HİSTEREKTOMİ YAPILAN OLGULARDA OVER REZERVİNİN ANTİMÜLLERİAN HORMON VE ULTRASONOGRAFİ İLE DEĞERLENDİRİLMESİ

Öz

Amaç: Bu çalışma da ooforektomi yapılmadan histerektomi uygulanan olgularda erken overyan yetmezlik riskini ortaya koymak amaçlandı.

Gereç ve Yöntem: Bu çalışmaya; 25-50 yaş arasında, daha önceden bilateral ooferektomi geçirmemiş, menopoz veya prematüre overyan yetmezliği olmayan, çeşitli endikasyonlarla histerektomi kararı alınan 28 hasta dahil edildi. Bu hastaların ameliyat öncesi ve ameliyattan 1 ay sonrası Antimüllerian hormon (AMH), over hacmi ve antral folikül sayısı (AFS) karşılaştırıldı.

Bulgular: Ameliyat sonrası bakılan AMH değerinde, overlerin hacminde ve AFS lerde istatistiksel olarak anlamlı derecede azalma saptandı (p < 0.05).

Sonuç: Histerektomi yapılan reprodüktif dönemdeki hastalarda ooferektomi operasyonu uygun endikasyonlar dahilinde yapılmalıdır ve histerektomi yapıldıktan sonra erken menopoza girebileceği öngörülerek, menopoz semptomlarının başlaması beklenmeden yakın takip ve uygun tedavi planlanmalıdır.

Anahtar Kelimeler

• Antimüllerian Hormon (AMH)
• Antral folikül sayısı
• Histerektomi
• Over rezervi

EVALUATION OF THE EFFECTS OF HYSTERECTOMY ON OVARIAN RESERVE BY ANTIMULLERIAN HORMONE AND ULTRASONOGRAPHY

Öz

Objective: Our study aimed to determine the risk of premature ovarian failure of patients to whom hysterectomy was performed without oophorectomy.

Materials and Methods: 28 hysterectomised patients due to various indications that met the eligibility criteria of age 25 to 50 years, had no history of bilateral oophorectomy, were not menopausal or premature ovarian failure, were included in this study. These patients’ AMH (Antimullarian hormone), ovarian volume and AFC (antral follicle count) were compared before and 1 month after surgery. Results: AMH, the volume of the ovaries and the number of antral follicles revealed a significant decrease after surgery. (p<0.05)

Conclusions: Oophorectomy performed in patients of reproductive age should be made within appropriate indications. Because hysterectomised women in reproductive period may enter early menopause, strict follow-up and appropriate treatment should be carried out without waiting for menopause symptoms

Anahtar Kelimeler

• Anti mullerian hormone (AMH)
• Antral follicle count
• Hysterectomy
• Ovarian reserve

Kaynakça

1. Dekel A, Efrat Z, Orvieto R, Levy T, Dicker D, Gal R.et al. The residual ovary syndrome: a 20-year experience. Eur Biol 1996; 68:159–64. Gynecol Reprod
2. Fong YF, Lim FK, Arulkumaran S. Prophylactic oophorectomy: a continuing controversy. Obstet Gynecol Surv 1998; 53:493–99.
3. Reich H. Issues surrounding surgical menopause. J Reprod Med 2001;46:297–306.
4. Laughlin GA, Barrett-Connor E, Kritz-Silverstein D, von Mühlen D. Hysterectomy, oophorectomy, and endogenous sex hormone levels in older women: the Rancho Bernardo study. J Clin Endocrinol Metab 2000;85:645–51. p* AMH ( ng/ml) Histerektomi öncesi
5. Histerektomi sonrası Sağ Over Hacmi (ml) Histerektomi öncesi Histerektomi sonrası 28 0,71 ± 0,87 0,45 ± 0,62 0,345 (0,03 - 3,56) 0,0001 28 0,090 (0,04 - 2,65) 28 7,26 ± 3,90 7,58 ± 5,86 6,20 (1,90 – 18,40) 5,79 (2,20 – 30,50) 0,048 28 Sol Over Hacmi (ml) Histerektomi öncesi
6. Ossewaarde ME, Bots ML, Verbeek AL, Peeters PH, van der Graaf Y, Grobbee DE, et al. Age at menopause, cause-specific mortality and total life expectancy. Epidemiology 2005;16:556–62.
7. Colditz GA, Willett WC, Stampfer MJ, Rosner B, Speizer FE, Hennekens CH. Menopause and the risk of coronary heart disease in women. N Engl J Med 1987;316:1105–10.
8. Falkeborn M, Schairer C, Naessén T, Persson I. Risk of myocardial infarction after oophorectomy and hysterectomy. J Clin Epidemiol 2000;53:832–7.

9. Atsma F, Bartelink ML, Grobbee DE, van der Schouw YT. Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis. Menopause 2006;13:265–79. Armstrong K, Schwartz JS, Randall T, Rubin
10. SC, Weber B. Hormone replacement therapy and life expectancy after prophylactic oophorectomy in women with BRCA1/2 mutations: a decision analysis. J Clin Oncol 2004;22:1045–54.
11. Lambalk CB. Value of elevated basal follicle- stimulating hormone levels and the differential diagnosis during the diagnostic subfertility work-up. Fertil Steril 2003;79:489-90.
12. Tsepelidis S, Devreker F, Demeestere I, Flahaut A, Gervy Ch, Englert Y.et al. Stable serum levels of anti- Mullerian hormone during the menstrual cycle: a prospective study in normo-ovulatory women. Hum Reprod 2007;22:1837-40.
13. Van Rooij IA, Tonkelaar Id, Broekmans FJ, Looman CW, Scheffer GJ, de Jong FH, et al. Anti-Mülleryan hormone is a promising predictor for the occurrence of 2004;11:601–6. transition. Menopause
14. Atabekoglu C, Taskin S, Kahraman K, Gemici A, Taskin EA, Ozmen B,et al. The effect of total abdominal hysterectomy on serum anti-Mullerian hormone study. Climacteric. 2012;15:393–7. levels:a pilot
15. YuanH, WangC, WangD, WangY.Comparison ofthe effect of laparoscopic supracervical hysterectomy for uterine fibroids on ovarian reserve by assessing serum anti-Mullerian hormone levels: a prospective cohort study. J Minim Invasive Gynecol. 2015:22:637-41. and total
16. Moorman PG, Myers ER, Schildkraut JM, Iversen ES, Wang F, Warren N. Effect of Hysterectomy With Ovarian Preservation on Ovarian Function. Obstet Gynecol 2011;118: 1271–9
17. Wang HY, Quan S, Zhang RL, Ye HY, Bi YL, Jiang ZM, Ng EH. Comparison of serum anti-Mullerian hormone myomectomy conditions. Eur Biol. 2013;171:368-71 hysterectomy and for J Obstet Gynecol Reprod
18. Cattanach J. Oestrogen deficiency after tubal ligation. Lancet 1985;1:847-9.
19. Janson PO, Jansson I. The acute effect of hysterectomyon ovarian blood flow. Am J Obstet Gynecol 1977;127:349-52
20. Chrisman HB, Saker MB, Ryu RK, Nemcek AA Jr, Gerbie MV, Milad MP. et al. The impact of uterine fibroid embolization on resumption of menses and ovarian function. J Vasc Interv Radial 2000;11:699-703