OBJECTIVE Ovarian hormones regulate glucose uptake and insulin sensitivity. Despite the high frequency of surgical menopause, its relationship with diabetes has not been extensively investigated. We assessed the association between hysterectomy with/or without bilateral oophorectomy (BSO) status, menopausal age and reproductive lifespan with incident diabetes.
RESEARCH DESIGN AND METHODS Data was from a cohort of 2,597 postmenopausal women enrolled in the NHANES I Epidemiologic Follow-up Study without diabetes mellitus at baseline. Cox proportional hazard regression models were used to calculate adjusted Hazard ratios and 95% confidence intervals.
RESULTS After a median follow-up of 9.2 years, the incidence of diabetes (in cases per 1000 person years) was 7.4 for women with no hysterectomy or BSO, 8.2 for hysterectomy alone and 8.5 for hysterectomy with BSO. Hysterectomy status was associated positively with diabetes (HR: 1.66, CI: 1.23-2.23). However the elevated risk was restricted to women with both hysterectomy and BSO after adjustment for relevant confounders (HR: 1.57, CI: 1.03, 2.41). An earlier age at menopause and a shorter reproductive lifespan also exhibited a linear relationship with the development of diabetes irrespective of type of menopause (PTREND = 0.001).
CONCLUSIONS Women with hysterectomy concomitant with BSO may represent a unique population with elevated risk for diabetes and other chronic diseases. Therefore the decision to remove the ovaries at the time of hysterectomy for benign conditions during the premenopausal years should be balanced with the risk of diabetes and its potential complications. Furthermore, the mechanism linking BSO to diabetes mellitus needs to be clarified
- Received August 23, 2013.
- Accepted October 31, 2013.
- © 2013 by the American Diabetes Association.
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