at baseline compared with 1 year later in 129 referent women; baseline AMH levels were also compared between groups.

The median percentage 1-year decrease in AMH levels was greater in the hysterectomy group than in the referent group (–40.7% vs. –20.9%; P<0.001); also, 12.8% of women in the hysterectomy group versus 4.7% in the referent group had undetectable AMH levels 1 year after baseline (P<0.02). These differences were not significant when white women were analyzed independently, but remained significant among black women.

Citation(s):

Trabuco EC et al. Association of ovary-sparing hysterectomy with ovarian reserve. Obstet Gynecol 2016 Apr 4; [e-pub].

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