Kritz-Silverstein D, Goldani Von Mühlen D, Barrett-Connor E
University of California, San Diego, Department of Family and Preventive Medicine, Division of Epidemiology, La Jolla, California, USA.
J Womens Health Gend Based Med. 2000 Sep;9(7):747-55. doi: 10.1089/15246090050147727.
This study examines the association of hysterectomy and oophorectomy with the prevalence and clustering of menopausal symptoms in a large population-based sample of older women. Subjects were 1121 women aged 50-89 from the Rancho Bernardo Study. Information on menopause, hysterectomy, oophorectomy, estrogen use, and other covariates was obtained in 1984-1987. A 1989 mailed survey obtained information on menopausal symptoms. In this sample, 22.1% reported hysterectomy with bilateral oophorectomy, and 25.3% reported hysterectomy with ovarian conservation. Mean time since hysterectomy was 26 (+/-12) years. Overall, 37% reported current estrogen use, and 40% reported past use. The duration of estrogen use was longer for women who had a hysterectomy (p < 0.001). Age-adjusted comparisons indicated that more women who had a hysterectomy, with or without bilateral oophorectomy, reported greater energy after menopause (p = 0.003 and p = 0.001, respectively), and more women with bilateral oophorectomy reported greater interest in sex (p = 0.007) and that life was getting better (p = 0.012) than women with natural menopause. Principal components factor analysis of the symptom data for all women yielded four factors: psychological, vasomotor, positive feelings, and self-image. Analyses performed within each group of women yielded similar factors and loadings. Adjusted comparisons of factor scores indicated that positive feelings were significantly higher in women who had a hysterectomy, with or without bilateral oophorectomy (p < 0.01) than in women with natural menopause. This difference was limited to current estrogen users. Vasomotor symptoms, psychological symptoms, and negative self-image did not differ by hysterectomy or oophorectomy status before or after stratification for estrogen use (p > 0.10). This study found after a hysterectomy, women are more likely to recall positive feelings about their menopause than women with natural menopause. Relief from symptoms leading to hysterectomy and use of replacement estrogen may be partly responsible. Results do not support the thesis that surgical menopause is associated with a sustained increased prevalence of vasomotor, psychological, or other symptoms.
本研究在一个基于人群的大型老年女性样本中，考察了子宫切除术和卵巢切除术与绝经症状的患病率及聚集情况之间的关联。研究对象为来自兰乔贝纳多研究的1121名年龄在50 - 89岁之间的女性。1984 - 1987年获取了有关绝经、子宫切除术、卵巢切除术、雌激素使用及其他协变量的信息。1989年通过邮寄调查问卷获取了有关绝经症状的信息。在这个样本中，22.1%的女性报告进行了双侧卵巢切除的子宫切除术，25.3%的女性报告进行了保留卵巢的子宫切除术。子宫切除术后的平均时间为26（±12）年。总体而言，37%的女性报告目前正在使用雌激素，40%的女性报告过去使用过雌激素。进行子宫切除术的女性雌激素使用时间更长（p < 0.001）。年龄调整后的比较表明，无论是否进行双侧卵巢切除术，进行子宫切除术的女性中，更多人报告绝经后精力更充沛（分别为p = 0.003和p = 0.001），并且与自然绝经的女性相比，更多进行双侧卵巢切除术的女性报告对性生活更感兴趣（p = 0.007）以及生活在改善（p = 0.012）。对所有女性的症状数据进行主成分因子分析得出四个因子：心理、血管舒缩、积极感受和自我形象。在每组女性中进行的分析得出了相似的因子和载荷。因子得分的调整比较表明，无论是否进行双侧卵巢切除术，进行子宫切除术的女性的积极感受显著高于自然绝经的女性（p < 0.01）。这种差异仅限于目前使用雌激素的女性。在根据雌激素使用情况进行分层前后，血管舒缩症状、心理症状和负面自我形象在子宫切除术或卵巢切除术状态方面并无差异（p > 0.10）。本研究发现，与自然绝经的女性相比，子宫切除术后的女性更有可能回忆起对绝经的积极感受。因导致子宫切除术的症状得到缓解以及使用替代雌激素可能是部分原因。研究结果不支持手术绝经与血管舒缩、心理或其他症状的持续患病率增加相关这一论点。
