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Hysterectomy with ovarian conservation also linked to increased CVD risk

By Bianca Nogrady
Hysterectomy, even with ovarian conservation, is associated with long-term increases in the risk of cardiovascular and metabolic disease, new US research suggests. 

A retrospective cohort study followed 2094 women, for a median of 21.9 years, who had undergone hysterectomy with ovarian conservation for benign indications, and age-matched them to a referent cohort who had not undergone hysterectomy. 

According to the findings, published in Menopause, women who underwent hysterectomy showed a 14% increase in the risk of de novo hyperlipidaemia, 13% increase in the risk of hypertension, 18% increase in the risk of obesity, 17% increase in the risk of cardiac arrhythmias and 33% increase in the risk of coronary artery disease. These increased risks remained even after excluding women with pre-existing chronic conditions at the time of the surgery. 

The risk appeared to be more pronounced in women who underwent the hysterectomy at age 35 years or younger. This group showed a 4.6-fold increase in the risk of congestive heart failure and a 2.5-fold increase in the risk of coronary artery disease, although these increases manifested 20 to 25 years after the procedure, at around the time of expected natural menopause. 

In contrast, women who underwent hysterectomy after the age of 50 years showed no significant increases in cardiovascular or metabolic disease relative to the reference cohort. 

The authors suggested that the cardiovascular and metabolic effects of hysterectomy could be mediated by indirect impacts on ovarian function. 

‘One theory is that the loss of collateral blood flow to the ovaries caused by hysterectomy results in decreased ovarian reserve and its sequelae,’ they wrote. ‘Alternatively, the uterus itself could have a paracrine or endocrine effect on the ovaries.’ 

Commenting on the findings, Dr Elizabeth Farrell, Medical Director of the Jean Hailes Institute for Women’s Health, said while the study was limited by its retrospective nature, it did suggest caution in the use of hysterectomy to treat benign conditions.

‘What a hysterectomy does in terms of ovarian function and menopause, we are yet to find out,’ Dr Farrell told Medicine Today. ‘The clinical implication is that we should try to manage these women as conservatively as possible until there’s no other choice but hysterectomy.’

The authors raised the possibility that hormone replacement therapy be considered for women of any age who undergo hysterectomy, which Dr Farrell said was an interesting suggestion that would require further studies, including prospective studies, to test their hypothesis.
Menopause 2017; doi: 10.1097/GME.0000000000001043.