Oophorectomy Status Research Articles

Mood symptoms after natural menopause and hysterectomy with and without bilateral oophorectomy among women in midlife.

To examine whether mood symptoms increased more for women in the years after hysterectomy with or without bilateral oophorectomy relative to natural menopause. Using data from the Study of Women's Health Across the Nation (n=1,970), depression and anxiety symptoms were assessed annually for up to 10 years with the Center for Epidemiological Studies Depression Index and four anxiety questions, respectively. Piece-wise hierarchical growth models were used to relate natural menopause, hysterectomy with ovarian conservation, and hysterectomy with bilateral oophorectomy to trajectories of mood symptoms before and after the final menstrual period or surgery. Covariates included educational attainment, race, menopausal status, age the year before final menstrual period or surgery, and time-varying body mass index, self-rated health, hormone therapy, and antidepressant use. By the tenth annual visit, 1,793 (90.9%) women reached natural menopause, 76 (3.9%) reported hysterectomy with ovarian conservation, and 101 (5.2%) reported hysterectomy with bilateral oophorectomy. For all women, depressive and anxiety symptoms decreased in the years after final menstrual period or surgery. These trajectories did not significantly differ by hysterectomy or oophorectomy status. The Center for Epidemiological Studies Depression Index means were 0.72 standard deviations lower and anxiety symptoms were 0.67 standard deviations lower 5 years after final menstrual period or surgery. In this study, mood symptoms continued to improve after the final menstrual period or hysterectomy for all women. Women who undergo a hysterectomy with or without bilateral oophorectomy in midlife do not experience more negative mood symptoms in the years after surgery. II.

Detecting early biomechanical effects of zoledronic Acid on femurs of osteoporotic female rats.

Aim. To investigate the biomechanical effects of zoledronic acid (ZA) on femurs of female osteoporotic rats after follow-up periods of 9 and 12 months. Methods. Eighty female Wistar rats were prospectively assessed. At 60 days of age, the animals were randomly divided into two groups: bilateral oophorectomy (O) (n = 40) and sham surgery (S) (n = 40). At 90 days of age, groups O and S were randomly subdivided into four groups, according to whether 0.1 mg/kg of ZA or distilled water (DW) was intraperitoneally administered: OZA (n = 20), ODW (n = 20), SZA (n = 20), and SDW (n = 20). The animals were sacrificed at 9 and 12 months after the administration of the substances, and then their right femurs were removed and analyzed biomechanically. Axial compression tests that focused on determining the maximum load (N), yield point (N), and stiffness coefficient (N/mm) of the proximal femur were performed in the biomechanical study. Results. ZA significantly increased the maximum load and yield point, reducing the stiffness coefficient concerning the oophorectomy status and follow-up period. Conclusion. Zoledronic acid, at a dose of 0.1 mg/kg, significantly increased the maximum loads and yield points and reduced the stiffness coefficients in the femurs of female rats with osteoporosis caused by bilateral oophorectomy.

P4-11-01: Bilateral Oophorectomy Is Associated with a Higher Prevalence of Arthritis and Lower Bone Mineral Density in Women 40 Years and Older.

