[KoK! Health] Why Women Who Have Had a Hysterectomy Should Be Careful of Stroke

Women who underwent hysterectomy before menopause were found to have a higher risk of cerebrovascular and cardiovascular diseases, such as stroke, compared to those who did not.

Professor Lee Byung-kwon of the Department of Cardiology at Yonsei University Gangnam Severance Hospital, