| Leiomyoma of uterus is the most common benign gynecologic diseasein Chinese women. The incidence of the disease is 20%~25% up to the ageof 35. Hysterectomy is the most main treatment in the long run, except forpremenopause women. Does removal of uterus affect ovarian function?Some researchers have some different opinions.Between March 2003 and March 2004, consecutive 100premenopausal patients aged between 40 and 50 year old with uterusLeiomyoma who were scheduled for hysterectomy or supracervicalhysterectomy or hysteromyomectomy at the second hospital of JiLinUniversity or Obestetic and gynecology hospital of Jilin were asked toparticipate in the study. Patients with a diagnosis of cancer (gynecologic ornon-gynecologic), psychiatric illness, neurologic disease, diabetes,endometriosis or a debilitating medical condition were excluded. Patientswith hormone replacement therapy (HRT) were excluded. The pathologyafter operation is all leimyoma and endometrium is hyperplastic. Bleedingin the procedure of operation was less than 200 ml. Randomised controlled40 heathy women at the same age. All the recruited women are withregularly menstruating. On the base of age, two study groups weredistinguished, the first group included 42 patients aged 40-44 years and thesecond one included 42 patients aged 45-49 years. There were no significantdifferences regarding age at the same group. The type of the operation wasdivided into hysterectomy, supracervical hysterectomy andhysteromyomectomy. Bloodsamples were drawn before surgery, threemonths and six months after surgery. Follicule-dtimulating hormone (FSH)and oestradiol (E2), progestogen (P), luteotropic (LH), testosterone (T),prolactin (PRL) were assayed with the E-L method. Every visit patientsfilled in a questionnaire, containing questions about typical climactericcomplaints and sexual function experienced both pre-and postoperatively.Except for bloodsamples, other symptoms observation lasted one year.Eighty-four percent (n = 84) of women undergoing hysterectomy returned thequestionnaire, while 90% (n = 36) of random controlled healthy women chose toparticipate. 6 months after operation, the serum concentration of the sixhormones was not significantly different with preoperation in hysterectomygroup at the age of 40~44 years old (I1),supracervical hysterectomy (II1)and hysteromyomectomy group (III1) (p>0.05), and was no significantdifferences between three groups (p>0.05). While 3 months after operation,the serum concentration of E2 went up and FSH declined in hysterectomygroup I1 and supracervical hysterectomy II1. There were significantlydifferent with preoperation and 6 month after operation (p<0.05) and thesame outcome was obtained comparison with hysteromyomectomy (III1) atthe same period (p<0.05). Compared with preoperation, there weresignificant differences in hysterectomy group (I2) and supracervicalhysterectomy (II2) at the age of 45~50 years old after 6 months operation(p<0.05) but not for 3 months after operation (p>0.05) in the serumconcentration of E2 and FSH. There were significant differences betweenhysterectomy group I2 or supracervical hysterectomy II2 andhysteromyomectomy (III2) (p<0.05) after 6 month. The serum concentrationof E2 decreased and FSH increased. Serum follicle stimulating hormonelevels >40 IU/L and E2>50pmol/L were found in five women followinghysterectomy. The average age was 47.40, earlier 0.8 years than Changchunnature average postmenopausal age (48.20) surveyed by Guoxiyong. But nosignificant differences could be found in hysteromyomectomy group III2after operation either 3months or 6 months with preopration. Aboutclimacteric symptoms, there were significant differences between I1 or II1and III1 or random control group (IV1) at the age of 40~44 after one yearoperation on flushing. The same outcome was obtained on proportion ofoverall climacteric symptoms. There were no significant differencesbetween I1 and II1, as well as III1 and IV1.At the age of 45~50 years old,although there were no significant differences between I2,II2 and III2,IV2,perhaps because of the samples small, the proportion of typical climactericsymptoms as flushing and overall climacteric symptoms were 92.31%,92.31% in I2;87.5%,87.5% in II2, while 53.85 %,87.5% in III2;52.63%,73.68% in IV2. Some difference can be found. On sexual function, 25%patients complained sexuality decrease after operation in I1 and 14.29% inII1, there were no differences between two groups. But the proportion wasdifferent. Two groups were significant differences with III1 or IV1. In summary, hysterectomied (hysterectomy ,supracervicalhysterectomy ) women, especially those up to 45 years, major uterinesurgery may prelude an earlier onset of menopause. Though those aged...
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