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Yuk JS, Yang SW, Yoon SH, Kim MH, Seo YS, Lee Y, Kim J, Yang K, Gwak G, Cho H. The increased risk of colorectal cancer in the women who underwent hysterectomy from the South Korean National Health Insurance Database. BMC Womens Health 2023; 23:519. [PMID: 37775754 PMCID: PMC10542264 DOI: 10.1186/s12905-023-02642-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/08/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Several population-based studies and observational studies have shown that oophorectomy is associated with an increased risk of colorectal cancer (CRC), and hormone replacement therapy has been associated with a reduction in the risk of colorectal cancer. This study was carried out to investigate whether hysterectomy, which may affect the levels of female hormones, is associated with a risk of cancer of the specific gastrointestinal tract. METHODS This population-based retrospective cohort study was conducted using insurance data provided by the Health Insurance Review and Assessment Service (HIRA) from January 1, 2007, to December 31, 2020. The hysterectomy group included 40- to 59-year-old women who underwent hysterectomy with uterine leiomyoma or uterine endometriosis from January 1, 2011, to December 31, 2014. The control group included women aged 40 to 59 years who visited medical institutions for medical examination from January 1, 2011 to December 31, 2014. RESULTS The hysterectomy and non-hysterectomhy groups comprised 66,204 and 89,768 subjects, respectively. The median ages in the non-hysterectomy group and hysterectomy group were 48 (range: 43-53) and 46 (range: 44-49) years, respectively. In the unadjusted results of the analysis, all colorectal cancer (CRC) increased in the hysterectomy alone group (HR 1.222, 95% confidence interval (CI) 1.016-1.47, p = 0.033), sigmoid colon cancer increased in the hysterectomy alone group (HR 1.71, 95% CI 1.073-2.724, p = 0.024), and rectal cancer increased in the hysterectomy with adnexal surgery group (HR 1.924, 95% CI 1.073-2.724, p = 0.002). The adjusted results showed that all CRC increased in the hysterectomy alone group (HR 1.406, 95% CI 1.057-1.871, p = 0.019), colon cancer increased in the hysterectomy alone group (HR 1.523, 95% CI 1.068-2.17, p = 0.02), and rectal cancer increased in the hysterectomy with adnexal surgery group (HR 1.933, 95% CI 1.131-3.302, p = 0.016). The all-cause mortality of GI cancer increased in the hysterectomy alone group (HR 3.495, 95% CI 1.347-9.07, p = 0.001). CONCLUSIONS This study showed that the risk of all CRC increased in women who underwent hysterectomy compared with women who did not. In particular, the risk of rectal cancer was significantly higher in the women who underwent hysterectomy with adnexal surgery than in the controls. There was no association between hysterectomy and other GI cancers.
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Affiliation(s)
- Jin -Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Seung-Woo Yang
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Sang-Hee Yoon
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Myoung Hwan Kim
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Yong-Soo Seo
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Yujin Lee
- Department of Surgery, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Jungbin Kim
- Department of Surgery, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Keunho Yang
- Department of Surgery, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Geumhee Gwak
- Department of Surgery, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Hyunjin Cho
- Department of Surgery, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea.
- Department of Surgery, Sanggye Paik Hospital, School of Medicine, Inje University, Dongil-Ro, Nowon-Gu, Seoul, 1342, Republic of Korea.
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2
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Zimmermann JSM, Sima RM, Radosa MP, Radosa CG, Ples L, Wagenpfeil S, Solomayer EF, Radosa JC. Quality of life and sexual function in patients aged 35 years or younger undergoing hysterectomy for benign gynecologic conditions: A prospective cohort study. Int J Gynaecol Obstet 2023; 160:548-553. [PMID: 35965372 DOI: 10.1002/ijgo.14400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/25/2022] [Accepted: 08/05/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate how hysterectomy performed for benign gynecologic pathologies affects the quality of life and sexual function of patients aged 35 years or younger, and if outcomes differ according to the surgical technique. METHODS Seventy-three patients who underwent total laparoscopic hysterectomy (TLH), supracervical laparoscopic hysterectomy (SLH), or vaginal hysterectomy (VH) for benign uterine disorders between April 2014 and June 2020 at the Department of Gynecology and Obstetrics, Saarland University Hospital, Homburg, Germany, were enrolled in this prospective observational cohort study. Quality of life and sexual function were assessed preoperatively and 6 months postoperatively using standardized validated questionnaires: the European Quality of Life Five-Dimension Scale (EQ-5D) and the Female Sexual Function Index (FSFI). RESULTS Thirty-three (45%) patients underwent TLH, 25 (34%) underwent SLH, and 15 (21%) patients underwent VH. The median preoperative EQ-5D score, FSFI score, and EQ-5D visual analog scale were 0.9 (range 0.62-1), 19.25 (range 2.4-27.4), and 50 (range 0-100); postoperative scores were 1 (range 0.61-1), 24.15 (range 3.9-29.3), and 90 (range 30-100), respectively (P ≤ 0.001). Postoperative scores were significantly higher than preoperative scores, with no significant difference according to the surgical technique. CONCLUSION Hysterectomy for benign indication in women aged 35 years or less significantly improved the patients' quality of life and sexual function with no differences regarding the surgical technique. CLINICAL TRIAL REGISTRATION The study was registered in the German trial registry (no. DRKS00005622).
