Hysterectomy, oophorectomy linked to raised stroke risk

Hysterectomy, oophorectomy linked to raised stroke risk | Image Credit: © Chinnapong - © Chinnapong - stock.adobe.com.

The risk of stroke is greater in women with hysterectomy or bilateral oophorectomy vs no surgery, according to a recent study published in Menopause, the journal of The Menopause Society.¹

This data supports the link between estrogen and stroke risk, indicated by an increased risk among postmenopausal women vs reproductive-aged women. Hysterectomy with bilateral oophorectomy was linked to an 18% increase in risk, vs 5% for hysterectomy alone.

“The results of this study demonstrate increased stroke risk related to hysterectomy and/or bilateral oophorectomy, highlighting that these common procedures carry longer-term risks,” said Stephanie Faubion, MD, MBA, medical director for The Menopause Society. “They also call attention to an opportunity for more careful assessment of cardiovascular risk.”

Stroke outcomes and data collection

Data was obtained from the National Health and Nutrition Examination Survey, a prospective CDC study with health, diet, personal, social, and economic information.² A retrospective cohort from 1999 to 2018 was developed using this data.

Reproductive health questions were used to collect hysterectomy and bilateral oophorectomy data. This included questions about whether patients had a hysterectomy, age at hysterectomy, whether an ovary was removed, and how many ovaries were removed.

This information was linked to the National Death Index for death certificate records. Stroke was based on International Classification of Diseases codes, with follow-up occurring until the end of the interview period, participant death, or December 31, 2019. Covariates included demographics, traditional risk factors, and female-specific factors.

There were 21,240 US women aged 20 to 85 years included in the final analysis, representing approximately 85.9 million patients. Among this cohort, 193 stroke-related deaths were reported.

Key findings on stroke risk

A significant link was reported between hysterectomy and stroke, with a hazard ratio (HR) of 2.34. However, when adjusting for demographics and traditional risk factors, the HR decreased to 1.16, no longer showing significance. Similarly, an HR of 1.28 was reported when further adjusting for female-specific factors.

There were also no significant associations found across subgroups based on age. However, hysterectomy with bilateral oophorectomy led to a significant increase in stroke risk of 51%, with an HR of 1.55. In comparison, non-significant HRs of 0.92 and 1.32 were reported for hysterectomy alone and hysterectomy with unilateral ovariectomy.

Hysterectomy with bilateral oophorectomy also had an HR of 1.62 for stroke vs hysterectomy alone, highlighting a significant increase in risk. There was also no significant association between hysterectomy and stroke risk in a sensitivity analysis of only patients without a history of stroke.

Meta-analysis findings

In a meta-analysis of 15 articles published between 2009 and 2023, increased odds of stroke were reported in patients with hysterectomy, with an HR of 1.09. However, this was only pronounced in benign indications during subanalysis. The HR for these indications was 1.10, vs 1.05 for benign and malignant indications.

Ovarian conservation and bilateral oophorectomy had HRs of 1.05 and 1.18, respectively, for stroke, both indicating increased risk. Overall, the data indicated increased stroke risk among women with hysterectomy with or without bilateral oophorectomy vs no surgery, though the data was limited by being self-reported and potentially including unilateral cases in the reference group.

“Future prospective studies with a large sample size and longer follow-up period are needed to address the disparities of type of stroke, age at surgery, surgical techniques, and menopause status on the association between stroke risk and hysterectomy and/or bilateral oophorectomy,” wrote investigators.

References

1. Hysterectomy with bilateral oophorectomy may increase risk of stroke. The Menopause Society. September 3, 2025. Accessed September 4, 2025. https://www.eurekalert.org/news-releases/1096712.
2. Shao C, Xu C, Zou D, et al. Stroke risk in women with or without hysterectomy and/or bilateral oophorectomy: evidence from the NHANES 1999-2018 and meta-analysis. Menopause. 2025;32(12). doi:10.1097/GME.0000000000002616