Association of Ovary-Sparing Hysterectomy With Ovarian Reserve

OBJECTIVE: To evaluate the association of hysterectomy on ovarian function by comparing antimu "llerian hormone, a marker of ovarian reserve, before and after hysterectomy. METHODS: The Prospective Research on Ovarian Function study prospectively followed 1) premenopausal women undergoing ovary-sparing hysterectomy for benign indications, and 2) a referent cohort with similar age distributions and intact reproductive organs; they reported that women undergoing hysterectomy became menopausal 1.9 years earlier than referents. In a planned secondary analysis, baseline antimu "llerian hormone levels and the absolute change and percentage change in antimu "llerian hormone levels between baseline and 1-year follow-up were compared between groups. RESULTS: Baseline median antimu "llerian hormone levels were similar between the hysterectomy group (n=148) and the referent group (n=172). After 1 year, patients undergoing hysterectomy had a significantly greater median percentage decrease (240.7% compared with -20.9%; P<.001), had a higher proportion with undetectable antimu "llerian hormone (12.8% compared with 4.7%; P=.02), and had on average 0.77 times the antimu "llerian hormone level (P=.001) compared with referents. These differences were attenuated among white women but remained significant among black women. Comparisons of women stratified by low or high ovarian reserve at baseline or among propensity score-matched cohorts showed similar findings; however, the absolute median change in antimu "llerian hormone levels was similar between groups (-0.3 compared with -0.2; P=.31). CONCLUSION: Women undergoing hysterectomy had similar antimu "llerian hormone levels at baseline and experienced a greater percentage decrease in levels after 1 year compared with referents, suggesting that hysterectomy may lead to ovarian damage that is unrelated to baseline ovarian reserve.