Hysterectomy prevalence and cardiovascular disease risk factors in American Indian women

Association of hysterectomy with nonalcoholic fatty liver disease among US women

BACKGROUND

A postmenopausal rise in the rates of nonalcoholic fatty liver disease (NAFLD) has been reported in women. This study thus sought to further probe the association of hysterectomy with NAFLD.

METHODS

The data utilized in this investigation were attained from the 2017-March 2020 cycle of the National Health and Nutrition Examination Survey (NHANES), reflecting a strategic utilization of comprehensive health and nutrition information in the US population, to conduct a cross-sectional examination of the relationship between self-reported hysterectomy and NAFLD. Subjects included in this study were women aged 20 years or older. The multivariable logistic regression methodologies were utilized to determine the pertinent odds ratios (ORs) and their associated 95% confidence intervals (CIs).

RESULTS

Of the 2,868 subjects enrolled in this study (mean age: 51.3 years, 95%CI: 50.0-52.6 years), 22.1% (95%CI: 19.7-24.7%) reported having undergone a hysterectomy, while 31.1% (95%CI: 28.1-34.1%) exhibited elastographic evidence of NAFLD, and 3.8% (95%CI: 2.6-5.6%) exhibited clinically significant fibrosis (CSF). Relative to women with no history of hysterectomy, those that had undergone hysterectomy exhibited a higher odd of NAFLD (OR:1.66, 95%CI: 1.24-2.21) in a multivariable model fully adjusted for age, ethnicity, body mass index, female hormone use, oophorectomy, diabetes, hyperlipidemia, and smoking status. Subgroup analyses revealed a stronger association among women who were not obese (OR:2.23, 95%CI:1.61-3.11), women who were not affected by diabetes (OR:1.76, 95%CI: 1.25-2.46), and without hyperlipidemia (OR: 1.87, 95%CI: 1.10-3.16). No significant association of hysterectomy with NAFLD encompassing CSF was identified.

CONCLUSIONS

The results of the present nationally representative analysis suggested an association between hysterectomy and increased NAFLD prevalence among US women. Knowledge of this relationship may better aid clinical efforts to screen for and manage NAFLD.

The epidemiological profile of hysterectomy in rural Chinese women: a population-based study

OBJECTIVES

Hysterectomy is one of the most common surgical procedures performed on women in developed countries; however, little is known about the epidemiology of hysterectomy in low-income to middle-income regions. This study seeks to evaluate the prevalence of hysterectomy and its risk factors in rural China.

METHODS

Questionnaires were collected from 3328 female adults aged 25â€"69 years in rural Anyang, China, in 2009â€"2011. Hysterectomy status was ascertained by the gynaecologist at the time of cytological test. Univariate and multivariate regression analyses were performed to assess the risk factors for hysterectomy.

RESULTS

The overall prevalence of hysterectomy was 3.31% (110/3328). Women above the age of 40 years had a higher prevalence of prior hysterectomy, compared with those aged 25â€"39 years (5.01% vs 0.33%). Obesity was marginally related with a higher risk of hysterectomy (adjusted OR=1.59; 95% CI 0.99 to 2.56; body mass index (BMI) ≥28.0 vs 18.5 ≤ BMI <24.0). History of prior pregnancy loss conferred a greater risk for hysterectomy (adjusted OR=1.51; 95% CI 1.02 to 2.23). Of the 75 (68.18%, 75/110) cases who provided further information on hysterectomy, 84.00% (63/75) had undergone total abdominal hysterectomy and 70.67% (53/75) had received surgery for leiomyoma.

CONCLUSIONS

Rural Chinese women had a relatively low prevalence of hysterectomy, and the majority of reported hysterectomies were performed abdominally for leiomyoma. Hysterectomy prevalence differed significantly by age, BMI and history of pregnancy loss. This study expands the current understanding of the epidemiology of hysterectomy in lower resource areas.

Factors related to hysterectomy in women with physical and mobility disabilities

This paper aims to identify self-report data for hysterectomy prevalence and to explore its correlated factors among women with physical and mobility disabilities in Taiwan. This paper was part of a larger study, "Survey on Preventive Health Utilizations of People with Physical and Mobility Disability in Taiwan", which is a cross-sectional survey conducted in 2009. We recruited 502 women aged ≧15 years who were officially registered as having physical and mobility disabilities. The results show that 11.3% of women with physical and mobility disabilities accepted hysterectomy surgery and that hysterectomy prevalence was increasing by age: 7% (45-49 years), 9.7% (50-54 years), 26.3% (55-59 years), 31% (60-64 years) and 17.6% (≧65 years). Multilevel logistic regression analyses revealed that being ≧50 years or older (OR=4.65, 95% CI=1.79-12.064), having had cervical cancer (OR=17.2, 95% CI=3.5-84.47) and not having a Pap smear test within the last 3 years (OR=2.79, 95% CI=1.194-6.561) were more likely to accept a hysterectomy operation than their counterparts. This study suggests that future studies should analyze hospital data and assesses long-term changes to understand an area's hysterectomy profile and correlated factors for these types of vulnerable populations.

The effect of hysterectomy or levonorgestrel-releasing intrauterine system on cardiovascular disease risk factors in menorrhagia patients: a 10-year follow-up of a randomised trial

OBJECTIVE

To compare, whether women with menorrhagia, treated with either hysterectomy or LNG-IUS, differ in their cardiovascular risk profile during 10-year follow-up.

