Hysterectomy and Stroke Risk: New Evidence Highlights Long-Term Health Implications

The surgical removal of the uterus — with or without the ovaries — may carry more long-term health risks than previously understood, according to a new large-scale analysis.

What the Research Shows

A recent meta-analysis, drawing on data from more than 2 million women worldwide, found:

• Hysterectomy alone (removal of uterus and cervix) was associated with a 5% increased risk of stroke.

• Hysterectomy with bilateral oophorectomy (removal of both ovaries) was linked to an 18% increased risk of stroke.

These findings, published in Menopause, suggest that procedures long considered routine may have under-recognised effects on cardiovascular and neurological health.

Why the Risk Increases

The ovaries continue to produce hormones, even after the menopause transition. When they are removed, women experience surgical menopause, often at an earlier age than natural menopause. Researchers believe this sudden drop in oestrogen and other hormones could explain the higher risks of stroke, cardiovascular disease, and potentially cognitive decline.

Stephanie Faubion, Medical Director of The Menopause Society, emphasised:

“These results highlight that common gynaecological surgeries carry longer-term risks. They underline the importance of careful cardiovascular risk assessment and prevention strategies for women undergoing hysterectomy or oophorectomy.”

Historical Context

Until the early 2000s, it was common practice in the US to remove both ovaries during hysterectomy — even when cancer was not present. Subsequent studies have since raised concerns:

• A 2009 study found women who had both ovaries removed faced a 14% higher risk of stroke and an increased risk of death from all causes.

• A 2022 Chinese cohort study involving over 300,000 women reported a 9% increased risk of stroke after hysterectomy or oophorectomy.

  
  

The new meta-analysis strengthens this body of evidence by combining multiple studies, making it less likely that the link is due to chance.

What This Means for Women

While hysterectomy and oophorectomy remain essential treatments for conditions like cancer, prolapse, severe endometriosis, or fibroids, experts stress they should be reserved for when less invasive alternatives are not effective.

Key takeaways:

• Not all women face the same risk: Age at surgery, hormone replacement therapy (HRT), and overall health may influence outcomes.

• Close monitoring is critical: Women who undergo hysterectomy — especially with ovary removal — should be offered proactive cardiovascular screening and stroke prevention strategies.

• More research is needed: Safer surgical techniques and non-surgical treatments could reduce the long-term health burden.

The study authors conclude:

“Women undergoing hysterectomy or bilateral oophorectomy should be closely monitored for early signs of stroke, and clinicians should prioritise preventive health strategies.”

This research adds to a growing recognition that women’s health procedures must be studied in the long term, not just in the immediate recovery phase.