Endocrine Abstracts

JOINT1937

Introduction: Hysterectomy is the most common non–obstetric surgery performed on women in late reproductive age in most countries of the world for the treatment of uterine cancer and various non-cancerous uterine conditions. Our aim to investigate the impact of hysterectomy on ovarian function, with a focus on hormonal changes and ovarian reserve by the data from the literature.

Material and Methods: For preparing our investigation we used data regarding clinical and lab data after hysterectomy from internet sourses such as PubMed, Web of Science, MedLine, Medscape, Scopus, Google Scholar.

Results: Elective bilateral salpingo-oophorectomy (BSO) in women under 50 is linked to a higher risk of coronary heart disease (CHD) and sexual dysfunction, and not recommended for women after 50. In contrast, for postmenopausal women, BSO can lower the risk of ovarian cancer without negatively affecting CHD, sexual function, hip fractures, or cognitive abilities. Taiwan National Health Insurance database indicated no significant difference in stroke risk between women who underwent hysterectomy. Whereas women who had hysterectomies before 45 showed a significantly increased risk of stroke. The same results were finds by a study from the Swedish Inpatient Registry. In the other prospective research on ovarian function study, premenopausal women who had a hysterectomy without bilateral oophorectomy faced nearly double the risk of ovarian failure compared to those who did not have a hysterectomy. After four years, 14.8% of women in the hysterectomy group experienced ovarian failure, reported a history of uterine fibroids. The risk was also notably higher in women who retained both ovaries. In the other study 20.6% women after hysterectomy were reached menopause during a five-year follow-up. Anti-Müllerian hormone (AMH) indicates ovarian follicular reserve. For women under 48, normal AMH level were predictive for reaching menopause within 12 months, whereas decrease in AMH levels raises the risk of early menopause. Due to the decreased follicles, the insufficient secretion of ovarian hormones contributed rise in FSH levels through negative feedback, the FSH/LH ratio rose significantly and become independent predictor of poor ovarian response and is linked to unfavorable outcomes in IVF treatment.

Conclusion: Hysterectomy affect the ovarian reserve which leads to early menopause, increased risk of CHD, stroke, fibroids, closely associated with patient age, disease, and the type of surgery, suggesting these factors should be considered in randomization stratification for future studies aimed at exploring possible effect modifications.