STUDY DESIGN

A total of 236 women were randomized to treatment by hysterectomy (n=117) or LNG-IUS (n=119). Their cardiovascular risk factors were analyzed at baseline, at 5 years, and at 10 years. As 55 originally randomized to the LNG-IUS group had hysterectomy during the follow-up, all analyzes were performed by actual treatment modality.

MAIN OUTCOME MEASURES

Waist circumference, body-mass index (BMI), blood pressure, and the levels of blood lipids, serum high-sensitivity CRP (hsCRP) and tumor necrosis factor alpha (TNF-α) were measured, and the use of medication for hypertension, diabetes, hypercholesterolemia, and ischemic heart disease was analyzed.

RESULTS

After 5 years, an increase in the use of diabetes medication during the follow-up was only detected in the hysterectomy group (from 1.7% to 6.7%, P=0.008 vs from 5.1% to 8.4%, P=0.08), as well as they had significantly higher serum levels of TNF-α (108.59 pg/ml vs 49.02 pg/ml, P=0.001) and hsCRP (1.55 μg/ml vs 0.78 μg/ml, P=0.038) at 5- and 10-years. There was no difference between the groups in the use of cardiovascular medication, neither was there difference in blood pressure, waist circumference, BMI, or concentrations of blood lipids.

CONCLUSIONS

Hysterectomy seems to be associated with increased levels of serum inflammatory markers and increased diabetes medication, which in turn, may predispose individual to future cardiovascular events.

Gynecological history in chronic fatigue syndrome: a population-based case-control study

BACKGROUND

Chronic fatigue syndrome (CFS) affects disproportionately more women than men, and the condition is more common at perimenopause. We examined gynecological history events as risk factors for CFS.

METHODS

In a case-control study from a randomly selected population sample from Wichita, Kansas, 36 women with CFS and 48 nonfatigued controls, of similar age, race, and body mass index (BMI), answered a structured gynecological history questionnaire.

RESULTS

CFS cases and controls had the same mean age (51 years) and age at menarche (12 years). Overall, a greater proportion of women with CFS than controls reported pelvic pain unrelated to menstruation (22.2% vs. 1.7%, p = 0.004), endometriosis (36.1% vs. 16.7, %, p = 0.046), and periods of amenorrhea (53.9 % vs. 46.2%, p = 0.06). Compared to controls, women in the CFS group had a higher mean number of pregnancies (2.8 vs 2.0, p = 0.05) and gynecological surgeries (1.8 vs. 1.1, p = 0.05). Similar proportions of the CFS (69.4%) and control (72.9%) groups were menopausal. Although menopausal women in the CFS and control groups had similar mean age (55.5 and 55.8, respectively), menopause occurred about 4.4 years earlier in the CFS group (41.7 years vs. 46.1 years, respectively, p = 0.11). Among menopausal women, 76% of the CFS group reported hysterectomy vs. 54.6% of controls (p = 0.09), and 56% of women with CFS reported oophorectomy vs. 34.3% of controls (p = 0.11).

CONCLUSIONS

The higher prevalence of gynecological conditions and gynecological surgeries in women with CFS highlights the importance of evaluating gynecological health in these patients and the need for more research to clarify the chronologic and the pathophysiological relationships between these conditions and CFS.

Timing of menarche, childbearing and hysterectomy risk

OBJECTIVES

To examine the associations of age at menarche, timing of first birth and parity with hysterectomy rates; to investigate whether these associations were independent of each other and other potential confounders and varied by reason for hysterectomy.

METHODS

Women from the Medical Research Council National Survey of Health and Development, a cohort followed prospectively since birth in March 1946 across England, Scotland and Wales, were studied. Survival analyses were used to assess the relationships between reproductive characteristics and hysterectomy.

RESULTS

Age at menarche was inversely associated with hysterectomy rates (adjusted Hazard Ratio for hysterectomy associated with a 1 year increase in menarche=0.85 (95% CI: 0.77-0.95)). Parity was also associated with hysterectomy; women with > or =3 children experienced higher rates of hysterectomy than women with 1-2 children, who themselves experienced higher rates than nulliparous women. The associations of parity and age at menarche with hysterectomy were independent of each other and potential confounders. The association between age at menarche and hysterectomy was stronger for hysterectomies performed for fibroids than for other reasons.

CONCLUSIONS

Our findings suggest that age at menarche is most likely acting to influence hysterectomy risk through its association with lifetime oestrogen exposure whereas parity is most likely acting through an effect on decision-making processes. This highlights the importance of considering both biological and social pathways to hysterectomy and confirms that medical need is not the only factor which needs to be considered when making treatment decisions for gynaecological problems.

Surgical menopause and cardiovascular risks

OBJECTIVE AND DESIGN

To review the relevant literature on the effect of surgical menopause on cardiovascular disease (CVD).

RESULTS AND CONCLUSIONS

Early menopause (before age 50) is associated with an increased risk of CVD. Bilateral oophorectomy around the time of menopause may impart either a small influence or no effect on increasing the risk of CVD; however, bilateral oophorectomy before menopause significantly increases the risk. Some data suggest a protective effect of estrogen therapy in this setting exist. The CVD risk is principally that of coronary heart disease and not cerebrovascular disease. Mortality rates may be increased in women with early menopause, either spontaneous or surgically induced. Hysterectomy per se, without bilateral oophorectomy, does not seem to increase CVD risk.