Increased health risks with hysterectomy alone

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Mayo Clinic researchers show that hysterectomy with ovarian conservation is associated with a significantly increased risk of several cardiovascular diseases and metabolic 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,” says Dr Shannon Laughlin-Tommaso, study author and Mayo Clinic OB-GYN. “While women are increasingly aware that removing their ovaries poses health risks, this study suggests hysterectomy alone has risks, especially for women who undergo hysterectomy prior to age 35.”

Women in this study were identified using the Rochester Epidemiology Project, a medical records database that includes the complete inpatient and outpatient records of all medical providers in Olmsted County, Minnesota.

The researchers identified 2,094 Olmsted County resident women who had a hysterectomy with ovarian conservation for benign disease between 1 January, 1980, and 31 December, 2002. The women were 18 years old or older on the date of their hysterectomy (index date). Each woman was age-matched to a woman residing in the same county on the index date who had not had a hysterectomy or any ovarian removal. The study determined prior cardiovascular and metabolic conditions prior to surgery and looked only for new onset of disease after hysterectomy.

The study shows that women who had a hysterectomy without any ovary removal had a 14% increased risk in lipid abnormalities, a 13% increased risk of high blood pressure, an 18% increased risk of obesity and a 33% increased risk of coronary artery disease. Furthermore, women under the age of 35 had a 4.6-fold increased risk of congestive heart failure and a 2.5-fold increased risk of coronary artery disease.

“Hysterectomy is the second most common gynaecologic surgery, and most are done for benign reasons, because most physicians believe that this surgery has minimal long-term risks,” says Laughlin-Tommaso. “With the results of this study, we encourage people to consider non-surgical alternative therapies for fibroids, endometriosis and prolapse, which are leading causes of hysterectomy.”

Abstract
Objective: The aim of the study was to determine the long-term risk of cardiovascular disease and metabolic conditions in women undergoing hysterectomy with bilateral ovarian conservation compared with age-matched referent women.
Methods: Using the Rochester Epidemiology Project records-linkage system, we identified 2,094 women who underwent hysterectomy with ovarian conservation for benign indications between 1980 and 2002 in Olmsted County, Minnesota. Each woman was age-matched (±1 y) to a referent woman residing in the same county who had not undergone prior hysterectomy or any oophorectomy. These two cohorts were followed historically to identify de novo cardiovascular or metabolic diagnoses. We estimated hazard ratios (HRs) and 95% CIs using Cox proportional hazards models adjusted for 20 preexisting chronic conditions and other potential confounders. We also calculated absolute risk increases and reductions from Kaplan–Meier estimates.
Results: Over a median follow-up of 21.9 years, women who underwent hysterectomy experienced increased risks of de novo hyperlipidemia (HR 1.14; 95% CI, 1.05-1.25), hypertension (HR 1.13; 95% CI, 1.03-1.25), obesity (HR 1.18; 95% CI, 1.04-1.35), cardiac arrhythmias (HR 1.17; 95% CI, 1.05-1.32), and coronary artery disease (HR 1.33; 95% CI, 1.12-1.58). Women who underwent hysterectomy at age ≤35 years had a 4.6-fold increased risk of congestive heart failure and a 2.5-fold increased risk of coronary artery disease.
Conclusions: Even with ovarian conservation, hysterectomy is associated with an increased long-term risk of cardiovascular and metabolic conditions, especially in women who undergo hysterectomy at age ≤35 years. If these associations are causal, alternatives to hysterectomy should be considered to treat benign gynecologic conditions.

Authors
Shannon K Laughlin-Tommaso, Zaraq Khan, Amy L Weaver, Carin Y Smith, Walter A Rocca, Elizabeth A Stewart

Mayo Clinic material
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