Is Timing of Menopause Impacted by Hysterectomy With Ovarian Conservation?

New findings presented at the 2019 North American Menopause Society Annual Meeting suggest that there is likely no difference in the age at which anti-Müllerian hormone (AMH) becomes undetectable in recipients of hysterectomy with ovarian conservation compared with women who transition naturally into menopause.

This finding emerged after researchers evaluated data from the Study of Women’s Health Across the Nation (SWAN), which included 3302 women with 25 years of follow-up data. The researchers compared data on women who underwent hysterectomy with conservation of least one ovary (n=74) vs women undergoing natural menopause with an observed final menstrual period (n=1536).

Among women with a natural menopausal transition, AMH was measured annually from early perimenopause through 1 year after their final menstrual period. In women who underwent hysterectomy, AMH was measured at least once preoperatively and annually afterwards until AMH was undetectable (less than 3 pg/mL). The age at which AMH became undetectable was compared between groups before and after adjustment for age, body mass index, race/ethnicity, smoking status, and other factors.

Ultimately, results of the study suggested that the median age at which AMH became undetectable was 50.2 years in both groups. The researchers noted that current smoking was associated with reaching undetectable AMH at an earlier age (hazard ratio [HR] 1.221), whereas Japanese-American race/ethnicity and higher BMI were associated with reaching undetectable AMH at a later age (HR 0.825 for race/ethnicity; HR 0.883 for BMI of 25 to 30 kg/m2, 0.882 for 30 kg/m2 or more compared with BMI of less than 25 kg/m2).

“These data suggest that there is not significant ovarian damage occurring at the time of hysterectomy with ovarian conservation,” the researchers wrote.

—Christina Vogt

Reference:
Davis A, Flyckt R, Finkelstein J, et al. Anti-Müllerian hormone (AMH) decline in women with hysterectomy or natural menopause: data from the Study of Women’s Health Across the Nation (SWAN). Paper presented at: North American Menopause Society Annual Meeting; September 25-28, 2019; Chicago, IL.