TOPLINE:

A meta-analysis of over two million participants reveals hysterectomy is linked to a 9% higher stroke risk, while bilateral oophorectomy increases stroke risk by 13%. National Health and Nutrition Examination Survey (NHANES) data from 21,240 women with 8.3-year median follow-up showed hysterectomy with bilateral oophorectomy elevates stroke risk by 51%.

METHODOLOGY:

• Analysis included data from NHANES 1999-2018, incorporating findings from NHANES with 15 other cohort studies identified through database searches.
• Researchers studied 21,240 women with 8.3 median follow-up years, documenting 193 stroke-related deaths, representing approximately 85.9 million US women.
• Survey-weighted Cox proportional hazards regression model was utilized, incorporating sampling weights and design variables to address NHANES multistage probability sampling framework.

TAKEAWAY:

• Meta-analysis of 2,065,490 participants showed hysterectomy was associated with a 9% higher stroke risk compared with no hysterectomy (hazard ratio [HR], 1.09; 95% CI, 1.04-1.15; P = .001).
• Bilateral oophorectomy showed a 13% increased stroke risk compared with no oophorectomy (HR, 1.13; 95% CI, 1.09-1.17; P < .001).
• Hysterectomy with bilateral oophorectomy was associated with a 51% increased risk for stroke compared with no surgery (HR, 1.55; 95% CI, 1.04-2.31).
• Subgroup analyses consistently demonstrated elevated risks across surgical indications and depending on ovarian conservation status.

IN PRACTICE:

“Women having a hysterectomy and/or bilateral oophorectomy had higher risks of stroke compared with those who did not have surgery. 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,” the authors of the study wrote.

SOURCE:

This study was led by Chuan Shao, MD, Chongqing General Hospital in Chongqing, China. It was published online in Menopause.

LIMITATIONS:

According to the authors, potential misclassification in NHANES may have attenuated true associations, particularly in bilateral oophorectomy ascertainment. The reliance on self-reported questionnaires at baseline failed to account for temporal changes during follow-up periods. Residual confounding persists as a concern inherent to observational designs, with earlier research omitting key socioeconomic determinants influencing surgical decisions.

DISCLOSURES:

The authors reported no relevant conflicts of interest or funding support.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.