Effect of exclusion: Rates of hysterectomy and comparisons of age at natural menopause

Abstract

The objectives of this study were to identify factors related to history of hysterectomy; to evaluate whether or not subgroups with different rates of hysterectomy also report significantly different mean ages at natural menopause; and to consider how variation in rates of hysterectomy may affect intrapopulation and cross‐population comparisons of median ages at natural menopause. Data were drawn from a community sample in upstate New York. It is demonstrated that hysterectomy rates are not random with respect to variables that are also related to age at natural menopause. For example, women reporting high levels of education reported lower rates of hysterectomy and earlier mean ages at menopause. In addition, median ages at menopause and rates of hysterectomy were examined by correlation and regression analysis across a selection of industrialized countries. Avenues for further study are suggested. Am. J. Hum. Biol. 11:687–693, 1999. © 1999 Wiley‐Liss, Inc.

Risk factors for hysterectomy among Mexican‐American women in the U.S. southwest

“…One difference between our results and those of earlier studies is the overall low levels of education reported by women in the HHANES sample. For example, the effect of education on hysterectomy rates in upstate New York was most obvious between women who had stopped at a college education and those who had gone on to graduate school (Leidy, 1999). In our analyses, those who had finished 6 years of school were over one and one-half times more likely (odds ratio 1.622) to have had a hysterectomy than were those women who had fewer completed years of education.…”

“…Contrary to the findings of Kjerulff et al (1993b), Leidy (1999), andMeilahan et al (1989), education increased the risk of hysterectomy. One difference between our results and those of earlier studies is the overall low levels of education reported by women in the HHANES sample.…”

“…Leiomyoma (fibroids) is the most common indication for hysterectomy, along with abnormal uterine bleeding, endometriosis, uterine prolapse, and gynecological malignancies (Lepine etal.,1997).WithintheU.S.,hysterectomyrates vary across geographic regions (Bernstein et al, 1992;Haas et al, 1993;NYSDH, 1988). Factors related to a higher risk of hysterectomy include lower education, occupational status and income levels (Brett et al, 1997;Kjerulff et al, 1993a,b;Leidy, 1999;Marks and Shinberg, 1997;Meilahn et al, 1989) previous tubal ligation (Goldhaber et al, 1993;Hillis et al, 1998), having a male physician or a physician with less recent medical training (Bickell et al, 1994), insurance coverage (Geller et al, 1996), use of IUD, and history of miscarriage (Brett et al, 1997;Geller et al, 1996).…”

Biological and behavioral determinants of fertility in Tierra del Fuego

“…These results suggest that the timing of the onset of natural sterility varies little among populations, except in cases where sexual infectious diseases are widespread. Then, factors such as taboos against intercourse at older ages (Leidy, 1993), disease-induced sterility (Pennington and Harpending, 1991;Jenkins, 1993), or the use of contraception and sterilizations (Leidy, 1999;Barroso et al, 2003) can vary the values in human populations. In Tierra del Fuego, women who were sterilized showed an earlier age at last birth than natural menopausal women, but the differences were not statistically significant (Table 6).…”

Menopause as a measure of population health: An overview

“…Johnston (2001) estimated a rate of surgical menopause of 43% among Blackfeet women of ages 50-69 years. Because hysterectomies are not random but are related to a woman's level of education and other social characteristics, studies that exclude women with hysterectomies may misrepresent the timing of menopause (Leidy, 1999). Further, many postmenopausal women take hormone replacement therapy (Brown et al, 2001); hence, the frequency of hot flash experience prior to interview is correspondingly low.…”