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Affiliation(s)
- Julia S M Zimmermann
- Department of Gynecology and Obstetrics, Saarland University Hospital, Homburg, Germany
| | - Romina-Marina Sima
- Department of Gynecology and Obstetrics, Saarland University Hospital, Homburg, Germany
| | - Marc P Radosa
- Department of Gynecology and Obstetrics, Klinikum Bremen-Nord, Bremen, Germany
| | - Christoph G Radosa
- Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, TU Dresden, Dresden, Germany
| | - Liana Ples
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology & Medical Informatics, Saarland University Hospital, Homburg, Germany
| | - Erich-Franz Solomayer
- Department of Gynecology and Obstetrics, Saarland University Hospital, Homburg, Germany
| | - Julia C Radosa
- Department of Gynecology and Obstetrics, Saarland University Hospital, Homburg, Germany
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Desai S, Singh RJ, Govil D, Nambiar D, Shukla A, Sinha HH, Ved R, Bhatla N, Mishra GD. Hysterectomy and women's health in India: evidence from a nationally representative, cross-sectional survey of older women. Womens Midlife Health 2023; 9:1. [PMID: 36609516 PMCID: PMC9825041 DOI: 10.1186/s40695-022-00084-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/28/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hysterectomy, particularly when conducted in women younger than 45 years, has been associated with increased risk of non-communicable diseases. In India, research indicates that hysterectomy is a common procedure for women, but there have been no studies on its long-term effects. We examined patterns of hysterectomy amongst women in India and associations with their health and well-being in later life. METHODS This analysis utilised the first wave of the Longitudinal Study on Aging in India, a nationally representative study of adults that included a module on health and well-being. We analysed data on 35,083 women ≥45 years in India. We estimated prevalence of hysterectomy and performed multivariable logistic regression to identify associated risk factors and to examine the association between hysterectomy status and eight self-reported chronic conditions, hospitalisation and mobility. RESULTS The prevalence of hysterectomy among women >=45 years was 11.4 (95% CI: 10.3, 12.6), with higher odds among urban women (aOR: 1.39; 1.17,1.64) and higher economic status (highest compared to lowest quintile: aOR: 1.95; 1.44, 2.63). Hysterectomy history was associated with four chronic conditions: hypertension (aOR: 1.51; 95% CI: 1.28, 1.79), high cholesterol (aOR: 1.43; 1.04, 1.97), diabetes (aOR: 1.69; 1.28, 2.24), and bone/joint disease (aOR: 1.54; 1.20, 1.97) and higher odds of any hospitalisation in the past year (aOR: 1.69; 1.36, 2.09). CONCLUSIONS In India, evidence suggests that hysterectomy is associated with major chronic conditions. The assessment for hysterectomy as a treatment option for gynaecological morbidity should consider potential health consequences in later life.
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Affiliation(s)
- Sapna Desai
- grid.510878.3Population Council Institute, Zone 5A India Habitat Centre, Lodhi Road, New Delhi, 110003 India
| | - Roopal Jyoti Singh
- grid.510878.3Population Council Institute, Zone 5A India Habitat Centre, Lodhi Road, New Delhi, 110003 India
| | - Dipti Govil
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, India
| | - Devaki Nambiar
- grid.464831.c0000 0004 8496 8261George Institute for Global Health, New Delhi, India
| | | | - Hemali Heidi Sinha
- grid.413618.90000 0004 1767 6103Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, India
| | - Rajani Ved
- Bill & Melinda Gates Foundation, New Delhi, India
| | - Neerja Bhatla
- grid.413618.90000 0004 1767 6103Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Gita D. Mishra
- grid.1003.20000 0000 9320 7537University of Queensland School of Public Health, Herston, Queensland Australia
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Ainsworth AJ, Sadecki E, Zhao Y, Weaver AL, Stewart EA. Women With a History of Primary Infertility and Increased Rates of Bilateral Oophorectomy. Obstet Gynecol 2022; 140:643-653. [PMID: 36075082 PMCID: PMC9669109 DOI: 10.1097/aog.0000000000004916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/12/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the association of primary infertility with subsequent bilateral oophorectomy and hysterectomy, using a population-based cohort of women with primary infertility and age-matched women in a referent group. METHODS The Rochester Epidemiology Project record-linkage system was used to assemble a population-based cohort of women with primary infertility diagnosed between 1980 and 1999 (index date). Women were age-matched (±1 year) 1:1 to women without a history of infertility or hysterectomy at the index date (referent group). Cox proportional hazards models were fit to compare long-term risks of bilateral oophorectomy and hysterectomy, respectively, between women with infertility and women in the referent group. RESULTS Among both groups of 1,001 women, the mean age at the index date was 29.2±4.4 years. Median duration of follow-up was 23.7 years for both groups. Women with primary infertility were 1.7 times (adjusted hazard ratio [aHR] 1.69, 95% CI 1.22-2.33) more likely to undergo bilateral oophorectomy compared with women in the referent group. In a sensitivity analysis that excluded women with a diagnosis of infertility related to endometriosis and their matched referent group participants, this association persisted (aHR 1.50, 95% CI 1.06-2.14). Women with primary infertility did not have a significant increased risk of hysterectomy (aHR 0.98, 95% CI 0.79-1.23). However, risk of hysterectomy was increased in those with primary infertility related to endometriosis (aHR 1.94, 95% CI 1.12-3.34). We observed that women with primary infertility were more likely to undergo hysterectomy with bilateral oophorectomy. Women in the referent group were more likely to undergo hysterectomy with ovarian conservation. Few women in either group had isolated bilateral oophorectomy. CONCLUSION Primary infertility, with and without a diagnosis of endometriosis, is associated with an increased risk of bilateral oophorectomy. In women with endometriosis-related infertility, there is an association with future hysterectomy. These findings represent important confounders in the evaluation of long-term health outcomes related to primary infertility.
