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Published on: September 12, 2025
Cardiovascular outcomes after hysterectomy: a systematic review and meta-analysis
Tanawat Attachaipanich1, Kotchakorn Kaewboot2, Suthinee Attachaipanich3
1Department of Internal Medicine, Kansas City School of Medicine, University of Missouri, Kansas City, Missouri, USA.
Insights
Hysterectomy increases cardiovascular disease risk, especially in premenopausal women. This includes higher rates of stroke and coronary artery disease. Cardiovascular risk assessment is recommended for these patients.
Area of Science:
- Cardiovascular health
- Gynecologic surgery outcomes
- Epidemiology
Background:
- Hysterectomy is a frequent surgical procedure for women.
- The impact of hysterectomy on cardiovascular health is not well understood.
- This study investigates cardiovascular outcomes in women with and without a history of hysterectomy.
Purpose of the Study:
- To compare cardiovascular outcomes between women who have undergone hysterectomy and those who have not.
- To analyze the association between hysterectomy and the incidence of cardiovascular events.
- To explore how the timing of hysterectomy (premenopausal vs. postmenopausal) influences cardiovascular risk.
Main Methods:
- A comprehensive meta-analysis was conducted, searching four databases.
- Included studies reported cardiovascular outcomes in women with and without hysterectomy.
- Data from 28 studies involving over 2.9 million participants were analyzed.
Main Results:
- Women undergoing hysterectomy had a higher incidence of cardiovascular disease (HR 1.19).
- Increased risk of stroke (HR 1.11) and coronary artery disease was observed, particularly after premenopausal hysterectomy.
- Hysterectomy with bilateral oophorectomy was associated with higher rates of stroke and myocardial infarction.
Conclusions:
- Hysterectomy is linked to an increased frequency of cardiovascular events.
- Premenopausal hysterectomy poses a significant cardiovascular risk.
- Consideration of cardiovascular risk assessment in women post-hysterectomy, especially premenopausal, is advised.
Background:
Hysterectomy is a common nonobstetric surgical procedure performed in women. However, the cardiovascular effects of hysterectomy remain unclear. This meta-analysis compared cardiovascular outcomes in women with and without a history of hysterectomy.
Methods:
A comprehensive search of four databases was conducted from inception to March 25, 2025. Studies were included if they reported cardiovascular outcomes in women with versus without hysterectomy.
Results:
A total of 28 studies involving 2,942,404 participants were included in this meta-analysis. Cardiovascular disease occurred more frequently among women undergoing hysterectomy than among those without hysterectomy (pooled hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.09-1.29; P < 0.01). A higher incidence of stroke was observed in women with hysterectomy (pooled HR 1.11, 95% CI 1.01-1.22, P = 0.03). The association between hysterectomy and cardiovascular outcomes differed by timing of surgery. An increased risk of stroke, coronary artery disease, and cardiovascular disease was identified following premenopausal hysterectomy. In contrast, no significant association with cardiovascular events was found for postmenopausal procedures. Additionally, a higher occurrence of stroke, myocardial infarction, and cardiovascular disease was observed in women undergoing hysterectomy with bilateral oophorectomy.
Conclusions:
Cardiovascular events occurred more frequently following hysterectomy, particularly among women before menopause. Cardiovascular risk assessment may be warranted in this population.
