Despite evidence suggesting that women whose uterus has been
removed may be more likely to experience heart troubles, a new study finds that
the usual signs of heart disease risk are not more severe in middle-aged women
After following more than 3 000 women for about 11 years,
researchers found that heart risk factors like cholesterol, markers of
inflammation and blood pressure were not significantly worse in women in the
years following an elective hysterectomy, compared to women who did not have
"I think it's encouraging to women and clinicians that
this is not something they have to worry about if they're considering
hysterectomy (in) midlife," said Karen Matthews, the study's lead author
from the University of Pittsburgh.
most common surgery
Hysterectomy, the surgical removal of the uterus, is the
second most common surgery among US women, after cesarean-section deliveries.
Often the procedure is used to remove or prevent cancer, especially among
younger women. But many women may elect to have the surgery for other reasons,
including to treat painful benign growths in the uterine wall known as fibroids
or to staunch heavy bleeding.
Hysterectomies can involve removal of the uterus only, or
the ovaries as well. Ovary removal in particular has been linked to increased
cardiovascular risk because it takes away the main source of estrogen in a
woman's body and plunges her abruptly into menopause.
Even the gradual decline of estrogen following natural
menopause has been linked to women's increased heart risks, so researchers have
investigated whether hysterectomy raises those risks.
But studies of the connection have produced mixed results .For
the new study, Matthews and her colleagues used data from the Study of Women's
Health Across the Nation, which followed a large, multiethnic group for more
than a decade to understand the experience of American women during and after
Women included in the
The 1 952 women included in the study were between 42 and 52
years old and not yet in menopause when tracking began. They were followed from
1996 through 2008, receiving annual checkups that recorded information about
their health, surgeries and whether or not they had started menopause.
Specifically, the researchers looked at physical
measurements that are markers for heart and cardiovascular disease. They
included various components of cholesterol, blood pressure, blood clotting
factors and molecules that are signals of inflammation.
Overall, the researchers report in the Journal of the
American College of Cardiology that none of those measurements in the 183 women
who chose to have their uterus removed - with or without their ovaries - were
significantly worse, compared to the 1 769 women who went through menopause
Matthews said their findings apply to women who are finished
having children, in their forties and are considering a hysterectomy to help
with excessive bleeding or other factors that cause a quality of life problem.
Why women had their uterus
and ovaries removed
She said they couldn't make a conclusion for women who need
to have their uterus and ovaries removed because of cancer."Our study
really couldn't examine that question because we had too few women who had
gynecological cancers, and the equation changes when you have gynecological
cancer," said Matthews.
But Dr JoAnn Manson, who has researched women's health after
hysterectomy but was not involved in the new study, suggested the results don't
mean that women who have hysterectomies are in the clear, because past studies
only saw a difference in heart risks after 10 to 15 years.
Manson, who is chief of preventive medicine at Brigham and
Women's Hospital in Boston, told Reuters Health that the abrupt transition to
menopause after a hysterectomy may only reverberate years later because
"atherosclerosis takes a while to develop.
That seems to take up to 10 and 15 years for clear
differences to emerge."For that reason, "This isn't totally
surprising that there wasn't a difference in risk factors during the follow up
period," Manson said. Matthews said that's one potential explanation for
why their results differ from previous studies, but she said there could be
other reasons, including that modern women are somehow different from women
included in past research."It may be that it's emerging much later, but I
would be surprised," Matthews said.