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Affiliation(s)
- Alessandra J Ainsworth
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, the Alix School of Medicine, and the Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
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Li N, Shen C, Wang R, Chu Z. The real experience with women's hysterectomy: A meta-synthesis of qualitative research evidence. Nurs Open 2022; 10:435-449. [PMID: 36071582 PMCID: PMC9834517 DOI: 10.1002/nop2.1348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/16/2022] [Accepted: 08/22/2022] [Indexed: 01/19/2023] Open
Abstract
AIM The aim of this meta-synthesis was to identify and synthesize qualitative research evaluating the real feelings, inner needs and emotional experience of women undergoing hysterectomy. DESIGN Meta-synthesis. METHODS The PubMed, Web of Science, Cochrane Library, CINAHL, Embase, Ovid Medline and Sino Med were systematically searched until November 2021 and updated until June 2022. Two reviewers independently extracted data into a Microsoft Excel sheet. Qualitative meta-synthesis was performed by coding relevant citations, organizing codes into descriptive themes and developing analytical themes. RESULTS Qualitative meta-synthesis yielded three themes and nine sub-themes: comprehensive consideration before hysterectomy (a. disease factors; b. fertility factors; c. opinions of others); emotions and experience after hysterectomy (a. postoperative physical condition; b. psychological resilience to the loss of the uterus; c. changes in the couple's relationship); coping strategies (a. self-denial and avoidance; b. change of perception and self-adjustment; c. seek help from others).
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Affiliation(s)
- Na Li
- The Second Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Chen Shen
- School of NursingNanjing Medical UniversityNanjingJiangsuChina
| | - Rao Wang
- The Second Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Zhiping Chu
- The Second Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
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Ouh YT, Min KJ, Lee S, Hong JH, Song JY, Lee JK, Lee NW. Analysis of the Relationship between Socioeconomic Status and Incidence of Hysterectomy Using Data of the Korean Genome and Epidemiology Study (KoGES). Healthcare (Basel) 2022; 10:healthcare10060997. [PMID: 35742048 PMCID: PMC9223165 DOI: 10.3390/healthcare10060997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 02/05/2023] Open
Abstract
Hysterectomy remains a frequent gynecologic surgery, although its rates have been decreasing. The aim of this study was to investigate whether socioeconomic status affected the risk of hysterectomy in Korean women. This prospective cohort study used epidemiologic data from 2001 to 2016, from the Korean Genomic and Epidemiology Study (KoGES). Multivariate logistic regression analyses were performed to estimate the association between household income or education level and hysterectomy. Among 5272 Korean women aged 40−69 years, 720 who had a hysterectomy and 4552 controls were selected. Variable factors were adjusted using logistic regression analysis (adjusted model). Adjusted odds ratios (aORs) for insurance type and hysterectomy were not statistically significant. The aOR was 1.479 (95% confidence interval (CI): 1.018−2.146, p < 0.05) for women with education of high school or lower compared to college or higher. Women whose monthly household income was <KRW 4,000,000 had a higher risk of undergoing hysterectomy than women whose monthly household income was ≥KRW 4,000,000 (aOR: 2.193, 95% CI: 1.639−2.933, p < 0.001). Overall, the present study elucidated that lower socioeconomic status could increase the incidence of hysterectomy. Our results indicate that the implementation of stratified preventive strategies for uterine disease in those with low education and low income could be beneficial.
