- Previous meta-analyses examining the association between hysterectomy and/or bilateral oophorectomy and stroke risk have had mixed results.
- This meta-analysis showed that hysterectomy and/or bilateral oophorectomy were associated with an increased risk of stroke.
- The authors suggested that women who undergo these surgeries should be closely monitored for early signs of stroke.
Hysterectomy and/or bilateral oophorectomy were associated with an increased risk of stroke, according to a meta-analysis.
Using data from the National Health and Nutrition Examination Survey (NHANES) and 15 other studies, hysterectomy was shown to be associated with a higher stroke risk compared with no hysterectomy (HR 1.09, 95% CI 1.04-1.15, P=0.001), reported Nan Wu, MD, of Chongqing General Hospital and Chongqing University in China, and colleagues.
This was also the case for bilateral oophorectomy compared with no bilateral oophorectomy, regardless of hysterectomy status (HR 1.13, 95% CI 1.09-1.17, P<0.001), they noted in Menopause.
With no hysterectomy as the reference, subgroup analyses by surgical indication showed a significant association between hysterectomy and a higher stroke risk for benign indications (HR 1.10, 95% CI 1.04-1.17, P=0.001) but not benign/malignant indications (HR 1.05, 95% CI 0.92-1.20, P=0.454). When stratified by ovarian conservation status, there was an elevated stroke risk in women with ovarian conservation (HR 1.05, 95% CI 1.01-1.08, P=0.01) and those with bilateral oophorectomy (HR 1.18, 95% CI 1.10-1.27, P<0.001).
"The high prevalence of this intervention necessitates comprehensive evaluation of its long-term health consequences," wrote Wu and colleagues. "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."
As for the biological mechanisms that may play a role here, the authors noted that these surgeries can lead to estrogen loss that impairs cardiovascular protection, and can result in "harmful hemorheologic changes."
Research has shown that hysterectomy induces menopausal transition, while postmenopausal iron dysregulation accelerates atherosclerosis, they pointed out. "Hysterectomy -- especially when performed abdominally -- can provoke a systemic inflammatory response, contributing to endothelial dysfunction."
Previous meta-analyses examining the association between hysterectomy and/or bilateral oophorectomy and stroke risk have had mixed results, the authors said.
"Future prospective studies with a large sample size and longer follow-up period are needed to address the disparities of type of stroke, age at surgery, surgical techniques, and menopause status on the association between stroke risk and hysterectomy and/or bilateral oophorectomy," Wu and colleagues concluded.
Looking at the unweighted NHANES data from 1999-2018 alone showed that hysterectomy was not significantly associated with mortality from stroke (HR 1.28, 95% CI 0.89-1.85). This cohort included 21,240 women (representing 85.9 million U.S. women) with a median of 8.3 years of follow-up and 193 stroke-related deaths.
The 15 cohort studies, published between 2009 and 2023, included more than 2 million women and examined fatal strokes as well as non-fatal strokes.
Study limitations included possible residual confounding due to issues such as drug use, education, and socioeconomic factors.
Disclosures
The study authors reported no disclosures.
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