Hysterectomy and perceived physical function in middle-aged Australian women: a 20-year population-based prospective cohort study
Hysterectomy is one of the most common gynaecological procedures worldwide. Changes in endocrine function may impact age-associated decline in physical function and these changes may be accelerated by hysterectomy. The aim of this study was to investigate associations between hysterectomy status and self-reported physical function limitations.
Our study sample (n = 8624) came from the mid-cohort (born 1945–1950) of the Australian Longitudinal Study on Women’s Health (ALSWH). Self-report of physical function was measured by the Physical Functioning (PF) subscale of the Medical Outcomes Study Short Form Health Survey (SF-36) over seven surveys (1998–2016), categorised into substantial, moderate and minimal PF-limitations. The associations between hysterectomy status and de novo substantial or moderate PF-limitations versus minimal PF-limitations were investigated using log-multinomial regression.
By Survey 8 (2016), 20% of the study sample had a hysterectomy with ovarian conservation (hysterectomy only) and 9% had a hysterectomy and both ovaries removed (hysterectomy-bilateral oophorectomy). Women with a hysterectomy only had a small increase in risk of substantial PF-limitations (versus minimal PF-limitations) compared to women with no hysterectomy (relative risk [RR]: 1.13; 95% confidence interval [95% CI] 1.00–1.27); the point estimate was stronger for women with a hysterectomy-bilateral oophorectomy (RR: 1.26; 95% CI 1.09–1.46). In a supplementary analysis, the increased risk of substantial PF-limitations was seen only in women who had surgery before the age of 45 years.
Compared to women with no hysterectomy, women with hysterectomy-bilateral oophorectomy were at increased risk of substantial PF-limitations versus minimal PF-limitations over 18 years of follow-up.
KeywordsHysterectomy Physical function Bilateral oophorectomy SF36 Women’s health
The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women’s Health by the University of Queensland and the University of Newcastle. We are grateful to the Australian Government Department of Health for funding and to the women who provided the survey data. We also thank Associate Professor Leigh Blizzard (University of Tasmania) for providing the Stata program to do the log-multinomial regression.
The ALSWH is funded by the Australian Government Department of Health. The funding source played no role in the design; in the collection, analysis or interpretation of data; in the writing of the manuscript or in the decision to submit the manuscript for publication. GM was supported by a National Health and Medical Research Council (NHMRC) Professional Research Fellowship (PRF) (APP 1121844).
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
The ALSWH has been granted ethics clearance by the Universities of Newcastle and Queensland (Ethics approvals H0760795 and 2004000224). Ethics for the longitudinal study was approved on 26 July 1995. All procedures (surveys) performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
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