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Hysterectomy with ovarian conservation may increase risk for CV, metabolic conditions

Hysterectomy with ovarian conservation was linked to increased long-term risk for metabolic and cardiovascular conditions, particularly in women aged 35 years and younger, according to findings recently published in Menopause.

“Previous studies of hysterectomy with ovarian conservation have had methodological limitations,” Shannon Laughlin-Tommaso, MD, OB-GYN at the Mayo Clinic, and colleagues wrote. “Most studies did not control for preexisting CVD which is increased in women undergoing hysterectomy. Some studies included women with a previous unilateral oophorectomy in the ovarian conservation group. Two recent studies have addressed some of these limitations, but had either limited data on preexisting CVD or short-term follow-up.”

Researchers studied 2,094 women aged older than 18 years that were part of the Rochester Epidemiology Project records-linkage system who had a hysterectomy with ovarian conservation for benign indications between 1980 and 2002. Among those, 529 were aged younger than 35 years when the hysterectomy took place, and 271 were older than 50 years. The women were matched in a 1:1 ratio by their age with a woman who had not had an oophorectomy or previous hysterectomy. The two groups were followed for a median of 21.9 years.

Laughlin-Tomasso and colleagues found that the women who had a hysterectomy and were 35 years and younger had a 4.6-fold increased risk for congestive heart failure and a 2.5-fold increased risk for coronary artery disease. In addition, all women had increased risks for: coronary artery disease (HR = 1.33; 95% CI, 1.12-1.58); obesity (HR = 1.18; 95% CI, 1.04-1.35); hyperlipidemia (HR = 1.14; 95% CI, 1.05-1.25), hypertension (HR = 1.13; 95% CI, 1.03-1.25), and cardiac arrhythmias (HR = 1.17; 95% CI, 1.05-1.32).

Researchers also wrote that CVD’s cumulative occurrence seemed to deviate between women with hysterectomy and referent women after approximately 20 years for coronary artery disease, and 5 to 15 years following hysterectomy date for several conditions.

“This is the best data to date that shows women undergoing hysterectomy have a risk of long-term disease — even when both ovaries are conserved," Laughlin-Tomasso said in a press release.

“Hysterectomy is the second most common gynecologic surgery, and most are done for benign reasons, because most physicians believe that this surgery has minimal long-term risks. With the results of this study, we encourage people to consider nonsurgical alternative therapies for fibroids, endometriosis, and prolapse, which are the leading causes of hysterectomy,” she added. - by Janel Miller

Disclosure: Laughlin-Tomasso reports no relevant disclosures. Please see the study for the other authors’ relevant financial disclosu