Hysterectomy with Ovarian Conservation independent risk factor for metabolic syndrome: Finds Cohort Study

Metabolic syndrome is a cluster of various cardiovascular risk factors like obesity, hyperglycemia, hypertension, and dyslipidemia and is linked to an increased risk of incident atherosclerotic cardiovascular disease (CVD), heart failure, and all-cause mortality. Hysterectomy is the most common gynecologic surgical procedure for various obstetric and gynecologic conditions. Previous research shows that hysterectomy with bilateral salpingo-oophorectomy (BSO) to an increased risk of metabolic syndrome and cardiovascular disease. Recent evidence linked ovary-sparing hysterectomy to an increased risk of CVD. As there is uncertainty on the association between ovary-sparing hysterectomy and CVD with metabolic syndrome, researchers from the Johns Hopkins University School of Medicine, Baltimore, conducted a study to examine the associations between hysterectomy with ovarian preservation and metabolic syndrome risk in a multiethnic cohort.

The study included 3,367 women from the MESA (Multi-Ethnic Study of Atherosclerosis) cohort. MESA is a large, community-based, ethnically diverse study of cardiovascular risk factors. Baseline data on hysterectomy, oophorectomy, and metabolic syndrome was collected from the participants. Based on the surgical status they were categorized as hysterectomy only, oophorectomy only, hystero-oophorectomy, and no surgery. The criteria for metabolic syndrome were taken based on the National Cholesterol Education Program criteria, having at least three of the following: large waist circumference, high triglycerides, low HDL cholesterol, high blood pressure, or high fasting glucose. Adjusted logistic regression to assess the cross-sectional associations between hysterectomy and or oophorectomy subgroups and prevalent metabolic syndrome at baseline. About 1355 participants free of baseline metabolic syndrome were involved and adjusted Cox regression models were used to evaluate incident metabolic syndrome.

Findings:

• The mean age was 59.09.5 years, with 42% White, 27% Black, 19% Hispanic, and 13% Chinese American participants.
• About 29% had a history of hysterectomy and 22% had oophorectomy.
• Nearly 750 metabolic syndrome events were seen over a median follow-up of 10.5 years.
• Hysterectomy and hystero-oophorectomy were both associated with incident metabolic syndrome compared with having neither hysterectomy nor oophorectomy.

Thus, the researchers concluded that ovary-preserving hysterectomy was independently associated with a higher risk of metabolic syndrome. The potential mechanisms that the authors believed include reduced blood flow to the ovaries after hysterectomy decreased hormone levels (progesterone, estradiol), and leads to premature ovarian failure, triggering early menopause and metabolic issues.

Further reading: Broni EK, Echouffo-Tcheugui JB, Palatnik A, et al. Associations between hysterectomy and metabolic syndrome: the Multi-Ethnic Study of Atherosclerosis. Am J Obstet Gynecol. 2024;231(4):448.e1-448.e12. doi:10.1016/j.ajog.2024.04.035