Abstract Background BRCA 1/2 mutation carriers are encouraged to have their ovaries removed by age 40 to reduce cancer risk and prolong survival. Given the recency of genetic testing, it will be some years before robust estimates are available of the long term adverse effects. In the meantime data from the general population can help inform women and providers about potential adverse effects so that preventive strategies can be implemented. Bone loss accelerates following natural menopause and oophorectomy before age 45 is a known risk factor for osteoporosis. However there is limited data quantifying the effects of bilateral oophorectomy on bone mineral density (BMD), an early sensitive marker of osteoporosis. Methods: We evaluated the associations of oophorectomy with arthritis and BMD in NHANES III, a nationally representative survey conducted 1988–1994. For analysis we included women aged 40 years and older with no history of cancer who reported a bilateral oophorectomy or intact ovaries. Women were asked if a doctor told them they had arthritis. Femoral neck BMD was measured by dual energy x-ray (DXA). Osteoporosis was defined as BMD (g/m2) more than 2.5 standard deviations below the mean of white women aged 20–29 years. Survey weights were used to account for the complex survey design. Odds Ratios (OR) for arthritis and osteoporosis were estimated using logistic regression. Oophorectomy status was categorized intact ovaries, oophorectomy <45 years, and oophorectomy ≥45 years. Multivariate models were adjusted for age at interview, race, income, smoking status, education, alcohol, and BMI. Analyses were repeated excluding women who reported using hormone replacement therapy (HRT). Results: The sample size was 4039 for the arthritis analysis and 3660 for the BMD analysis. Women with oophorectomy were more likely to report arthritis than women with intact ovaries (45.4% vs. 32.1% p<0.001).The prevalence was even higher in women with oophorectomy <45 years (47.7%). The age-standardized mean femoral neck BMD was lower for women reporting oophorectomy at <45 years than women with intact ovaries (0.711 vs. 0.743 g/m2 p=0.017). In multivariate models women with oophorectomy had greater odds of arthritis than women with intact ovaries, particularly among women with oophorectomy <45 years (OR=1.78 95% CI 1.31−2.42). The odds of arthritis were even greater after excluding HRT users (OR=1.99 95% CI=1.25−3.18). Similarly, women who had a prior oophorectomy had greater odds of osteoporosis than women with intact ovaries, particularly among women with oophorectomy <45 years (OR=1.78 95% CI 1.07−2.97). The odds were increased further after excluding HRT users (OR=2.92 95% CI 1.32−6.44). Conclusions: The prevalence of arthritis and osteoporosis were significantly greater in women who reported bilateral oophorectomy. Results were most profound among women whose oophorectomy was performed before age 45 and among women who never used HRT. These results suggest that women who undergo oophorectomy for cancer prevention should be closely monitored for osteoporosis over the long term. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-01.

Sex Hormone Concentrations and the Risk of Breast Cancer Recurrence in Postmenopausal Women without Hot Flashes

We examined if the reduced risk of breast cancer events seen among women without baseline hot flash symptoms in the Women's Healthy Eating and Living (WHEL) dietary intervention trial was related to changes in sex hormone concentrations. Baseline and year one concentrations of total and bioavailable estradiol, and testosterone and sex hormone-binding globulin (SHBG) were compared by intervention arm among 447 postmenopausal women without hot flashes. Cox proportional hazard models tested interaction terms between study arm and baseline hormone concentrations adjusted for study site, antiestrogen use, positive nodes, tumor size, oophorectomy status, and hormone replacement therapy use. Sex hormone concentrations did not differ by study arm at baseline nor at year one. Twenty-two (9.8%) events occurred in the intervention arm versus 42 (18.9%) in the comparison arm (P = 0.009). Baseline bioavailable testosterone was significantly, positively associated with additional events (HR 1.69, 95% CI: 1.00-2.84; P = 0.049). There were significant interactions between the intervention and total (P = 0.015), and bioavailable (P = 0.050) testosterone: the intervention was more protective among participants with higher baseline total (HR 0.3, 95% CI: 0.2-0.7) or bioavailable (HR 0.4, 95% CI: 0.2-0.7) testosterone than for participants with lower baseline total (HR 0.8, 95% CI: 0.4-1.5) or bioavailable (HR 0.8, 95% CI: 0.4-1.5) testosterone. No significant effects were seen for estradiol or SHBG. The WHEL dietary intervention may have modified other risk factors of recurrence correlated with testosterone. Sex hormones should be considered as part of a larger biological system related to the risk of breast cancer recurrence.

Is there an association between hysterectomy and subsequent adiposity?

ObjectivesTo examine the associations between hysterectomy and subsequent adiposity and to investigate whether these associations vary by characteristics of hysterectomy and are independent of pre-hysterectomy adiposity and potential confounding factors. MethodsUsing information on women from the 1946 and 1958 British birth cohort studies (N=1790 and 4552, respectively), collected prospectively across life, regression analyses were used to examine the associations between hysterectomy and subsequent body mass index (BMI) and waist circumference. ResultsIn unadjusted analyses there was a difference of 1.18kg/m2 (95% CI: 0.64, 1.74) in mean BMI and of 2.72cm (1.45, 3.99) in waist circumference at age 44–45 years between women who had undergone hysterectomy and those who had not in the 1958 cohort, and differences of 0.76kg/m2 (−0.05, 1.57) and 0.34cm (−1.58, 2.26) at age 43 years and 0.81kg/m2 (0.14, 1.49) and 1.45cm (−0.15, 3.05) at age 53 years in the 1946 cohort. These differences attenuated and were no longer significant after adjustment for pre-hysterectomy BMI and confounders. There was no strong evidence of variation in associations by oophorectomy status, timing, route of or reason for procedure. ConclusionsThis study demonstrates that British women who had previously undergone hysterectomy had higher BMI and waist circumference in middle-age than others. These differences appear to be accounted for by the higher BMI in earlier adulthood and increased levels of risk factors associated with both adiposity and hysterectomy risk among women who had undergone hysterectomy. This suggests that women are unlikely to gain weight as a direct result of hysterectomy.

