Ovarian function and ovarian blood supply following premenopausal abdominal hysterectomy

Abstract

IntroductionThe issue of conserving the ovaries at hysterectomy in premenopausal women with benign gynecologic disease has been the subject of considerable controversy. Some clinicians prefer prophylactic oophorectomy in premenopausal women during hysterectomy to prevent future development of malignant changes in conserved ovaries. Other clinicians prefer to conserve apparently normal ovaries, because bilateral oophorectomy in premenopausal women results in an abrupt imbalance, sudden onset of menopausal symptoms, decreased libido, increased cardiovascular risk and osteoporosis.Material and methodsTwo hundred and twenty multipara women (who had completed their families), with benign uterine pathology were included in this prospective study for abdominal hysterectomy with bilateral ovarian preservation. Pre-operative vaginal ultrasound, Doppler studies, diagnostic hysteroscopy and endometrial biopsy were done followed by laboratory studies including Anti-mullerian hormone (AMH), follicle stimulating hormone (FSH) and estradiol for all studied women. Doppler studies, AMH, FSH and estradiol were repeated 6 and 12 months post-operative for assessment of the ovarian function and ovarian blood supply after hysterectomy.ResultsPre-operative AMH, FSH and estradiol of the studied women were statistically insignificant compared to AMH, FSH and estradiol 6 and 12 months post-operative. Twelve months post-operative right and left ovarian volumes (6.92 ± 0.18 and 6.85 ± 0.19 cm3, respectively) were significantly larger than pre-operative right and left ovarian volumes (6.19 ± 0.22 and 5.86 ± 0.23 cm3, respectively), and, 12 months post-operative right and left ovarian pulsatility indices (2.92 ± 0.15 and 2.96 ± 0.16 cm/s, respectively) were significantly lower than pre-operative right and left ovarian pulsatility indices (3.45 ± 0.19 and 3.36 ± 0.2 cm/s, respectively). Eight (3.6%) cases of the studied women developed an ovarian cyst 6 months after hysterectomy, 3 were spontaneously resolved and the remaining 5 (2.27%) cases underwent exploratory laparotomy.ConclusionsThere is no evidence of ovarian dysfunction affecting conserved ovaries one year after hysterectomy in premenopausal women as evident by AMH, FSH and estradiol. Furthermore, an increased ovarian volume and reduced ovarian pulsatility indices indicate a possible increase in ovarian blood supply, and preserved non-compromised ovarian function.

Effect of Hysterectomy on Ovarian Reserve in the Early Postoperative Period Based on the Type of Surgery

“…It is controversial whether hysterectomy with ovarian preservation affects ovarian reserve [ 3 ]. The assessment of the ovarian reserve using serial AMH level measurement is considered a useful tool for evaluating the ovarian function after hysterectomy [ 3 11 ], and several studies have been conducted to ascertain whether the postoperative AMH level decreases when compared with the preoperative level, but the results are conflicting [ 11 12 13 14 15 16 17 ]. Some authors reported that hysterectomy with ovarian conservation could accelerate ovarian failure [ 8 9 10 ].…”

“…A prospective cohort study of 83 patients with symptomatic uterine fibroids who underwent LH with conservation of both ovaries reported that serum AMH levels were decreased significantly at 4 months after LH [ 15 ], On the contrary, Abdelazim et al [ 16 ] reported that the preoperative AMH level (1.75 ± 4.61 ng/mL) of the 220 studied women was not significantly different compared with the AMH level 6 and 12 months after AH (1.78 ± 2.45 ng/mL and 1.81 ± 2.19 ng/mL, respectively). The results from these two studies are in agreement with our results that serum AMH levels significantly decreased immediately after surgery in the LAVH group, but not in the AH group.…”

Does Saving Uterus Save Ovaries?

“…More recent data suggest that there is no significant difference in ovarian function after premenopausal hysterectomy up to 1 year. Abdelzeim and colleagues studied ovarian blood supply by Doppler and concluded that the ovarian pulsatile index (PI) reduced and ovarian volume increased indicating increased blood supply and documented maintained AMH, FSH and estradiol levels at 1-year follow-up period [5]. Nahás et al also observed reduced PI values on Doppler ultrasonography suggesting decrease in the resistance flow in the ovarian arteries in women of reproductive age who underwent total abdominal hysterectomy [6].…”

Primary ovarian insufficiency and fertility preservation: review article

“…Toxins, viral infection, cigarette smoking, chemicals and pesticides can speed the ovarian follicle depletion through stimulation of the autoimmune destruction of the ovarian follicles [12,13]. The POI may develop after a hysterectomy in spite of ovarian preservation due to disturbed ovarian blood supply after the hysterectomy [14].…”