Hysterectomy, oophorectomy, and endogenous sex hormone levels in older women: the Rancho Bernardo Study.
Hysterectomy, oophorectomy, and endogenous sex hormone levels in older women: the Rancho Bernardo Study.
复制标题
DOI：
10.1210/jcem.85.2.6405
复制
发表时间：
2000-02
期刊：
影响因子：
--
通讯作者：
G. Laughlin;E. Barrett-Connor;D. Kritz-Silverstein;D. Mühlen
中科院分区：
文献类型：
--
作者：
G. Laughlin;E. Barrett-Connor;D. Kritz-Silverstein;D. Mühlen
本研究探讨了未使用雌激素替代治疗的社区绝经后妇女子宫切除术和卵巢切除术状态、实际年龄和绝经年限与血浆总睾酮和雌二醇、雄烯二酮、雌酮和性激素结合球蛋白（SHBG）水平的横截面相关性。1984-1987年，对684名年龄在50-89岁之间的妇女进行了子宫切除术和卵巢切除术状态的调查，并获得了血浆。其中，438例（67%）未接受子宫切除术或卵巢切除术（完整），123例（18%）报告子宫切除术伴双侧卵巢切除术，123例（18%）报告子宫切除术伴保留一侧或双侧卵巢。在调整年龄和体重指数后，双侧卵巢切除的女性的总睾酮和生物可利用睾酮水平与完整女性相比降低了40%以上（P < 0.001），在保留卵巢的女性中观察到中间水平。雄烯二酮水平约低10%，无论是否保留卵巢的女性相比，在完整的妇女（P = 0.039）。双侧卵巢切除妇女的总雌二醇水平往往较低（P = 0.095）。生物可利用的雌二醇、雌酮和SHBG水平在子宫切除术和卵巢切除术状态之间没有差异。在完整的妇女中，总的，但不是生物利用度，睾酮水平随年龄增加（P = 0.015），达到绝经前的水平为70-79十年，此后相对稳定的水平。在卵巢切除的妇女中，总的和生物可利用的睾酮水平不随年龄而变化，在50-89岁的年龄范围内比完整的妇女低40-50%。在未行卵巢切除的女性中，雄烯二酮水平随年龄增长下降27%，SHBG水平随年龄增长增加30%（P < 0.001）。其他激素水平不随年龄变化。根据绝经或手术后的年数进行分层也得到了类似的结果。这些结果表明，绝经后卵巢仍然是一个关键的来源，雄激素在整个生命周期的老年妇女。卵巢切除术后数年睾丸激素水平降低的临床后果尚不清楚。需要重新考虑预防性卵巢切除术和临床试验来评估卵巢切除术后雄激素替代的效果。
This study examines the cross-sectional association of hysterectomy and oophorectomy status, chronological age, and years since menopause with plasma levels of total and bioavailable testosterone and estradiol, androstenedione, estrone, and sex hormone-binding globulin (SHBG) in community-dwelling postmenopausal women who were not using estrogen replacement therapy. Six hundred and eighty-four women, aged 50-89 yr, were surveyed for hysterectomy and oophorectomy status and had plasma obtained between 1984-1987. Of these, 438 (67%) had not undergone hysterectomy or oophorectomy (intact), 123 (18%) reported hysterectomy with bilateral oophorectomy, and 123 (18%) reported hysterectomy with conservation of 1 or both ovaries. After adjustment for age and body mass index, both total and bioavailable testosterone levels were reduced by more than 40% (P < 0.001) in hysterectomized women with bilateral oophorectomy compared to those in intact women, with intermediate levels observed in hysterectomized women with ovarian conservation. Androstenedione levels were about 10% lower in hysterectomized women with or without ovarian conservation compared to those in intact women (P = 0.039). Total estradiol levels tended to be lower (P = 0.095) in bilaterally oophorectomized women. Levels of bioavailable estradiol, estrone, and SHBG did not differ by hysterectomy and oophorectomy status. Among intact women, total, but not bioavailable, testosterone levels increased with age (P = 0.015), reaching premenopausal levels for the 70-79 decade with relatively stable levels thereafter. Among oophorectomized women, total and bioavailable testosterone levels did not vary with age and were 40-50% lower than those in intact women throughout the 50-89 yr age range. Androstenedione levels decreased 27% and SHBG levels increased 30% (P < 0.001) with age in intact, but not oophorectomized, women. Levels of other hormones did not vary with age. Stratification by years since menopause or surgery yielded similar results. These results demonstrate that the postmenopausal ovary remains a critical source of androgen throughout the lifespan of older women. The clinical consequences of lower testosterone levels years after oophorectomy are unknown. Reconsideration of prophylactic oophorectomy and clinical trials to evaluate the effects of androgen replacement after oophorectomy are needed.