title: The association of hysterectomy and menopause: a prospective cohort study.
abstract: OBJECTIVE
  To determine whether or not hysterectomy leads to an earlier onset of the menopause.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Gynaecology service of large urban hospital.
  
  
  METHODS
  Premenopausal women with and without hysterectomy.
  
  
  METHODS
  Multivariate survival analysis techniques were used to adjust for differences in initial follicle stimulating hormone (FSH) levels, body mass index, smoking and unilateral oophorectomy between the groups.
  
  
  METHODS
  FSH levels were measured for five years following hysterectomy and compared with the comparison group. Menopause was defined as a single FSH measurement of at least 40 IU/L.
  
  
  RESULTS
  Two hundred and fifty-seven women undergoing hysterectomy were compared with 259 women who had not undergone a hysterectomy. Fifty-three women (20.6%) in the hysterectomy group and 19 women (7.3%) in the comparison group reached menopause over the five years of the study. Women in the hysterectomy group with a pre-operative FSH <10 IU/L reached menopause 3.7 years (95% CI 1.5-6.0 years) earlier than women in the comparison group independent of BMI, smoking and unilateral oophorectomy. Twenty-eight women in the hysterectomy group had unilateral oophorectomy and 10 (35.7%) of these women reached menopause over the five years of follow up. Women in the hysterectomy group with unilateral oophorectomy reached menopause 4.4 years (95% CI 0.6, 7.9 years) earlier than women with both ovaries in the hysterectomy group independent of baseline FSH, BMI and smoking.
  
  
  CONCLUSIONS
  Hysterectomy is associated with an earlier onset of menopause. Hysterectomy with unilateral oophorectomy is associated with an even earlier onset of the menopause in this study.
authors.affiliation: Department of Obstetrics and Gynecology, National Women's Hospital, University of Auckland, New Zealand.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Farquhar
authors.forename: Lynn
authors.initials: L
authors.lastname: Sadler
authors.forename: Sally A
authors.initials: SA
authors.lastname: Harvey
authors.forename: Alistair W
authors.initials: AW
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000465:Algorithms; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008593:Menopause / Q000097:blood; D008875:Middle Aged; D015999:Multivariate Analysis; D010052:Ovariectomy; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology*; D011446:Prospective Studies
chemical_list: D005640:Follicle Stimulating Hormone