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Affiliation(s)
- Yung-Taek Ouh
- Department of Obstetrics and Gynecology, School of Medicine, Kangwon National University, Chuncheon 24289, Korea;
| | - Kyung-Jin Min
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Ansan 15355, Korea;
- Correspondence:
| | - Sanghoon Lee
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Seoul 02841, Korea; (S.L.); (J.Y.S.)
| | - Jin-Hwa Hong
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul 08308, Korea; (J.-H.H.); (J.-K.L.)
| | - Jae Yun Song
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Seoul 02841, Korea; (S.L.); (J.Y.S.)
| | - Jae-Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul 08308, Korea; (J.-H.H.); (J.-K.L.)
| | - Nak Woo Lee
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Ansan 15355, Korea;
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Wan S, Zhao X, Pei J, Han Z, Che R, Qin S, Hua X. Association of age at benign hysterectomy with leukocyte telomere length in a nationally representative population. Maturitas 2022; 159:46-51. [DOI: 10.1016/j.maturitas.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/16/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
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Pilli P, Sekweyama P, Kayira A. Women's experiences following emergency Peripartum hysterectomy at St. Francis hospital Nsambya. A qualitative study. BMC Pregnancy Childbirth 2020; 20:729. [PMID: 33238899 PMCID: PMC7687817 DOI: 10.1186/s12884-020-03428-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/13/2020] [Indexed: 11/18/2022] Open
Abstract
Background Emergency peripartum hysterectomy (EPH) is a known remedy for saving women’s lives when faced with the challenging situation of severe post partum hemorrhage not responsive to conservative management. However, EPH by its nature is also a traumatic birth event that causes serious physical, emotional and psychological harm. Unfortunately at St. Francis Hospital Nsambya nothing much is known about these experiences since no study has been undertaken and these women are not routinely followed up. The purpose of this study was to explore these emotional experiences. Methods This was a qualitative phenomenological study carried out between August and December 2018. All those women who had undergone EPH between January 2015 and August 2018 were eligible to participate in the study. Purposive sampling was used. 18 women were interviewed before saturation was reached. All interviews were audio-recorded and then transcribed verbatim. Thematic analysis was used to analyze the data. Results Three major themes were identified as the main experiences of these women in this study and they were; Loss of Womanhood, Joy for being alive and Loss of marital safety. Conclusion Women experience serious emotional consequences following EPH. We recommend routine follow-up to help appreciate these experiences and advise them on appropriate mitigating measures.
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Affiliation(s)
- Patrick Pilli
- Department of Obstetrics and Gynecology, St. Francis Hospital Nsambya, P.O.Box 7146, Kampala, Uganda. .,Mother Kevin Postgraduate Medical School, Uganda Martyrs University, P.O.Box 7146, Kampala, Uganda.
| | - Peter Sekweyama
- Department of Obstetrics and Gynecology, St. Francis Hospital Nsambya, P.O.Box 7146, Kampala, Uganda.,Mother Kevin Postgraduate Medical School, Uganda Martyrs University, P.O.Box 7146, Kampala, Uganda
| | - Anthony Kayira
- Department of Obstetrics and Gynecology, St. Francis Hospital Nsambya, P.O.Box 7146, Kampala, Uganda.,Mother Kevin Postgraduate Medical School, Uganda Martyrs University, P.O.Box 7146, Kampala, Uganda
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Association between hysterectomy and depression: a longitudinal follow-up study using a national sample cohort. ACTA ACUST UNITED AC 2020; 27:543-549. [DOI: 10.1097/gme.0000000000001505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Bostancı Ergen E, Akpak YK, Kılıççı Ç, Abide Yayla Ç, Ayas S. Does minimally invasive surgery reduce anxiety? J Turk Ger Gynecol Assoc 2019; 20:142-146. [PMID: 29983402 PMCID: PMC6751831 DOI: 10.4274/jtgga.galenos.2018.2018.0073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate whether there were any differences in preoperative and postoperative anxiety in patients who underwent total laparoscopic hysterectomy (TLH) (n=37) and total abdominal hysterectomy (TAH) (n=37). Material and Methods: All premenopausal patients who underwent TLH or TAH because of benign uterine disorders were enrolled. Anxiety status was assessed 6 hours before and after the operation using standardized validated questionnaires: State-Trait Anxiety Inventory. Results: In the TAH group, the state anxiety level of the patients significantly increased, whereas there was a significant decrease in the TLH group. For the trait anxiety level, there was a statistically significant increase in the TAH group postoperatively. In the TLH group, trait anxiety levels decreased postoperatively. In the analysis of between-group differences, pre and postoperative the state anxiety level was higher in the TAH group. A statistically significant difference was determined between the groups in respect of the postoperative state anxiety levels (p<0.05), but not in the preoperative state anxiety levels (p>0.05). Statistically significant differences were determined between the groups in respect of education, occupation, and curettage rates (p<0.05). Conclusion: Women undergoing TLH for benign uterine disease may have lower levels of preoperative and postoperative anxiety than women undergoing TAH.
