Comparison of serum anti-Mullerian hormone levels following hysterectomy and myomectomy for benign gynaecological conditions

Objective: To compare serum anti-Mullerian hormone (AMH) levels following hysterectomy and myomectomy.

Study design: Prospective longitudinal observational study. Serum AMH, follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels were measured pre-operatively (T1) and 2 days (T2) and 3 months (T3) following hysterectomy and myomectomy in 70 women aged 36-45 years. Hysterectomy (laparoscopy-assisted vaginal hysterectomy=10; total abdominal hysterectomy=25) with conservation of both ovaries for benign diseases of the uterus was performed in 35 women, and myomectomy (laparoscopy myomectomy=15; open myomectomy=20) was performed in another 35 women. The follow-up period was 3 months following surgery. The results were analysed using the t-test or one-way analysis of variance by repeated-measures ANOVA.

Results: Serum AMH in the hysterectomy group was 1.08±0.77 ng/ml at T1, 0.78±0.58 ng/ml at T2 and 0.81±0.58 ng/ml at T3; the level was significantly lower at T2 and T3 compared with T1. In the myomectomy group, the corresponding values were 1.54±0.95 ng/ml, 1.18±0.77 ng/ml and 1.50±0.58 ng/ml; serum AMH was significantly lower at T2 compared with T1, but the difference between T3 and T1 was not significant. There were no significant differences in serum FSH and LH in either group between these three time points.

Conclusion: Serum AMH was significantly lower 2 days and 3 months following hysterectomy compared with the pre-operative level. Following myomectomy, serum AMH was significantly lower than the pre-operative level 2 days following the procedure, but was similar to the pre-operative level 3 months after surgery. Therefore, hysterectomy may have a more lasting adverse effect on ovarian reserve than myomectomy. A long-term study of AMH levels is needed.