Postmenopausal Hormone Therapy and Risk of Cardiovascular Disease by Age and Years Since Menopause

Observational studies have demonstrated a lower risk of coronary heart disease (CHD) events in postmenopausal women taking hormone therapy, but, in contrast, clinical trials have shown no benefit and in some instances suggest an increased risk of CHD. This discrepancy may in part result from the timing of initial hormone therapy in relation to age and the interval since the onset of menopause. This report is a secondary analysis of Women's Health Initiative studies-all randomized controlled trials-in which 10,739 postmenopausal women with a history of hysterectomy were assigned to receive 0.625 mg daily of conjugated equine estrogens (CEE) or placebo, and another 16,608 not having hysterectomy received either CEE plus 2.5 mg of medroxyprogesterone acetate (MPA) or placebo. Hormone therapy did not lower the overall risk of CHD. After adjusting for risk factors, the hazard ratio (HR) for CHD was lower in women taking CEE alone than in those given both CEE and MPA. The overall risk of stroke was increased, with no apparent difference between individual trials. Although events became more numerous with advancing age, there was no significant added effect of hormone therapy by age for any outcome in the combined trials. The HR for CHD was 0.76 in women within 10 years of menopause, 1.10 for those 10 to 20 years after menopause, and 1.28 for those more than 20 years after menopause. Findings were similar for women with and those without previous cardiovascular disease. The effect of hormone therapy on the risk of stroke was not influenced by years since menopause. Estimated absolute excess risk figures associated with hormone therapy became progressively larger with increasing age starting at age 60 years. Age and years since menopause correlated with one another at a high level. There were no significant trends for hormone therapy by years since last treatment, and no significant interactions were noted between either previous hormone use or oophorectomy status on the one hand and, on the other, in-trial hormonal effects by age or years since menopause. These findings offer some reassurance that hormone therapy still is a reasonable option for the management of menopausal symptoms over the short term, but they do not imply that prolonged hormone use is safe. The investigators agree that hormone therapy is appropriate for the short-term relief of moderate or severe vasomotor symptoms-but not over the long-term to prevent cardiovascular disease.

Relation of demographic factors, menstrual history, reproduction and medication use to sex hormone levels in postmenopausal women

In postmenopausal women, levels of estrogens, androgens, and perhaps prolactin have been related to risk of breast and other hormonal cancers in women. However, the determinants of these hormone concentrations have not been firmly established. Associations among various demographic, menstrual, and reproductive factors, medication use and endogenous sex hormone concentrations (estradiol, free estradiol, estrone, estrone sulfate, testosterone, free testosterone, sex hormone binding globulin, androstenedione, dehydroepiandrosterone (DHEA), DHEA sulfate (DHEAS), dihydrotestosterone, and prolactin) were evaluated in a cross-sectional analysis from a simple random sample of 274 postmenopausal women selected from the Women's Health Initiative Dietary Modification Trial. In multiple regression analyses on log-transformed hormones, the concentrations of DHEA, and DHEAS were negatively and statistically significantly associated with age (both beta=-0.03, P<0.001, respectively). Estradiol, estrone, DHEA, and free testosterone concentrations were higher in African-American than in non-Hispanic White women, but after multivariate adjustment the associations were statistically significant only for free testosterone (beta=0.38, P=0.01). Women who had a history of bilateral oophorectomy had a mean 35% lower testosterone concentration compared with women with at least one ovary remaining (beta=-0.43, P=0.002), and lower free testosterone (beta=-0.42, P=0.04) after multivariate adjustment. Women who reported regular use of NSAIDs had higher DHEA concentrations (beta=0.20, P=0.04) and lower prolactin concentrations (beta=-0.18, P=0.02) compared with non-users. These results suggest that while age, oophorectomy status, and NSAID use may be associated with selected sex hormone concentrations, few menstrual or reproductive factors affect endogenous sex hormones in the postmenopausal period.

