Female sex hormones in relation to insulin resistance after hysterectomy: A pilot study

Summary Background & aim Surgery causes development of insulin resistance. Women undergoing hysterectomy have different female sex hormonal status, ranging from premenopausal to postmenopausal. The aim of the study was to explore the relation between the female sex hormones and insulin resistance (IR%) after hysterectomy. Methods A secondary analysis from a randomised controlled single-centre study at the Department of Obstetrics and Gynaecology, Orebro University Hospital, Sweden. Twenty women were randomised to robot-assisted laparoscopic or abdominal hysterectomy. Blood were drawn before and after surgery for measurement of oestrogens, progesterone, and gonadotropins alongside determination of insulin sensitivity using the hyperinsulinemic normolycaemic clamp. Results Female sex hormonal status was not correlated to insulin sensitivity before operation. Premenopausal women developed more IR% than postmenopausal women ( p  = 0.012). Premenopausal women also showed a significant decrease in absolute levels of oestradiol (E2) ( p  = 0.016), and the relative decrease in E2 from preoperative to postoperative values (E2%) was significantly higher (p = 0.001). There was a significant positive correlation in the entire study population between E2% and IR% (r = 0.72, p  = 0.001, r 2 0.51) that remained when adjusted for age ( p  = 0.028), BMI ( p  = 0.001), and preoperative insulin sensitivity ( p  = 0.011) separately. Conclusions Premenopausal women developed a higher degree of postoperative insulin resistance that was associated with a parallel relative change in oestradiol levels compared with the postmenopausal women. It remains unclear whether these are independent phenomena in the overall stress response or whether a causal relationship exists.