Does Hysterectomy Result in Earlier Menopause?
This is such a great question and after thirty years practicing gynecology, no one has ever asked me this. The short answer is yes. Women who’ve had a hysterectomy with ovarian sparing still go through menopause later in their life. However, do they go through menopause earlier than women who have not had a hysterectomy?
Now, for the longer more in depth answer. For years I tried to get women to keep their ovaries if they were having a hysterectomy for routine benign gynecology conditions. Immediate menopause occurs if the ovaries are surgically removed prior to the natural onset of menopause.
However, many women after hysterectomy begin having menopausal symptoms which may be annoying enough to address with supplemental hormone therapy for quality of life (and other) reasons.
My theory was always that during hysterectomy, the ovary on each side loses about 1/3 of its blood supply immediately after the uterine arteries have been clamped and severed in surgery. I described this to women considering hysterectomy and basically informed them that this was basically a surgically induced stroke of their ovaries.
Imagine if you stroked out 1/3 of your heart and still expected to have the same cardiac output. Or if I reduced your brain flow by 33% and then asked to teach you how to do calculus. (I’m aware I am being a little ridiculous).
Some spared ovaries will have a compensatory increase in blood flow to sustain normal function. Some will not and those ovaries begin to be less effective at what they do. Age related ovarian dysfunction seems to accelerate in women who’ve had a hysterectomy.
In fact, some women who undergo ovary sparing hysterectomy are at risk for early menopause according to a study published in the journal Obstetrics & Gynecology.
This study compared baseline hormone levels in women just prior to hysterectomy with women who had intact reproductive organs. They then compared hormone levels in the two groups one year later.
The women who underwent hysterectomy had a 40.7% decrease in hormone levels compared to the “intact” women who had a 20.9% decrease. The authors concluded that these findings suggest that hysterectomy may lead to ovarian damage that is unrelated to a woman’s baseline ovarian reserve.
The average onset of menopause occurs at 51.4 years. Overall, women who have undergone hysterectomy with ovarian sparing enter menopause 1.9 years earlier than women who have not undergone this procedure.