Early hysterectomy may be an independent risk factor for developing diabetes in the future, according to a French cohort study.
Compared with women who had an intact uterus, women who had a hysterectomy experienced a 20% higher risk of developing type 2 diabetes over 16 years of follow-up, after adjusting for age at menarche, menopausal status and age at menopause, and oral use. Contraception and hormone replacement therapy, and the number of pregnancies, said Fabrice Bonnet, MD, of the Center Hospitalier Universitaire de Rennes in France.
However, when broken down by age at hysterectomy, this elevated risk of diabetes appears to apply only to women who had a hysterectomy before age 45, as demonstrated during a presentation in European Association for the Study of Diabetes Meeting (EASD):
- Hysterectomy before 40: HR 1.38 (95% CI 1.10-1.74, s= 0.005)
- Hysterectomy before 45: HR 1.52 (95% CI 1.31-1.78, s<0.0001)
“A hysterectomy is a risk factor for developing diabetes in the future,” Bonet noted. “We should target women with hysterectomies earlier because they are at higher risk.”
In addition to age, oophorectomy was another factor that seemed to play in the risk of type 2 diabetes. Specifically, women who had had a hysterectomy alone—with their ovaries preserved—noted only a slightly increased risk of diabetes compared to women who had No history of hysterectomy or oophorectomy (HR 1.13, 95% CI 0.99-1.30, s= 0.06).
But when hysterectomy was performed with oophorectomy, women noted a significantly higher risk of developing diabetes (HR 1.26, 95% CI 1.11-1.42, s= 0.0003).
Additionally, women who have had a hysterectomy also tend to experience more severe depressive symptoms than those who have not. Bonnet suggested that depression could be a mediating factor between the two, as it has been linked to both hysterectomy and diabetes.
Severe depressive symptoms were defined as a score of 23 or higher on the revised Center for Epidemiological Studies (CES-D) Depression Scale Questionnaire. Among the women without a history of hysterectomy, 10.4% reported severe depressive symptoms versus 12.5% of those who had a hysterectomy.
Another contemplative factor can refer to decreased ovarian function, which leads to decreased secretion of estrogen and Müllerian hormone after hysterectomy. “A lot of evidence suggests a protective role for ovarian secretion in relation to the risk of late-onset diabetes,” Bonnet noted.
For this analysis, the researchers analyzed data from Study group E3N of 98,995 French women born between 1925 and 1950 and recruited in 1993. These women completed biennial questionnaires, self-report data on lifestyle factors, hormonal factors, medications, medical events, illnesses, and depression using the CES-D questionnaire. Diet was also measured using a 208-item questionnaire.
A total of 83,582 women were included in the final analysis, representing those who did not have diabetes at baseline. Over 16 years of follow-up, 2,672 women developed diabetes: 2.9% of 64,484 women without a history of hysterectomy and 4.2% of 16,426 women who underwent hysterectomy.
Only women who had undergone hysterectomy for benign gynecological conditions were eventually included, as were those who had undergone hysterectomy and/or oophorectomy prior to the diagnosis of diabetes. Diabetes was identified through self-reported questionnaires for the use of antidiabetic medications.
At baseline, women who had a hysterectomy tended to have a higher body mass index, were more likely to be more physical activity, had menopause before age 45, used hormone replacement therapy, and were less likely to smoke.
The study was funded by INSERM, the French National Institute for Health and Medical Research.
Bonnet did not report any disclosures.