The age of ovarian failure following premenopausal hysterectomy with ovarian conservation

Abstract

Objective To test the hypothesis that premenopausal hysterectomy compromises ovarian function and accelerates ovarian failure. Design Longitudinal prospective cohort study. Annual follow-up with serum follicle-stimulating hormone levels with all women being 46 years of age or less at the time of hysterectomy for benign disease. Setting Gloucestershire Royal Hospital, Gloucester, UK. Participants Five hundred and thirty-one women recruited over a four-year period from 1994 to 1997. Results The median age of women in the study was 37 (range 22–46). Women had earlier ovarian failure after unilateral oophorectomy (hazard ratio 2.41, 95% confidence interval (CI) 1.44–4.04) and after vaginal hysterectomy (hazard ratio 2.04, 95% CI 1.33–3.14) compared with abdominal hysterectomy. The mean age of ovarian failure across all groups was 45.87 (±3.58), and 59 (11%) women remained in the study at the end of 10 years who had not yet entered the menopause. Conclusion This is the largest number of cases collected prospectively looking at ovarian failure after hysterectomy. Earlier ovarian failure occurred in those women having unilateral oophorectomy or vaginal hysterectomy. Early ovarian failure was not confirmed across the study group with only 2% of women having confirmed ovarian failure by Kaplan–Meier estimate one year after surgery and 14% at five years.