Background: Women often experience medically unexplained symptoms as they age, and their possible causes
include changes in autonomic activity. Heart rate variability is a relevant marker for autonomic function.
Methods: The autonomic activities of patients who underwent gynecologic surgery were prospectively measured and
evaluated by menopausal status. Parameters included the standard deviation of the mean R-to-R intervals (SDNN)
and index of the sympathetic nervous system (SNS) function. Patients also evaluated the severity of their headache,
hot flashes, anxiety, irritability, fatigue and shoulder stiffness using the visual analog scale (VAS-P, VAS-H, VAS-A,
VAS-I, VAS-F and VAS-S, respectively). Measurements were conducted shortly before, immediately after, and 1
week after surgery.
Results: The study cohort (N = 101) consisted of 14 premenopausal, 39 surgically menopausal, and 48 naturally
menopausal patients. At 1 week after surgery, surgically menopausal patients had significantly smaller mean SDNN
than premenopausal patients. Surgically menopausal patients also showed significant correlation between the SNS
index and VAS-I and VAS-F.
Conclusions: The SNS index in surgically menopausal patients can be a promising tool for evaluating the severity
of menopausal symptoms. Parasympathetic nerve activity decreased immediately after the operation in the surgical
menopausal group. Therefore, early hormone replacement therapy may be necessary in surgical menopause group.
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