Hysterectomy and Ovary Removal Increase Stroke Risk
New meta-analysis shows need for monitoring women long after surgery
A large meta-analysis suggests women who undergo hysterectomy and/or bilateral oophorectomy face an increased risk of stroke, highlighting the need for close long-term monitoring and preventive care.
Study Details
Researchers analyzed data from the U.S. National Health and Nutrition Examination Survey (NHANES) spanning 1999–2018 and combined it with findings from 15 cohort studies published between 2009 and 2023, covering more than 2 million women. Previous studies on this question produced mixed results, but this updated meta-analysis provides stronger evidence of a connection between these surgeries and stroke risk.
Methodology
The team evaluated stroke outcomes in women with and without hysterectomy and/or bilateral oophorectomy. Hazard ratios (HRs) were calculated to estimate the risk of stroke in women who had undergone surgery compared with those who had not. Subgroup analyses looked at surgical indications, ovarian conservation status, and other clinical factors.
Key Findings
Hysterectomy alone was associated with a modestly higher risk of stroke (HR 1.09).
Bilateral oophorectomy (removal of both ovaries) carried a greater risk (HR 1.13), regardless of hysterectomy status.
Women with ovarian conservation still showed elevated risk (HR 1.05), but risk was even higher with ovary removal (HR 1.18).
The stroke risk was significant when surgery was performed for benign indications, but not for combined benign/malignant reasons.
The researchers suggested that estrogen loss following surgery may reduce cardiovascular protection, while hysterectomy may also trigger systemic inflammation and accelerate vascular changes.
Implications for Practice
For patients: Women who undergo hysterectomy or ovary removal should be informed that their stroke risk may rise after surgery, particularly if both ovaries are removed. Preventive measures such as blood pressure monitoring, lifestyle changes, and routine follow-up with healthcare providers become especially important.
For healthcare providers: These findings underscore the importance of discussing long-term vascular health with patients considering these procedures, especially for benign conditions. Early detection of stroke risk factors and tailored preventive strategies may help mitigate outcomes.