The surgical removal of the uterus and both ovaries may come at a serious and overlooked cost to individual health, scientists from China suggest, after a meta-analysis of data from research on more than 2m women found that having a hysterectomy to remove the uterus and cervix is linked to a 5% higher stroke risk than not having the surgery.
Additionally, they said, having a hysterectomy along with the removal of both ovaries (a bilateral oophorectomy) is linked to an 18% higher risk of stroke, reports ScienceAlert.
“The results… (highlight) that these common procedures carry longer-term risks,” said Stephanie Faubion, medical director for The Menopause Society, a non-profit organisation that seeks to improve women’s health.
“They also call attention to an opportunity for more careful assessment of cardiovascular risk and implementation of risk reduction strategies in women having these surgeries.”
Today, hysterectomies and oophorectomies are some of the most common procedures for women, yet we still know very little about the long-term health effects.
While many of the surgeries are for non-terminal conditions, recent evidence suggests they could come at a life-threatening cost to the body and brain.
Recommendations differ, but typically, hysterectomies are reserved as a last resort for serious gynaecological conditions, like cancer, prolapse, endometriosis, postpartum haemorrhage, or uterine fibroids.
Before the turn of the century, however, it was relatively common practice in the United States to remove both ovaries during a hysterectomy. Only in recent decades has evidence suggested that this approach comes with potential dangers
A large-scale study from 2009 found that women who had both their ovaries removed as part of a hysterectomy for benign disease faced a significantly increased risk of dying from any cause, including coronary heart disease and lung cancer.
Compared with those who retained their ovaries, those who had them removed faced a 14% higher risk of stroke.
The reason is unclear, but some scientists suspect that because the ovaries release hormones, these outcomes are linked to premature menopause.
Today, the removal of both ovaries is generally not recommended in pre-menopausal patients unless they face serious risks, like cancer.
But the link between oophorectomies and stroke is complex, and it could be influenced by factors like age at the time of surgery, the use of hormone replacement therapy, and various definitions of stroke.
In 2018, for instance, some researchers found that young women who have an oophorectomy and use oestrogen replacements are not necessarily at an increased risk of stroke.
In 2024, however, a meta-analysis revealed the opposite, finding hysterectomy was associated with stroke risk, especially when both ovaries were removed.
To clear up confusion, researchers in China analysed long-term national health data from the US, collected from more than 21 000 women between 1999 and 2018. They then combined this research with 15 other studies for statistical comparison.
Analysing the national data from 1999 to 2018, it seemed that hysterectomy was not significantly associated with stroke risk. It was only associated with an elevated risk if both ovaries were removed as well.
However, in the larger meta-analysis the data did demonstrate an increased risk for both groups. This suggests that some previous studies may be underpowered to reliably detect a significant association, requiring larger sample sizes.
“The current study indicates that hysterectomy and/or bilateral oophorectomy are associated with an increased risk of stroke, underscoring that women who have had these surgeries should be closely monitored and require proactive preventive health measures for early signs of stroke,” the authors of the recent meta-analysis concluded.
“Moreover, our findings encourage clinical researchers to explore new safer surgical techniques or alternative treatments for diseases related to hysterectomy/bilateral oophorectomy.”
The study was published in Menopause.
Study details
Stroke risk in women with or without hysterectomy and/or bilateral oophorectomy: evidence from the NHANES 1999-2018 and meta-analysis
Shao, Chuan; Xu, Chao; Zou, Dewei; Zhang, Gang; Jiang, Haotian; Zeng, Cheng; Tang, Tao; Tang, Hui; Wu, Nan.
Published in Menopause on 2 September 2025
Abstract
Objective
We aimed to assess the relationship between hysterectomy and/or bilateral oophorectomy and the risk of stroke—a topic of ongoing debate in current research.
Methods
We utilised data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 to estimate both crude and multivariable-adjusted hazard ratios (HRs) and 95% CIs, applying survey-weighted Cox proportional hazards regression model. The modelling incorporated sampling weights and design variables to address NHANES’s multistage probability sampling framework. In addition, a meta-analysis was conducted, incorporating findings from NHANES with those from other cohort studies identified through database search.
Results
This unweighted NHANES cohort included 21 240 women with 8.3 median follow-up years, documenting 193 stroke-related deaths. Compared with no hysterectomy, hysterectomy was not significantly associated with stroke mortality (HR: 1.28, 95% CI: 0.89-1.85). However, a meta-analysis of 2,065,490 participants from NHANES and 15 other studies demonstrated hysterectomy was linked to a 9% higher stroke risk (HR: 1.09, 95% CI: 1.04-1.15) compared with no hysterectomy. Similar finding was identified for bilateral oophorectomy (HR: 1.13, 95% CI: 1.09-1.17) compared with no bilateral oophorectomy. Subgroup analyses stratified by surgical indication, ovarian conservation status, and reference population consistently demonstrated elevated risks.
Conclusions
In summary, the data from NHANES and other studies indicate women with hysterectomy and/or bilateral oophorectomy may be associated with an increased stroke risk. Additional prospective studies are needed to confirm the association between hysterectomy and/or bilateral oophorectomy and stroke risk.
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