Published: 2018-03-27

Assessment of ovarian function by clinical, hormonal and sonological parameters in post hysterectomy premenopausal women

G. D. Maiti, Darshana Wayzade, M. K. Tangri, Shilpa Gupta, Vibhu Chatterjee


Background: Hysterectomy with or without ovarian preservation is one of the common gynaecological major surgery performed worldwide. Ovarian function in future life therefore remains a contentious subject when ovaries are preserved. Assessment of ovarian function was done by clinical, hormonal and sonological parameters in post hysterectomy premenopausal women to assess, onset of menopausal symptoms, serum hormonal levels, and anatomical status.

Methods: The study was a prospective observational study of 110 premenopausal patients of 30 to 50 years of age undergoing hysterectomy for benign uterine conditions carried out from September 2014 to August 2016. Patients were followed up after operation at 3 months, 6 months and 1 year. Serum LH, serum FSH, serum Estrogen, bilateral ovarian volume and bilateral ovarian Doppler study were done at baseline and each visit. Patients were interviewed at each visit for menopausal symptoms. Menopausal Rating scale (MRS) questionnaire was used as a basis for assessing menopausal symptoms.

Results: Significant difference noted in all the parameters like serum FSH, right and left ovarian volume and right and left ovarian pulsatility index at period of one year compared to preoperative values. No significant difference seen for serum LH and serum estrogen at period of one year. At 1 year 34 patients (34%) developed menopausal symptoms.

Conclusions: For all premenopausal patients who undergo hysterectomy for benign conditions of uterus with their ovaries preserved, proper follow up should be done after the surgery for assessing ovarian function at intervals.


Estrogen, Hysterectomy, Menopausal symptoms, Ovarian function, Ovarian doppler, Ovarian volume

Full Text:



Singh AJ, Arora AK. Profile of menopausal women in rural north India. Climacteric. 2005 Jun;8(2):177-84.

Singh A, Arora AK. Why hysterectomy rates are lower in India. Indian J Community Med. 2008 Jul;33(3):196-7.

Gallagher JC. Effect of early menopause on bone mineral density and fractures. Menopause. 2007 May-Jun;14(3 Pt 2):567-71.

Jacobsen BK, Heuch I, Kvale G. Age at natural menopause and all-cause mortality: a 37-year follow-up of 19,731 Norwegian women. Am J Epidemiol. 2003 May;157(10):923-9.

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 84. Elective and risk reducing salpingo-oophorectomy. Obstet Gynecol. 2008;111:231-41.

Berek JS, Chalas E, Edelson M. Prophylactic and risk reducing bilateral salpingo-oopherectomy: recommendations based on risk of ovarian cancer. Obstet Gynecol. 2010;116:1088-95.

Tinkanen H, Kujansuu E, Laippala P. The association between hormone levels and vascular resistance in uterine and ovarian arteries in spontaneous menstrual cycles: a Doppler ultrasound study. Acta Obstet Gynecol Scand. 1995 Apr;74(4):297-301.

Heinemann LAJ, Potthof FP, Schneider HP. International version of the menopause rating scale (MRS). Health Qual Life Outcomes. 2003;1:28.

Patricia GM, Evan RM, Joellen MS, Edwin SI, Frances W et al. Effect of Hysterectomy With Ovarian Preservation on Ovarian Function. Obstet Gynecol. 2011 December;118(6):1271-9.

Ahn EH, Bai SW, Song CH. Effect of hysterectomy on conserved ovarian function. Yonsei Med J. 2002 Feb;43(1):53-8.

Chalmers C. Does hysterectomy in premenopausal woman affect ovarian function? Med Hypotheses. 1996 Jun;46(6):573-5.

Cooper GS, Thorp JM. FSH levels in relation to hysterectomy and to unilateral oophorectomy. Obstet Gynaecol. 1999 Dec;94(6):969-72.

Siddle N, Sarrel P, Whitehead M. The effect of hysterectomy on the age at ovarian failure: identification of a subgroup of women with premature loss of ovarian function and literature review. Fertil Steril. 1987 Jan;47(1):94-100.

Bhattacharya S, Mollison J, Pinion S. A comparison of bladder and ovarian function two years following hysterectomy or endometrial ablation. Br J Obstet Gynaecol. 1996 Dec;103(12):898-903.

Dogan MM, Basaran Z, Ekici E. Effect of hysterectomy on ovarian blood supply and function. J Obstet Gynaecol. 1998;18:263-6.

Stone SC, Dickey RP, Mickal A. The acute effect of hysterectomy on ovarian function. Am J Obstet Gynecol. 1975 Jan;121(2):193-7.

Souza AZ, Fonseca AM, Izzo VM, Clauzet RM, Salvatore CA. Ovarian histology and function after total abdominal hysterectomy. Obstet Gynecol. 1986 Dec;68(6):847-9.

Avanie P, Deepali H, Subhash K. Assessment of menopausal symptoms in perimenopause and postmenopause women above 40 years in rural area. IJHBR. 2013;1(3):166-174.

Pavlik EJ, DePriest PD, Gallion HH. Ovarian volume related to age. Gynecol Oncol. 2000Jun; 77(3):410-2.

Kelsey TW, Wallace WHB. Ovarian volume correlates strongly with the number of nongrowing follicles in the human ovary. Obstet Gynecol Int. 2012;2012:1-5.

Backer LC, Rubin CS, Marcus M, Kieszak SM, Schober SE. Serum follicle-stimulating hormone and luteinizing hormone levels in women aged 35-60 in the U.S. population: the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). Menopause. 1999;6(1):29-35.