I’ve written in a past article about the risks of hysterectomy that are seldom discussed, not only in the medical community but with patients as they consider surgery.
To maintain my board-certification as an obgyn, I’m required to read 15 articles that I choose from a library curated by the American Board of Obstetrics and Gynecology (ABOG). Their library covers general obgyn topics as well as sub-specialist articles like oncology and high-risk obstetrics.
Given my interests, I’ve chosen mostly articles that relate to menopause, hormone replacement therapy, and midlife in some way.
My most recent read was published in AJOG, the journal referred to as “The Gray”. It reveals the association between hysterectomy and metabolic syndrome.
What is metabolic syndrome?
Metabolic syndrome is classified as meeting 3 of 5 of the following criteria:
Triglycerides above 150 mg/dL
Fasting glucose above 100 mg/dL
HDL cholesterol lower than 50 mg/dL (this is the cholesterol that decreases cardiovascular risk as it increases, especially for women)
Waist circumference above 35 inches (88 cm) for women
Blood pressure 130/85 mmHg or higher
Why does metabolic syndrome matter?
By sheer numbers, it matters because this affects over 40% of American adults.
Adults with MetS have:
twice the risk of cardiovascular disease
five times the risk of diabetes, which in itself is a cardiovascular risk.
What does metabolic syndrome leave out?
The big omission of metabolic syndrome, particularly for women, is body composition. Body composition is the matter of body fat, muscle and how and where a woman stores her fat. Interestingly, a woman who stores fat in the upper body has a different and higher risk than a woman who stores fat in the lower body. Stay tuned for an upcoming article on why Dad Bod isn’t healthy for women.
It remains controversial as to whether a constellation of symptoms like metabolic syndrome is causing obesity or if obesity is leading to the syndrome. It’s a chicken or the egg scenario.
We do know that fat cells are very active. We’ve previously thought of fat as just hanging on our bodies, doing nothing but bothering us.
In reality, fat is a hormonally active organ. Not only do fat cells produce estrogen from testosterone in a process called peripheral conversion using an enzyme called aromatase, but fat cells produce signals including:
Leptin
Resistin
Adiponectin
IL-6
TNF-alpha
These signals are telling the body what the energy state is and therefore, how the body should use incoming food. For example, leptin is insulin-sensitizing meaning it helps the body utilize insulin and therefore, glucose.
IL-6 and TNF-alpha are pro-inflammatory substances that decrease the body’s ability to use insulin (ie, insulin resistance).
How is hysterectomy related?
In this AJOG article I recently read, an association was found between having a hysterectomy and later developing metabolic syndrome.
We’ve discussed why metabolic syndrome matters.
It’s important to note here that association does not equal causation. This is frequently where a medical article will be blown out of proportion by the media, where the journal article will report an “association between x and y” the media headline will state “x causes y”.
What I find interesting about this article is that hysterectomy alone, even if a woman kept her ovaries, was associated with metabolic syndrome. My prior article focused on ovarian removal and the risks associated with that. We again think of the ovaries as being dead after menopause when in reality, they produce low levels of hormones even for years after menopause.
When I was in residency training, the practice of removing ovaries for convenience or no reason at at all was falling by the wayside.
Now it seems hysterectomy alone can also predispose a woman to increased risks, including life-threatening risks like cardiovascular disease.
The authors do not advise using their article as a point of decision-making because this is an early finding that does not show causation. This means if a woman is considering hysterectomy, this article should not be used to make her final decision.
They question whether hysterectomy is causing metabolic syndrome or if the association is actually due to the original reasons for hysterectomy, indications like fibroids and dysregulated bleeding that are associated with chronic inflammation and vascular disruption.
Hysterectomies can be life-saving both for some women with medical indications and quality of life motivations to have the procedure done. With over half a million performed in the U.S. each year and hospitals motivated to maintain high-throughput surgical practices, I simply wonder if some of these surgeries could be avoided, particularly if they increase longevity risks to women.
Resources:
Some of the information contained in this article is the result of my training, medical knowledge, and personal experience without a specific source to be cited.
Disclaimer: This is not medical advice. This is for educational purposes only. Discuss with your doctor.
https://www.biosciencetrends.com/downloadpdf/343
https://pubmed.ncbi.nlm.nih.gov/38703940/
