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Hysterectomy Linked to Higher Levels of Inflammatory Markers Than Natural Menopause: Presented at NAMS

By Paula Moyer

SAN DIEGO, CA -- October 6, 2005 -- Women who have had a hysterectomy have higher levels of inflammatory factors than women who go through menopause without having a hysterectomy, whether or not the ovaries are removed as part of the hysterectomy, according to findings presented here September 30^th at the 16^th annual meeting of the North American Menopause Society (NAMS).

"In particular, having a hysterectomy may have a deleterious effect on C-reactive protein (CRP)," said principal investigator Donna Kritz-Silverstein, PhD, Adjunct Professor of Family and Preventive Medicine, University of California - San Diego, La Jolla, California, United States.

Studies have previously shown that elevated CRP levels are associated with an increased risk of cardiovascular disease; therefore, physicians might want to monitor women who have had more closely, the investigators said.

They conducted the study because earlier research suggested that combined hysterectomy and oophorectomy could have a compromising impact on heart disease risk factors. Dr. Kritz-Silverstein and colleagues therefore evaluated the relationship between hysterectomy and oophorectomy and levels of inflammatory markers and cortisol in menopausal women.

Among these women, 15.9% had had a hysterectomy with bilateral oophorectomy, and 18.8% had a hysterectomy with ovaries left intact; 25.9% were currently using hormone replacement therapy (HRT).

The investigators recruited 1151 women who were 50 to 93 years old (average 70.2), who had visited their clinic between 1984 and 1987. The investigators obtained blood specimens from the women to measure levels of the inflammatory markers CRP and interleukin-6 (IL-6). In the women who were not taking HRT, the investigators assessed cortisol levels.

Median CRP level was 1.68 mg/L, with an interquartile range of 0.88-3.62. The IL-6 levels averaged 3.05 pg/mL, and the cortisol levels average 282.9 nmol/L.

CRP levels increased in relation with body mass index (BMI, P < .001). Other factors that increased CRP levels were HRT use and early menopause (P < .001 and P = .01, respectively). IL-6 increased with age and years of menopause (P < .0001 for both).

Smoking was linked to an increase in IL-6 (P = .016). Cortisol levels increased with age and BMI (P = .001 and P = .026, respectively).

Both before and after adjusting for age, BMI and HRT, women who had hysterectomy had higher CRP levels than those who had not had hysterectomy. The researchers noted that women with intact ovaries had a higher risk of elevated CRP levels than women who had bilateral oophorectomy (P = .03 and P = .09, respectively, compared to natural menopause).

However, there were no differences among the women by hysterectomy and oophorectomy status for IL-6 or cortisol levels (P > .10 for each).

Stratified regression analyses showed that, among current HRT users, those who had had hysterectomies, with and without bilateral oophorectomy, had significantly higher CRP levels than those who had undergone menopause naturally (P = .03 and P = .002, respectively). Women who were and were not using HRT did not differ from each other in a statistically significant manner.


[Presentation title: Hysterectomy, Oophorectomy and Inflammatory Markers in Postmenopausal Women. Abstract P-53]

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