Hysterectomy may lead to early menopause

By Sophie Ramsey

BMJ Group News

What do we know already?

Many women have hysterectomies, with around 40,000 carried out by the NHS each year. The operation is sometimes done to treat cancer, but it’s often used to treat other conditions, including heavy periods and fibroids (lumps in the womb).

If a woman having the surgery hasn’t gone through the menopause, surgeons usually remove her womb but leave one or both of her ovaries intact, so they can keep producing hormones. This is to prevent an early menopause, which increases a woman’s risk of weak bones (osteoporosis), heart disease, and other problems.

Even so, doctors have long suspected that women who retain their ovaries may be more likely to go through an early menopause after this operation. Studies haven’t provided a clear answer, as most have been small or had other problems, such as relying on women to recall when they went through the menopause.

Researchers have now done a large, five-year study comparing 406 women who had a hysterectomy with 465 women of similar ages and backgrounds who did not have the surgery. None of the women had gone through the menopause at the start of the study. Their ages ranged from 30 to 47.

What does the new study say?

Women who had a hysterectomy were nearly twice as likely to go through the menopause during the study. After roughly four years of follow-up, about 15 percent of the women in the hysterectomy group had gone through the menopause, compared with 8 percent of the women who didn’t have the surgery.

The risk of menopause was highest for women who had one of their ovaries removed, but it still remained high even when both ovaries were left in place.

How reliable is the research?

This is the largest study to date on hysterectomies and early menopause, and it was carefully done. For example, rather than relying on women to say whether they’d gone through the menopause, the researchers regularly checked their levels of a hormone linked to the menopause.

The study’s findings are also similar to those of an earlier trial, which was good-quality but smaller.

However, we still can’t be certain that women had a higher risk of an early menopause because of their surgery, as this type of study can’t show cause and effect. It’s possible that some women were more likely to go through the menopause during the study because of the underlying problem that prompted their surgery. For example, for women who had surgery for heavy periods, their heavy bleeding might have been a sign of the menstrual changes that can happen before the menopause.

What does this mean for me?

There are a couple of messages to take from this study. First, if you are weighing up whether or not to have a hysterectomy, you and your doctor can discuss the chance of an early menopause. Together, you can decide whether the benefits outweigh the possible risks for you, or whether another treatment might be a better option.

Also, if you have already had a hysterectomy, you and your doctor can be alert to the possibility of an early menopause. If it occurs, you can take early steps to lower your chances of related problems, such as weakened bones.