IMS Menopause Live

Long-term risks of hysterectomy for benign indication: what is known?

21 March 2022

Summary

Hysterectomy is the most common treatment option for women with uterine fibroids, providing definitive relief of the associated burdensome symptoms. Nevertheless, as with all surgical interventions, it is associated with the risk of complications, short-term morbidities, and mortality. Although all these aspects have previously been described, information regarding the potential long-term risks of hysterectomy is only recently becoming available. Bearing this in mind, recently, Madueke-Laveaux et al. [1] conducted a systematic review of the literature to identify long-term risks related to hysterectomies performed for uterine fibroids with or without oophorectomies since the short-term risks of both morbidity and mortality have already been widely studied. They included in their review studies published between 2005 and December 2020 that assessed the long-term impact of hysterectomy for benign pathology in women, identifying 29 relevant studies. The review of the identified articles showed that hysterectomy even with ovarian preservation can increase the risk of cardiovascular events (very strongly associated with hypoestrogenism), certain cancers (i.e urinary tract), the need for further surgery, and premature ovarian failure and menopause that lead to long-term sequelae such as fragility fractures, cognitive impairment and impairment of quality of life in different domains. In addition, when hysterectomy was performed in younger women (< 44 years) a significant higher rate of depression was found after 10 years of follow-up when compared to menopausal women over 50 years with established menopause. The authors remark that it is important to recognize that the available studies examine possible associations and hypotheses rather than causality, hence the results should be taken with caution.

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