Climacteric syndrome and oxidative stress in women of reproductive age after hysterectomy with and without oophorectomy

Abstract

Introduction. Surgical menopause triggers an abrupt and early decline in ovarian hormones, contributing to the development of climacteric symptoms, including vasomotor and psycho-emotional manifestations. This hormonal deficiency is associated with reduced activity of antioxidant enzymes and elevated oxidative stress markers, mechanisms that may exacerbate symptom severity and increase the risk of metabolic and cardiovascular complications. The present study aimed to evaluate the impact of hysterectomy with or without oophorectomy on the severity of climacteric syndrome and oxidative stress markers, with the objective of identifying distinct pathophysiological patterns. Materials and methods. An analytical observational cohort study was conducted involving 100 women who underwent hysterectomy, including 50 women with bilateral oophorectomy (G1A) and 50 women with ovarian preservation (G1B). To establish reference baseline values, a control group (G0 ) consisting of 50 healthy women was assessed through a single evaluation. The surgical cohorts were followed longitudinally, with clinical and biochemical assessments performed preoperatively and at 10–12 days, 6 months, and 12 months postoperatively. Symptom severity was assessed using the Greene Climacteric Scale, whereas oxidative stress status was evaluated through seven biomarkers: MDA, PPOA, NO₂⁻, NO₃⁻, SOD, CAT, and AAT. Statistical analyses included one-way analysis of variance (ANOVA) with Tukey’s post hoc test for comparisons at individual time points and repeated-measures analysis of covariance (RM-ANCOVA) for longitudinal assessments. Results. In the preoperative period, total Greene Climacteric scores were higher in G1B (13.34 ± 6.09) than in G1A (9.06 ± 6.26) and G0 (3.38 ± 2.98; p < 0.001). Postoperatively, scores increased in both surgical groups, reaching peak values at 6 months (G1A: 14.46 ± 5.72; G1B: 16.46 ± 7.71) and stabilizing at 12 months. Vasomotor symptoms were more pronounced in G1A (2.88 ± 1.17 at 6 months; p < 0.05). Oxidative stress markers (MDA, PPOA, NO₂⁻, NO₃⁻) indicated a persistent redox imbalance, more marked in G1A, whereas antioxidant markers (SOD, CAT, AAT) were higher in G1B. Correlations between oxidative stress markers and total Greene scores were generally not significant. Conclusions. Ovarian preservation attenuated the decline in antioxidant markers despite a greater psychosomatic symptom burden, whereas bilateral oophorectomy was associated with acute vasomotor symptoms and reduced antioxidant capacity. These distinct clinical and biochemical profiles highlight the need for individualized perioperative management, including psychological, hormonal, and antioxidant interventions, to optimize quality of life following surgical menopause.