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Affiliation(s)
- Evrim Bostancı Ergen
- Clinic of Gynecology Obstetrics and Reproductive Medicine, İstanbul Zeynep Kamil Woman and Child Diseases Training and Research Hospital, İstanbul, Turkey
| | - Yaşam Kemal Akpak
- Clinic of Gynecology Obstetrics and Gynecology, University of Health Sciences, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Çetin Kılıççı
- Clinic of Gynecology Obstetrics and Reproductive Medicine, İstanbul Zeynep Kamil Woman and Child Diseases Training and Research Hospital, İstanbul, Turkey
| | - Çiğdem Abide Yayla
- Clinic of Gynecology Obstetrics and Reproductive Medicine, İstanbul Zeynep Kamil Woman and Child Diseases Training and Research Hospital, İstanbul, Turkey
| | - Selçuk Ayas
- Clinic of Gynecology Obstetrics and Reproductive Medicine, İstanbul Zeynep Kamil Woman and Child Diseases Training and Research Hospital, İstanbul, Turkey
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Wilson LF, Mishra GD. Age at Menarche, Level of Education, Parity and the Risk of Hysterectomy: A Systematic Review and Meta-Analyses of Population-Based Observational Studies. PLoS One 2016; 11:e0151398. [PMID: 26963512 PMCID: PMC4786144 DOI: 10.1371/journal.pone.0151398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 02/26/2016] [Indexed: 12/13/2022] Open
Abstract
Background Although rates have declined, hysterectomy is still a frequent gynaecological procedure. To date, there has been no systematic quantification of the relationships between early/mid-life exposures and hysterectomy. We performed a systematic review and meta-analyses to quantify the associations between age at menarche, education level, parity and hysterectomy. Methods Eligible studies were identified by searches in PubMed and Embase through March 2015. Study-specific estimates were summarised using random effects meta-analysis. Heterogeneity was explored using sub-group analysis and meta-regression. Results Thirty-two study populations were identified for inclusion in at least one meta-analysis. Each year older at menarche was associated with lower risk of hysterectomy—summary hazard ratio 0.86 (95% confidence interval: 0.78, 0.95; I2 = 0%); summary odds ratio 0.88 (95% confidence interval: 0.82, 0.94; I2 = 61%). Low education levels conferred a higher risk of hysterectomy in the lowest versus highest level meta-analysis (summary hazard ratio 1.87 (95% confidence interval: 1.25, 2.80; I2 = 86%), summary odds ratio 1.51 (95% confidence interval: 1.35, 1.69; I2 = 90%)) and dose-response meta-analysis (summary odds ratio 1.17 (95% confidence interval: 1.12, 1.23; I2 = 85%) per each level lower of education). Sub-group analysis showed that the birth cohort category of study participants, the reference category used for level of education, the year the included article was published, quality of the study (as assessed by the authors) and control for the key variables accounted for the high heterogeneity between studies in the education level meta-analyses. In the meta-analyses of studies of parity and hysterectomy the results were not statistically significant. Conclusions The present meta-analyses suggest that the early life factors of age at menarche and lower education level are associated with hysterectomy, although this evidence should be interpreted with some caution due to variance across the included studies.
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Affiliation(s)
- Louise F. Wilson
- The University of Queensland, Centre for Longitudinal and Life Course Research, School of Public Health, Public Health Building, Herston Road, Herston, Queensland, 4006, Australia
- * E-mail:
| | - Gita D. Mishra
- The University of Queensland, Centre for Longitudinal and Life Course Research, School of Public Health, Public Health Building, Herston Road, Herston, Queensland, 4006, Australia
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Bahri N, Tohidinik HR, Fathi Najafi T, Larki M, Amini T, Askari Sartavosi Z. Depression Following Hysterectomy and the Influencing Factors. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e30493. [PMID: 27066267 PMCID: PMC4819414 DOI: 10.5812/ircmj.30493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 07/07/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hysterectomy is one of the most common gynecological surgeries performed worldwide. However, women undergoing this surgery often experience negative emotional reactions. OBJECTIVES This study was done with the aim of investigating the relationship between hysterectomy and postoperative depression, three months after the procedure. MATERIALS AND METHODS This longitudinal study was conducted in the province of Khorasan-Razavi in Iran, using multistage sampling. At first, three cities were selected from the province by cluster sampling; then, five hospitals were randomly selected from these cities. The participants included 53 women who were hysterectomy candidates in one of the five selected hospitals. The participants' demographics and hysterectomy procedure information were entered into two separate questionnaires, and the Beck depression inventory (BDI) was employed to measure their severity of depression before and three months after the surgery. The statistical package for the social sciences (SPSS) version 16 was used for the statistical analysis, and a P value of < 0.05 was considered to be statistically significant. RESULTS The means and standard deviations of the participants' depression scores before and three months after their hysterectomies were 13.01 ± 10.1 and 11.02 ± 10.3, respectively. Although the mean score of depression decreased three months after the hysterectomy, the difference was not statistically significant. However, a significant relationship was found between the satisfaction with the outcome of the hysterectomy and the postoperative depression score (P = 0.04). CONCLUSIONS In this study, undergoing a hysterectomy did not show a relationship with postoperative depression three months after the surgery. Moreover, the only factor related to depression following a hysterectomy was satisfaction with the surgery.
