Study finds increased risk of type 2 diabetes after hysterectomy especially in younger women

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A study of more than 83,000 middle aged French women who had undergone a hysterectomy could show that they are at higher risk of developing type-2 diabetes (T2D). The results of the study, which was presented at the annual meeting of the European Association for the Study of Diabetes (EASD), in Stockholm, Sweden (19-23 September), is available here.

All women participated in the French E3N study. This study examines risk factors associated with cancer in women who were born between 1925-1950.

“The findings of this large French cohort suggest a 52% increase in incident type 2 diabetes risk for women who have undergone hysterectomy before age 45,” says Professor Fabrice Bont, CHU de Rennes and Centre for Research in Epidemiology and Population Health. Importantly, the risk of developing diabetes increases when both ovaries have been removed. However, this increased risk does not disappear if both ovaries remain intact. This is not due to unhealthy eating habits or inactivity.

As a treatment for fibroids, heavy periods, endometriosis and gynecological carcinomas, hysterectomy may be recommended. Sometimes, the surgery involves removing the uterus (or womb), along with the fallopian tubes or cervix.

Each year, more than 400,000 hysterectomies in the U.S. are performed, 80,000 in France, and 55,000 in Britain. They are performed mostly for benign disease in women aged 40-50.

Studies in France, in particular, have shown that hysterectomy is associated to increased risk of high blood pressure and cardiovascular diseases like stroke. This is especially true when it is accompanied with ovary removal. Few studies have examined the connection between hysterectomy, the risk of developing T2D. These studies have mostly been done on post-menopausal women, and did not consider the possible influence of diet or physical activity.

Researchers followed 83.582 women (average age 51; range 45-60 years at inclusion), who were not suffering from diabetes when the study began. Researchers analysed data collected every 2 years using a questionnaire that assessed lifestyle factors including diet, body mass, smoking, age at first period (puberty), age at menopause, menopausal status and age at menopause.

They also looked into whether a poor lifestyle could increase the risk of T2D in women who had a full hysterectomy. The analyses did not include women with gynecological carcinomas.

17.141 women had a hysterectomy, while 2,672 developed T2D. This average follow-up was 16 years.

After adjusting for factors such as education, smoking status and family history of diabetes, women who had a hysterectomy were 27% more likely than those who didn’t.

After further adjustment for reproductive factors (e.g. age at first period), this association did not change significantly [puberty], menopausal condition) and hormonal treatments, e.g., oral contraceptives, HRT.

The relationship between incident T2D and hysterectomy was not affected by the type of diet or level of activity.

Furthermore, the authors found no association between overweight (BMI≥25 kg/m2) and an higher risk of diabetes.

The results showed that a hysterectomy that left the ovaries intact was associated with a 13% increase in diabetes risk, compared with a 26% greater risk following both an oophorectomy and a full hysterectomy.

Professor Bonnet said, “This indicates that ovarian conservation might be beneficial in decreasing the risk of type-2 diabetes.” “Our findings also show that women who had a Hysterectomy were more likely be depressed (assessed via a self-administrated survey). It is well-known that depression can increase the risk of developing diabetes. Our data suggests that hysterectomy may be associated with a higher risk of developing diabetes.

Importantly, the overall risk for T2D in women who had a previous hysterectomy prior to the age of 45 was 52% higher in this age group than in those who did not have a hysterectomy. After age 45, there was no statistically significant increase in the risk for women who had a full hysterectomy.

Professor Bonnet states that there are times when a hysterectomy might be the best option for a woman. However we need to ensure that patients are aware of the possible health risks associated with this procedure, especially before the age 45. Also, they are informed about nonsurgical alternatives to fibroids, endometriosis and prolapse. These are the most common reasons for hysterectomy. “More research is needed to identify the underlying causes of diabetes in these women.

Although their findings don’t suggest that all women who have had a hysterectomy in the past 45 years will develop T2D, the authors acknowledge that they did not find any. They do indicate a moderate risk association and cannot rule out other factors or missing data. The authors also point out that the study was based on self-reports about lifestyle factors, BMI, and disease diagnosis. This might not have been accurate.

Women with endometriosis could be at higher risk for stroke.

Study shows that hysterectomy increases the risk of type 2 diabetes, especially among younger women (2022 and September 21).
Retrieved 21 September 2022
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