Hysterectomy linked to increased risk of diabetes | Latest news for doctors, nurses and pharmacists | psychiatry

According to a study from France presented at EASD 2022, having a hysterectomy, especially at a young age, may be associated with an increased risk of developing diabetes.

“The results of this large French cohort suggest that women who have a hysterectomy before the age of 45 have a 52 percent increased risk of developing type 2 diabetes (T2D),” said lead author Professor Fabrice Bonnet by CHU de Rennes and The Center for Research in Epidemiology and Public Health, Villejuif, France.

The E3N cohort comprised women aged 40–65 when recruited in 1993. The present analysis was performed on 83,582 women (mean age 51 years) in this cohort without diabetes at baseline. Questionnaires distributed every 2 years were used to assess food intake and physical activity, while diabetic status was assessed through questionnaires, medical records, or antidiabetic drug prescriptions. Gynecological cancer was an exclusion criterion.

The women were followed for an average of 16 years, during which time 17,141 underwent hysterectomy for benign gynecologic disease and 2,672 were diagnosed with T2D.

Compared to women who had not had a hysterectomy, those who had not had a hysterectomy were older, had a higher BMI and level of physical activity, and were more likely to have had a menopause before age 45 and were on hormone replacement therapy but less likely smokers.

Incident diabetes was diagnosed more frequently in women who had or had not undergone a hysterectomy (4.2 percent vs. 2.9 percent; p<0.0001). [EASD 2022, abstract 151]

After adjustment for confounders*, hysterectomy was associated with a significantly increased risk of diabetes compared to no hysterectomy (adjusted hazard ratio [adjHR]1.27, 95 percent confidence interval [CI], 1.02–1.25; p=0.02). Results were retained after further adjustment for reproductive factors and hormonal treatments** (adjHR, 1.20, 95 percent CI, 1.09-1.33; p=0.0003).

The association was not affected by diet quality or physical activity level. However, age at hysterectomy appeared to have an impact. For example, women who underwent a hysterectomy aged < 40 years and < 45 years had a significantly increased risk of diabetes compared to women in their respective age groups who did not have a hysterectomy (adjHR**, 1.38, 95 percent CI, 1.10-1.74; p = 0.005 and
adjHR, 1.52, 95 percent CI, 1.31-1.78; p<0.0001). Reversed hysterectomy in old age ≥Age 45 had no effect on diabetes risk (adjHR, 1.07, 95 percent CI, 0.95-1.21; p=0.23; p_interaction=0.0048).

Oophorectomy as a modifying factor?

In women who had had a hysterectomy, the risk of diabetes was significantly increased in women who had also had an oophorectomy (adjHR**, 1.26, 95 percent CI, 1.11-1.42; p=0.0003), but was less prominent in those who had not undergone oophorectomy (adjHR, 1.13, 95 percent CI, 0.99-1.30; p=0.06).

“This suggests that ovarian preservation may be beneficial in reducing the risk of T2D,” Bonnet noted.

Increased risk of depression

In 2005, a total of 42,340 women in the cohort were assessed for depression (based on the revised Center for Epidemiological Studies Depression Scale [CES-D] Score). Among the 4,595 women diagnosed with depression (CES-D
≥23), the risk was greater in women with vs. without a history of hysterectomy (12.5 percent vs. 10.4 percent; p<0.0001).

“[These findings suggest] Depression may be a factor underlying the increased risk of developing diabetes after a hysterectomy,” Bonnet said.

Message to take away

Bonnet and co-authors noted that the results merely suggest a possible association between hysterectomy and T2D. In addition, unmeasured confounders and self-reported lifestyle data may have influenced the results. Further studies are warranted to elucidate the mechanisms behind this possible link, they said.

“There are circumstances where a hysterectomy is the best choice for a woman, but we need to ensure that patients are aware of the potential health risks associated with this procedure, particularly before the age of 45, and who are not -Surgical alternative therapies for fibroids, endometriosis and prolapse, which are the main reasons for hysterectomy,” concluded Bonnet.