Sexualidad de la mujer histerectomizada: modelo predictivo al seto mes posterior a la cirugía

The effects of hysterectomy on sexuality has been extensively studied. To establish a model to predict the quality of sexual life in hysterectomized women, six months after surgery. Analytical, longitudinal and prospective study of 90 hysterectomized women aged 45+/-7 years. Two structured interviews at the time of surgery and six months later were carried out to determine the characteristics of sexuality and communication within the couple. In the two interviews, communication and the quality of sexual life were described as "good" in 72 and 77% of women, respectively (NS). The variables that had a 40% influence on the quality of sexual life sixth months after surgery, were oophorectomy status, the presence of orgasm, the characteristics of communication and the basal sexuality with the couple. The sexuality of the hysterectomized women will depend, on a great extent, of pre-surgical variables. Therefore, it is important to consider these variables for the education of hysterectomized women.

Early postoperative changes in testosterone, dehydroepiandrosterone sulfate, and sex hormone-binding globulin after hysterectomy with or without concomitant oophorectomy

To investigate the cross-sectional associations of hysterectomy and oophorectomy status, chronological age, and body mass index with early postoperative plasma levels of total and free T, DHEAS, and sex hormone-binding globulin (SHBG). A cross-sectional study. University hospital. Ninety-two women age 35-47 years who were scheduled for hysterectomy and/or oophorectomy, advocated for benign gynecological pathologies. Ninety-two eligible premenopausal women underwent hysterectomy and/or oophorectomy, with plasma T, DHEAS, and SHBG levels assayed before surgery and during the postoperative period. Effects of time x operation and age x operation interactions between oophorectomized and nonoophorectomized groups and within-subject main effect of time on plasma androgen levels. Of 92 women, hysterectomy alone was performed in only 49 (53.3%) cases. Oophorectomy, either unilateral or bilateral, was performed in 35.8% of cases. Age x within-group interactions exhibited an important difference (P=.03) in total T levels. The time x between- and within-group interaction effects on plasma DHEAS levels of postoperative day 7, compared with day 1, were statistically significant (P<.001). The effect of time x group interaction was remarkable, in terms of SHBG levels during the postoperative period. Age x oophorectomy interaction exhibited a statistically significant change of decline in DHEAS levels on postoperative day 7 (P=.05). The present study demonstrated a time and operation effect decline in plasma DHEAS levels. In contrast, the time x operation interaction on SHBG levels exhibited an increase toward postoperative day 7.

Effects of Conjugated Equine Estrogen on Risk of Fractures and BMD in Postmenopausal Women With Hysterectomy: Results From the Women's Health Initiative Randomized Trial

Further analyses from the Women's Health Initiative estrogen trial shows that CEE reduced fracture risk. The fracture reduction at the hip did not differ appreciably among risk strata. These data do not support overall benefit over risk, even in women at highest risk for fracture. The Women's Health Initiative provided evidence that conjugated equine estrogen (CEE) can significantly reduce fracture risk in postmenopausal women. Additional analysis of the effects of CEE on BMD and fracture are presented. Postmenopausal women 50-79 years of age with hysterectomy were randomized to CEE 0.625 mg daily (n = 5310) or placebo (n = 5429) and followed for an average 7.1 years. Fracture incidence was assessed by semiannual questionnaire and verified by adjudication of radiology reports. BMD was measured in a subset of women (N = 938) at baseline and years 1, 3, and 6. A global index was used to examine whether the balance of risks and benefits differed by baseline fracture risk. CEE reduced the risk of hip (hazard ratio [HR], 0.65; 95% CI, 0.45-0.94), clinical vertebral (HR, 0.64; 95% CI, 0.44-0.93), wrist/lower arm (HR, 0.58; 95% CI, 0.47-0.72), and total fracture (HR, 0.71; 95% CI, 0.64-0.80). This effect did not differ among strata according to age, oophorectomy status, past hormone use, race/ethnicity, fall frequency, physical activity, or fracture history. Total fracture reduction was less in women at the lowest predicted fracture risk in both absolute and relative terms (HR, 0.86; 95% CI, 0.68-1.08). CEE also provided modest but consistent positive effects on BMD. The HRs of the global index for CEE were relatively balanced across tertiles of summary fracture risk (lowest risk: HR, 0.81; 95% CI, 0.62-1.05; mid risk: HR, 1.09; 95% CI, 0.92-1.30; highest risk: HR, 1.04; 95% CI, 0.88-1.23; interaction, p = 0.42). CEE reduces the risk of fracture and increases BMD in hysterectomized postmenopausal women. Even among the women with the highest risk for fractures, when considering the effects of estrogen on other important health outcomes, a summary of the burden of monitored effects does not indicate a significant net benefit.