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Affiliation(s)
- Narjes Bahri
- Department of Midwifery, Nursing and Midwifery School, Gonabad University of Medical Sciences, Gonabad, IR Iran
| | - Hamid Reza Tohidinik
- Department of Public Health, School of Health, Gonabad University of Medical Sciences, Gonabad, IR Iran
| | - Tahereh Fathi Najafi
- Department of Midwifery, Mashhad Branch, Islamic Azad University, Mashhad, IR Iran
| | - Mona Larki
- Student Research Committee, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding Author: Mona Larki, Student Research Committee, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-9163519526, Fax: +98-5157223814, E-mail:
| | - Thoraya Amini
- Student Research Committee, Nursing and Midwifery School, Gonabad University of medical Sciences, Gonabad, IR Iran
| | - Zahra Askari Sartavosi
- Student Research Committee, Nursing and Midwifery School, Gonabad University of medical Sciences, Gonabad, IR Iran
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[Prevalence of hysterectomy in women 18 to 79 years old: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:716-22. [PMID: 23703490 DOI: 10.1007/s00103-012-1660-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In many countries, hysterectomy is one of the most frequently performed surgical procedures in gynaecology. The aim of this study is to analyse the prevalence of hysterectomy in Germany by socio-demographic factors and factors of (reproductive) health. Analyses are based on data from the "German Health Interview and Examination Survey for Adults (DEGS1)", which is part of the health monitoring of the Robert Koch Institute (RKI). The prevalence of hysterectomy among participating women (18-79 years old) was 17.5% (n = 689). Most women (49.1%) were 40-49 years old when surgery was performed. 6.1% of hysterectomised women had cancer of the uterus or ovaries, and 19.7% underwent a simultaneous oophorectomy. There were significant differences in the prevalence of hysterectomy regarding social status, place of residence in 1988, number of live births, and body weight. DEGS1 is the first study showing the prevalence of hysterectomy in a representative sample of the German population. More detailed analyses of the DEGS data, among other data sources, are needed to evaluate the importance of the described associations and to assess trends. An English full-text version of this article is available at SpringerLink as supplemental.
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Psychological outcomes after hysterectomy for benign conditions: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2013; 174:5-19. [PMID: 24398028 DOI: 10.1016/j.ejogrb.2013.12.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/27/2013] [Accepted: 12/06/2013] [Indexed: 11/23/2022]
Abstract
Hysterectomy is one of the commonest operative procedures in the developed world, mostly occurring among premenopausal women, with contradictory results regarding post-operative psychological wellbeing. This review aims to inform practice by examining whether hysterectomy predicts depression or anxiety outcomes. We searched PubMed, EMBASE, and PsycINFO electronic databases for articles published before November 2012. Reference lists of relevant articles were hand searched, and expert opinions were sought. Refereed studies investigating an association between hysterectomy for benign (non-cancerous) conditions and post-operative symptoms of depression or anxiety were chosen for this review. Two authors independently abstracted data from original articles. Authors of relevant studies were contacted for data that could not be extracted from the published articles. Review Manager 5.1 was used throughout the meta-analysis to calculate the summary relative risks (RRs), and the weighted standardized mean difference (WstdMD), and their corresponding 95% confidence intervals (CI). A random effects model was used in data analysis and verified using a fixed effect model. Overall, hysterectomy was associated with a decreased risk of clinically relevant depression (RR=1.69, 95% CI 1.19-2.38). Additionally, hysterectomy was associated with a decrease in standardized depression outcomes (standardized mean difference (SMD) 0.38 (95% CI 0.27-0.49)). Conversely, there was no significant association between hysterectomy and risk of clinically relevant anxiety (RR=1.41, 95% CI 0.72-2.75). In conclusion, data from before and after studies suggest that hysterectomy for benign gynecological conditions is not adversely associated with anxiety and may be positively rather than adversely associated with depression.
