Women who undergo hysterectomy face up to an 18 per cent higher risk of stroke, especially if both ovaries are removed, according to new research.
A meta-analysis of data from more than 2 million people found that removing the uterus and cervix alone raises risk by 5 per cent, while combining this with removal of both ovaries increases the risk to 18 per cent.
The findings suggest that these common gynaecological surgeries may carry longer-term health risks that require closer follow-up for patients.
Researchers in China analysed US health data from more than 21,000 women collected between 1999 and 2018, then combined it with 15 other studies for comparison. In the US dataset, hysterectomy alone was not significantly linked to stroke, but when both ovaries were removed, risk increased. In the larger meta-analysis, however, an elevated risk was found for both groups.
A hysterectomy removes the uterus and cervix. An oophorectomy involves removing one or both ovaries, which produce hormones including oestrogen. A bilateral oophorectomy removes both ovaries.
These procedures are among the most common surgeries for women in the US, carried out for conditions such as cancer, prolapse, endometriosis, postpartum haemorrhage or uterine fibroids.
Before 2000, it was relatively common to remove both ovaries during hysterectomy. But a 2009 study found women who had both ovaries removed for non-cancer reasons faced increased risk of death from causes including coronary heart disease and lung cancer. Compared with women who kept their ovaries, those who had them removed also faced a 14 per cent higher risk of stroke.
The mechanism behind the stroke risk is unclear, though scientists suspect it is linked to premature menopause caused by hormone loss when ovaries are removed.
Today, bilateral oophorectomy is generally not recommended for pre-menopausal women unless they face serious risks such as cancer.
The relationship between these surgeries and stroke appears complex, and may also be affected by factors such as age at surgery, use of hormone replacement therapy and differing definitions of stroke. In 2018, for instance, researchers found that young women who had an oophorectomy and used oestrogen replacement were not necessarily at increased risk. In 2024, however, a meta-analysis reported the opposite, showing hysterectomy was associated with stroke risk, especially when both ovaries were removed.
Stephanie Faubion, medical director for The Menopause Society, said: “The results highlight that these common procedures carry longer-term risks.
“They also call attention to an opportunity for more careful assessment of cardiovascular risk and implementation of risk reduction strategies in women who undergo these surgeries.”
The authors concluded: “The current study indicates that hysterectomy and/or bilateral oophorectomy are associated with an increased risk of stroke, underscoring that women who have had these surgeries should be closely monitored and require proactive preventive health measures for early signs of stroke.
“Moreover, our findings encourage clinical researchers to explore new safer surgical techniques or alternative treatments for diseases related to hysterectomy/bilateral oophorectomy.”
The study was published in Menopause.