Prophylactic Oophorectomy Reduces Breast Cancer Penetrance During Prospective, Long-Term Follow-Up of BRCA1 Mutation Carriers

Breast cancer penetrance estimates in BRCA1 mutation carriers have varied from 40% to 85%; this heterogeneity has been attributed to variations in risk among different study populations. No study has taken oophorectomy status into account in estimating penetrance. Because prophylactic oophorectomy reduces breast cancer risk by approximately 50%, we hypothesized that population differences in oophorectomy prevalence might significantly influence breast cancer penetrance estimates. Females from multiple-case breast/ovarian cancer families that segregate deleterious BRCA1 mutations were observed prospectively for breast cancer incidence and oophorectomy. Within this cohort, 33 cases of breast cancer developed in 98 women with deleterious BRCA1 mutations during follow-up, yielding an estimated cumulative lifetime breast cancer risk of 80%. This estimate increased to 94% when the study participants were censored at the time of oophorectomy. Six of the 33 mutation-positive women who underwent oophorectomy during follow-up developed breast cancer, compared with 27 of 65 mutation carriers with intact ovaries (hazard ratio = 0.38; 95% CI, 0.15 to 0.97). Estimates of absolute breast cancer risk demonstrated that the protective effect of oophorectomy was strongest among women who were premenopausal at the time of surgery. When surgical status was ignored, the strong protective effect of oophorectomy, coupled with the high prevalence of the procedure in these families, led to a significantly lower estimate of the breast cancer penetrance in BRCA1 mutation carriers. Differing rates of oophorectomy likely represent an underappreciated basis for a portion of the heterogeneity in estimated breast cancer penetrance described in BRCA mutation carriers, particularly mutation carriers from extensively affected, multiple-case families.

Ovarian Conservation at the Time of Hysterectomy for Benign Disease

To the Editor: Prophylactic oophorectomy during hysterectomy for benign disease has recently been challenged1 using a Markov Decision Analysis. While this is appropriate from a mathematical perspective, as the conclusions may change future clinical practice, it is urgent to clarify some of the weaknesses of this approach. First, any decision analysis only incorporates the risks selected, not all risks. For example, gallbladder disease, which is associated with higher estrogen levels, is not considered. While one may suspect that the mortality associated with increased gallbladder surgery is minor, it is an illustration of the kind of risks overlooked. Second, the study is entirely dependent on the “risk estimates” incorporated. Figure 1 is entirely explicable by the difference in coronary heart disease risk assumed. Below age 55 the coronary heart disease relative risk (RR) is 2. This is decreased by 6% annually, but there are no data for post-65 years old, and so a RR 1 was assumed. Unfortunately, estrogen’s effect on coronary heart disease is highly debated and the Women’s Health Initiative (WHI)2 indicated that hysterectomy patients, regardless of oophorectomy status, had a significant increase in total mortality and fatal and nonfatal cardiovascular disease. This observation is ignored and would essentially remove the difference in Figure 1. Comparing Table 2 of the original paper (which should, but does not, include 95% confidence intervals) with Figure 1 shows that oophorectomy with estrogen therapy is not statistically significantly different from ovarian preservation. Other risks are selected by author consensus when studies conflict. Finally, the assertion by Parker et al that the difference in surgical mortality is insignificant disregards the probability (3–4%) of the need to reoperate for ovarian pathology. The writer believes the current algorithm is too crude as a basis for clinical judgment. A nulliparous smoker with a family history of endometrial cancer is at a far higher risk of ovarian cancer than one without these factors. The current paper would have us treat them the same. Clearly this is inappropriate.