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Bowel dysfunction after total abdominal hysterectomy for benign conditions: a prospective longitudinal study. Eur J Gastroenterol Hepatol 2013; 25:1217-22. [PMID: 23765125 DOI: 10.1097/meg.0b013e328362dc5e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIM On the basis of retrospective studies, hysterectomy has been considered a risk factor for functional bowel disorders. The aim of this study was to prospectively evaluate the patients' bowel function and general health-related quality of life (QoL) before and after hysterectomy. Our hypothesis was that hysterectomy in properly selected patients can impact positively on the patients' self-reporting of their general health and bowel function. MATERIALS AND METHODS A prospective longitudinal observational study was conducted in a university-based teaching hospital. Eighty-five patients who were scheduled for total abdominal hysterectomy for a nonmalignant cause completed the study. The main outcome measure was the patient's perception of her bowel function, which was assessed preoperatively and at 6, 12, 26 and 52 weeks postoperatively using the gastrointestinal quality of life questionnaire. The patient's general health was also assessed using a generic general health questionnaire (EQ5D and EQVAS). The effect of time on change in questionnaire score was assessed using mixed model repeated measures at a significance level of 0.05. RESULTS The scores in the three questionnaires declined significantly at 6 weeks postoperatively as compared with those obtained preoperatively. However, there was a subsequent increase in the scores up to 12 months postoperatively. Smoking and use of laxative were identified as potential confounding variables. CONCLUSION Apart from a transient negative effect, total abdominal hysterectomy improves the patient's gastrointestinal-related QoL, probably as part of general improvement in their QoL.
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Tom SE, Cooper R, Patel KV, Guralnik JM. Menopausal characteristics and physical functioning in older adulthood in the National Health and Nutrition Examination Survey III. Menopause 2012; 19:283-9. [PMID: 21993081 PMCID: PMC3258455 DOI: 10.1097/gme.0b013e3182292b06] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We hypothesized that natural menopause would be related to better physical functioning compared with surgical menopause and that later age at menopause would be related to better physical functioning. METHODS Our sample comprised 1,765 women 60 years or older who participated in the National Health and Nutrition Examination Survey III, a cross-sectional study representative of the US population. Women recalled age at final menstrual period and age at removal of the uterus and ovaries and reported age, race and ethnicity, height, weight, educational attainment, smoking status, number of children, and use of estrogen therapy. Respondents completed a walk trial and chair rises and reported functional limitations. RESULTS Women with surgical menopause had chair rise times that were an average of 4.4% slower than did those of women with natural menopause (95% CI, 0.56-8.27). Women with natural menopause at age 55 years or more had an average walking speed of 0.05 meters/second (95% CI, 0.01-0.10) faster than did women with natural menopause at age less than 45 years. Later ages at natural and surgical menopause were also related to lower self-reported functional limitation. Women with surgical menopause at age 55 years or more had odds of functional limitation 0.52 times (95% CI, 0.29-0.95) that of women with surgical menopause at age less than 40 years, with similar patterns for natural menopause. CONCLUSIONS Women with surgical menopause and earlier age at menopause had worse physical function in older adulthood. These groups of women may benefit from interventions to prevent functional decline.
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Affiliation(s)
- Sarah E. Tom
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing and Division of Population Health, University College London
| | - Kushang V. Patel
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging
| | - Jack M. Guralnik
- Department of Epidemiology and Public Health, Division of Gerontology, University of Maryland School of Medicine
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Tom SE, Cooper R, Wallace RB, Guralnik JM. Type and timing of menopause and later life mortality among women in the Iowa Established Populations for theEpidemiological Study of the Elderly (EPESE) cohort. J Womens Health (Larchmt) 2011; 21:10-6. [PMID: 21970557 DOI: 10.1089/jwh.2011.2745] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The relationship between menopausal characteristics and later life mortality is unclear. We tested the hypotheses that women with surgical menopause would have increased all-cause and cardiovascular mortality compared with women with natural menopause, and that women with earlier ages at natural or surgical menopause would have greater all-cause and cardiovascular mortality than women with later ages at menopause. METHODS Women who participated in the Iowa cohort of the Established Populations for the Epidemiologic Study of the Elderly (n=1684) reported menopausal characteristics and potential confounding variables at baseline and were followed up for up to 24 years. Participants were aged 65 years or older at baseline and lived in rural areas. We used survival analysis to examine the relationships between menopausal characteristics and all-cause and cardiovascular mortality. RESULTS A total of 1477 women (87.7% of respondents) died during the study interval. Women with an age at natural menopause ≥55 years had increased all-cause and cardiovascular disease mortality compared with women who had natural menopause at younger ages. Type of menopause and age at surgical menopause were not related to mortality. These patterns persisted after adjustment for potential confounding variables. CONCLUSIONS Among an older group of women from a rural area of the United States, later age at natural menopause was related to increased all-cause and cardiovascular mortality. Monitoring the cardiovascular health of this group of older women may contribute to improved survival times.
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Affiliation(s)
- Sarah E Tom
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555, USA.
