Does a hysterectomy with unilateral oophorectomy (removal of one ovary) cause premature ovarian failure?

Hysterectomy with Unilateral Oophorectomy and Risk of Premature Ovarian Failure

Hysterectomy with unilateral oophorectomy significantly increases the risk of premature ovarian failure, with women having nearly a threefold higher risk compared to women without hysterectomy. 1

Risk Assessment

• Women who undergo hysterectomy with unilateral oophorectomy have a hazard ratio of 2.93 (95% CI 1.57-5.49) for developing premature ovarian failure compared to women with intact uteri 1
• Even hysterectomy alone with ovarian preservation increases risk of earlier ovarian failure (hazard ratio 1.74,95% CI 1.14-2.65) 1
• Vaginal hysterectomy appears to have a higher risk (hazard ratio 2.04,95% CI 1.33-3.14) compared to abdominal hysterectomy for causing earlier ovarian failure 2
• Approximately 14.8% of women with hysterectomies experience ovarian failure after 4 years of follow-up compared with 8.0% of women with intact uteri 1

Mechanisms of Ovarian Failure After Hysterectomy

• Hysterectomy may compromise ovarian blood supply by disrupting the utero-ovarian vascular connections 1
• Removal of one ovary further reduces overall ovarian reserve, compounding the risk 2
• The remaining single ovary after unilateral oophorectomy has reduced overall follicular pool, accelerating the timeline to menopause 3
• Endocrine studies show that even when cycles remain, hormone levels (progesterone and estrogen) may be lower than in age-matched women without hysterectomy 4

Clinical Implications

• Women with unilateral oophorectomy should be monitored for signs of premature ovarian failure, including irregular menses, amenorrhea, and symptoms of estrogen deficiency 3
• Baseline follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol levels should be assessed in patients at risk 3
• Anti-Müllerian hormone (AMH) correlates well with ovarian reserve and is better than age, basal FSH, estradiol, and inhibin B in assessing ovarian function 3
• Bone mineral density testing should be considered for patients showing signs of hypogonadism 3

Management Considerations

• Hormone replacement therapy should be considered for women experiencing premature menopause due to hysterectomy with unilateral oophorectomy, as it can prevent detriments to bone health, cardiovascular health, and quality of life 3
• Hormone therapy should be continued until the average age of natural menopause in women with premature ovarian failure 5
• Patients should be educated about the importance of reporting symptoms of estrogen deficiency promptly 3
• Referral to an endocrinologist or gynecologist is warranted for patients with signs and symptoms of ovarian dysfunction and/or abnormal hormone levels 3

Special Considerations

• For patients with Lynch syndrome requiring hysterectomy, the timing of oophorectomy should be carefully considered, as premature menopause due to oophorectomy can cause detriments to bone health, cardiovascular health, and quality of life 3
• In endometriosis patients, hysterectomy with ovarian conservation may lead to higher reoperation rates (13%) compared to those with bilateral oophorectomy (5%), though pain outcomes appear similar between groups 6

Conclusion

Hysterectomy with unilateral oophorectomy significantly increases the risk of premature ovarian failure. Patients should be counseled about this risk prior to surgery and monitored closely afterward for signs of ovarian dysfunction. Hormone replacement therapy should be considered for those who develop premature ovarian failure to mitigate the long-term health consequences.