Associations between Reproductive and Menstrual Factors and Postmenopausal Androgen Concentrations

Reproductive and menstrual characteristics, as well as high circulating estrogen and androgen concentrations, are associated with the risk of breast and ovarian cancer in postmenopausal women. To explore possible etiological relationships between menstrual and reproductive characteristics and cancer risk, we examined associations between menstrual and reproductive factors and serum concentrations of total testosterone, free testosterone, androstenedione, dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEA-S). This study was conducted in 167 postmenopausal women, using data from the pre-randomization visit of an exercise clinical trial. Participants were sedentary, overweight/ obese, and not on hormone therapy. DHEA-S concentrations were 42% higher, total testosterone concentrations were 35% lower, and free testosterone concentrations were 23% lower in women with both ovaries removed compared with those with both remaining (p = 0.01, p = 0.01, and p = 0.03, respectively). Women who had used herbal therapy in the past had, on average, 25% higher concentrations of total and free testosterone than women who had never used these herbal therapies (p = 0.03 and p = 0.004, respectively). No other significant associations were detected. Overall, this study does not support the hypothesis that reproductive or menstrual factors, with the exception of oophorectomy status, are associated with postmenopausal androgen concentrations.

Risk of Cardiovascular Disease by Hysterectomy Status, With and Without Oophorectomy

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in women and may vary by hysterectomy (or oophorectomy) status. This study compared CVD risk factors and rates between postmenopausal women who had and had not undergone hysterectomy, with or without oophorectomy. This analysis was conducted on 89 914 women in the Women's Health Initiative (WHI) Observational Study. Participants reported demographic characteristics, medical history, dietary habits, physical activity, medications, and previous hysterectomy (with or without oophorectomy). Baseline weight, height, waist circumference, and blood pressure were measured. CVD events were ascertained during 5.1 years of mean follow-up and adjudicated with standard criteria. Black, Hispanic, and American Indian women had higher rates of hysterectomy than white women (52.9%, 44.6%, and 49.2% versus 40.0%, respectively), and Asian/Pacific Islander women had lower rates (33.8%). Women with a hysterectomy (regardless of oophorectomy status) had an adverse risk profile at baseline compared with women with no hysterectomy, including a higher proportion of hypertension, diabetes, high cholesterol, obesity, and lower education, income, and physical activity (all P<0.01). Total mortality and fatal and nonfatal CVD were higher among women with a hysterectomy. Hysterectomy (regardless of oophorectomy status) was a significant predictor of CVD (HR: 1.26, P<0.001). After adjustment for demographic variables and CVD risk factors, the effect was reduced and nonsignificant. Women with a hysterectomy had a worse risk profile and higher prevalence and incidence of CVD in this cohort. Multivariate models suggest that hysterectomy is not the major determinant of this outcome; rather, CVD risk may be due to the more adverse initial risk profile of women who had undergone hysterectomy.

Hysterectomy status and life satisfaction in older women.

This cross-sectional, population-based study examines the long-term effect of hysterectomy on life satisfaction in 1177 women aged 55-94 years. A 1992 mailed survey obtained information on menopausal history, including hysterectomy and oophorectomy status, and estrogen use. Two standardized measures ascertained general life satisfaction: the Life Satisfaction Index-Z (LSI-Z) and the Satisfaction with Life Scale (SWLS). A separate question asked participants to rate life satisfaction (better, the same, or worse) after menopause or hysterectomy compared with before. Twenty-three percent of the women reported hysterectomy with bilateral oophorectomy an average of 24 years earlier, and 26% reported hysterectomy with ovarian conservation an average of 28 years earlier. Women who were 20 or more years posthysterectomy or postmenopause were significantly more likely to rate their life satisfaction as better than were women 5 or fewer years posthysterectomy or postmenopause (p < 0.01). Among women with a hysterectomy, 53% with oophorectomy and 60% with ovarian conservation rated life satisfaction better after hysterectomy. Only 42.2% of women without a hysterectomy rated life satisfaction as better after menopause (p < 0.001). Differences persisted after adjustment for age and other covariates: p < 0.01 for hysterectomy with ovarian conservation and p < 0.001 for hysterectomy with bilateral oophorectomy vs. no hysterectomy. Even among women who had never used estrogen, a significantly greater proportion of those who had a hysterectomy with ovarian conservation rated their life satisfaction as better compared with women who did not have a hysterectomy (p < 0.05). There were no differences in standard life satisfaction scores (LSI-Z or SWLS) by hysterectomy status. There are no long-term adverse effects of hysterectomy on life satisfaction. When queried specifically, women report increased life satisfaction following hysterectomy. Relief from symptoms necessitating hysterectomy may be responsible for this increase. This difference may be specific to hysterectomy because there were no differences in general life satisfaction as assessed with standardized measures.