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McLean LA, Heilbrun ME, Eller AG, Kennedy AM, Woodward PJ. Assessing the role of magnetic resonance imaging in the management of gravid patients at risk for placenta accreta. Acad Radiol 2011; 18:1175-80. [PMID: 21820635 DOI: 10.1016/j.acra.2011.04.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 04/07/2011] [Accepted: 04/18/2011] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES The role of magnetic resonance imaging (MRI) in the diagnosis of placenta accreta remains uncertain. The purpose of this study was to evaluate the incremental benefit of MRI after ultrasound (US) for a large cohort of gravid patients at risk for a placenta accreta. MATERIALS AND METHODS A retrospective review of outcomes in women with risk factors for a placenta accreta between November 1995 and February 2008 was performed. Inclusion criteria were high-risk women with abnormal placenta implantation on US or operative diagnosis of placenta accreta, with or without a prenatal MRI. Delivery mode, diagnosis, and transfusion requirements were compared. RESULTS Ranging in age from 19 to 43 years, with zero to five prior cesarean sections, 139 women met inclusion criteria. The MRI was performed in 28.7% (40/139). US, MRI, and operative diagnoses were highly correlated (P < .001). Women who underwent both US and MRI were more likely to deliver by cesarean hysterectomy (P < .001). When the cohort is stratified by outcome diagnosis (normal, previa, accreta), no difference in delivery mode is found; regardless of whether subjects were imaged by US alone or US and MRI. Transfusion requirements were highest in the US and MRI group (mean of 3.9 units vs. 0.9 units in the US only group, P < .001). CONCLUSION This study fails to demonstrate that the incremental use of MRI for placenta accreta changes delivery mode in stratified analysis. Patients who underwent both US and MRI were most likely to have a cesarean hysterectomy delivery, and required more blood products, suggesting that undergoing tests may be indicative of an abnormal and at risk patient population.
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Affiliation(s)
- Logan A McLean
- Department of Radiology, University of Utah School of Medicine, Salt Lake City, 8413-2140, USA
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Arena S, Zupi E. Heavy menstrual bleeding: considering the most effective treatment option. ACTA ACUST UNITED AC 2011; 7:143-6. [PMID: 21410340 DOI: 10.2217/whe.11.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tom SE, Kuh D, Guralnik JM, Mishra GD. Self-reported sleep difficulty during the menopausal transition: results from a prospective cohort study. Menopause 2011; 17:1128-35. [PMID: 20551846 DOI: 10.1097/gme.0b013e3181dd55b0] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between menopausal transition status and self-reported sleep difficulty. METHODS With the use of data on women participating in the Medical Research Council National Survey of Health and Development who have been followed up from birth in March 1946 (n = 962), relationships between menopausal transition status and self-reported sleep difficulty were assessed annually in women between ages 48 and 54 years. RESULTS Menopausal transition status was related to severe self-reported sleep difficulty. The odds of reporting severe self-reported sleep difficulty were increased approximately by 2- to 3.5-fold (95% CI ranges from 1.08-3.27 to 1.99-6.04) for women in most menopausal transition statuses compared with women who remained premenopausal. After adjustment for current psychological, vasomotor, and somatic symptoms and waking frequently at night to use the toilet, only women who had a hysterectomy remained at an increased risk for moderate sleep difficulty. CONCLUSIONS The modest relationship between menopausal transition status and moderate sleep difficulty may be related to greater variation in individual definitions of moderate difficulty. Attention to the level of sleep difficulty in this group of women will assist in the decision to address current health symptoms versus sleep itself. Women without prior health problems may experience severe self-reported sleeping difficulty during the menopausal transition and require tailored care from health professionals.
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Affiliation(s)
- Sarah E Tom
- Group Health Research Institute, Seattle, WA 98101-1448, USA.
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Prediction of peripartum hysterectomy and end organ dysfunction in major obstetric haemorrhage. Eur J Obstet Gynecol Reprod Biol 2010; 153:165-9. [DOI: 10.1016/j.ejogrb.2010.07.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Revised: 07/11/2010] [Accepted: 07/23/2010] [Indexed: 11/22/2022]
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Menopausal status and physical performance in midlife: findings from a British birth cohort study. Menopause 2009; 15:1079-85. [PMID: 18520694 DOI: 10.1097/gme.0b013e31816f63a3] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test the associations of menopausal status, timing of menopause, and hysterectomy with physical performance at age 53 years. DESIGN Using data on women participating in the Medical Research Council National Survey of Health and Development who have been followed up since birth in March 1946 (N = 1,386), associations of interest were examined. Menopausal status, grip strength, chair rises, and standing balance time were assessed at age 53, and covariates were measured across life. RESULTS Women who were postmenopausal and not using hormone therapy at age 53 had lower mean grip strength than women who were still pre- or perimenopausal at this age. However, this trend of decreasing grip strength across the three natural menopausal categories (from pre- to postmenopausal) was explained by current body size. Those women who had undergone hysterectomy before age 40 had significantly weaker grip strength than women who had undergone hysterectomy at later ages; in fully adjusted analyses, those women who had a hysterectomy before age 40 had a mean grip strength 5.21 kg (95% CI: 2.18-8.25) lower than women who had a hysterectomy between ages 50 and 53. There were no significant associations between menopausal status or age athysterectomy and chair rise or standing balance time and also no significant associations between timing of menopause and any of the performance measures. CONCLUSIONS Women who have hysterectomies at young ages represent a group who may require more support than other women to achieve and maintain good physical performance, especially muscle strength, in midlife.
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