Hysterectomy, oophorectomy, and cognitive function in older women.

It has been proposed that estrogen deficiency is a cause of memory loss in postmenopausal women. Bilateral oophorectomy leads to an abrupt decrease in gonadal hormone levels including testosterone. Hysterectomy with ovarian conservation may also lead to a decline in ovarian hormones. This study examines the effects of hysterectomy and oophorectomy on cognitive function in a large sample of older, postmenopausal women with and without current estrogen replacement therapy. Cross-sectional. Community-based sample in Southern California. Subjects were 885 postmenopausal women aged 60 to 89 who were initially enrolled in the Rancho Bernardo Study between 1972 and 1974 and had a follow-up clinic visit in 1988-91. All were Caucasian, middle to upper-middle class, relatively well educated, and ambulatory. Participants completed 12 standardized tests of cognitive function in 1988-91. Hysterectomy and oophorectomy status were assessed and use of estrogen therapy was also ascertained and validated. Of the 885 women, whose mean age +/- standard deviation was 74.3 +/- 7.5, 225 reported having had a hysterectomy with conservation of one or both ovaries and 190 reported having a hysterectomy with bilateral oophorectomy. Current estrogen use was reported by 35.4%. Among women not using estrogen, there were no significant differences on mean cognitive function scores by hysterectomy and oophorectomy status. Among current estrogen users, after adjustment for age, education, age at menopause, and past estrogen use, those with a hysterectomy and bilateral oophorectomy performed significantly less well on serial sevens and Trails B. These differences, although statistically significant, were small and unlikely to be of clinical significance. No differences in cognitive function were observed between women who had a hysterectomy with ovarian conservation and intact women. The present study suggests that, overall, there are no long-term effects of hysterectomy and bilateral oophorectomy on cognitive function and does not support the thesis that estrogen deficiency is associated with poor cognitive function in postmenopausal women.

Prevalence and clustering of menopausal symptoms in older women by hysterectomy and oophorectomy status.

This study examines the association of hysterectomy and oophorectomy with the prevalence and clustering of menopausal symptoms in a large population-based sample of older women. Subjects were 1121 women aged 50-89 from the Rancho Bernardo Study. Information on menopause, hysterectomy, oophorectomy, estrogen use, and other covariates was obtained in 1984-1987. A 1989 mailed survey obtained information on menopausal symptoms. In this sample, 22.1% reported hysterectomy with bilateral oophorectomy, and 25.3% reported hysterectomy with ovarian conservation. Mean time since hysterectomy was 26 (+/-12) years. Overall, 37% reported current estrogen use, and 40% reported past use. The duration of estrogen use was longer for women who had a hysterectomy (p < 0.001). Age-adjusted comparisons indicated that more women who had a hysterectomy, with or without bilateral oophorectomy, reported greater energy after menopause (p = 0.003 and p = 0.001, respectively), and more women with bilateral oophorectomy reported greater interest in sex (p = 0.007) and that life was getting better (p = 0.012) than women with natural menopause. Principal components factor analysis of the symptom data for all women yielded four factors: psychological, vasomotor, positive feelings, and self-image. Analyses performed within each group of women yielded similar factors and loadings. Adjusted comparisons of factor scores indicated that positive feelings were significantly higher in women who had a hysterectomy, with or without bilateral oophorectomy (p < 0.01) than in women with natural menopause. This difference was limited to current estrogen users. Vasomotor symptoms, psychological symptoms, and negative self-image did not differ by hysterectomy or oophorectomy status before or after stratification for estrogen use (p > 0.10). This study found after a hysterectomy, women are more likely to recall positive feelings about their menopause than women with natural menopause. Relief from symptoms leading to hysterectomy and use of replacement estrogen may be partly responsible. Results do not support the thesis that surgical menopause is associated with a sustained increased prevalence of vasomotor, psychological, or other symptoms.

Hysterectomy, Oophorectomy, and Endogenous Sex Hormone Levels in Older Women: The Rancho Bernardo Study

This study examines the cross-sectional association of hysterectomy and oophorectomy status, chronological age, and years since menopause with plasma levels of total and bioavailable testosterone and estradiol, androstenedione, estrone, and sex hormone-binding globulin (SHBG) in community-dwelling postmenopausal women who were not using estrogen replacement therapy. Six hundred and eighty-four women, aged 50–89 yr, were surveyed for hysterectomy and oophorectomy status and had plasma obtained between 1984–1987. Of these, 438 (67%) had not undergone hysterectomy or oophorectomy (intact), 123 (18%) reported hysterectomy with bilateral oophorectomy, and 123 (18%) reported hysterectomy with conservation of 1 or both ovaries. After adjustment for age and body mass index, both total and bioavailable testosterone levels were reduced by more than 40% (P < 0.001) in hysterectomized women with bilateral oophorectomy compared to those in intact women, with intermediate levels observed in hysterectomized women with o...

Hysterectomy, oophorectomy, and endogenous sex hormone levels in older women: the Rancho Bernardo Study.

This study examines the cross-sectional association of hysterectomy and oophorectomy status, chronological age, and years since menopause with plasma levels of total and bioavailable testosterone and estradiol, androstenedione, estrone, and sex hormone-binding globulin (SHBG) in community-dwelling postmenopausal women who were not using estrogen replacement therapy. Six hundred and eighty-four women, aged 50-89 yr, were surveyed for hysterectomy and oophorectomy status and had plasma obtained between 1984-1987. Of these, 438 (67%) had not undergone hysterectomy or oophorectomy (intact), 123 (18%) reported hysterectomy with bilateral oophorectomy, and 123 (18%) reported hysterectomy with conservation of 1 or both ovaries. After adjustment for age and body mass index, both total and bioavailable testosterone levels were reduced by more than 40% (P < 0.001) in hysterectomized women with bilateral oophorectomy compared to those in intact women, with intermediate levels observed in hysterectomized women with ovarian conservation. Androstenedione levels were about 10% lower in hysterectomized women with or without ovarian conservation compared to those in intact women (P = 0.039). Total estradiol levels tended to be lower (P = 0.095) in bilaterally oophorectomized women. Levels of bioavailable estradiol, estrone, and SHBG did not differ by hysterectomy and oophorectomy status. Among intact women, total, but not bioavailable, testosterone levels increased with age (P = 0.015), reaching premenopausal levels for the 70-79 decade with relatively stable levels thereafter. Among oophorectomized women, total and bioavailable testosterone levels did not vary with age and were 40-50% lower than those in intact women throughout the 50-89 yr age range. Androstenedione levels decreased 27% and SHBG levels increased 30% (P < 0.001) with age in intact, but not oophorectomized, women. Levels of other hormones did not vary with age. Stratification by years since menopause or surgery yielded similar results. These results demonstrate that the postmenopausal ovary remains a critical source of androgen throughout the lifespan of older women. The clinical consequences of lower testosterone levels years after oophorectomy are unknown. Reconsideration of prophylactic oophorectomy and clinical trials to evaluate the effects of androgen replacement after oophorectomy are needed.

Oophorectomy Status and Bone Density in Older, Hysterectomized Women

This study examined the long-term effects of hysterectomy, with and without bilateral oophorectomy, and treatment with estrogen replacement on bone mineral density in older hysterectomized women. Subjects were 346 women 60-89 years of age, who were participants in the Rancho Bernardo Study and attended a follow-up clinic visit in 1988-1991. Bone density was measured at the ultradistal wrist, midshaft radius, lumbar spine and hip. Of these women, 182 had a hysterectomy with conservation of one or both ovaries and 164 had a hysterectomy with bilateral oophorectomy. Current estrogen users had the highest bone densities; those who never used estrogen replacement had the lowest. Only 9.1% of oophorectomized women, compared to 19.2% of those with ovarian conservation had never used estrogen (P < .01). After adjustment for covariates including estrogen replacement therapy, hysterectomized women with ovarian conservation had marginally higher bone densities at the wrist (P < .09) and spine (P < .06) than oophorectomized women. We found significant differences only among women currently using estrogen (P < .05 for wrist and P < .01 for spine densities, respectively). Bone density did not differ at any site by oophorectomy status among past or never users of estrogen. Hysterectomized women who use estrogen replacement therapy have better bone density, regardless of a bilateral oophorectomy. In addition, bilateral oophorectomy may not have a long-term negative effect on bone density; hysterectomized women who do not use estrogen appear to have equivalent bone density whether or not they had a bilateral oophorectomy.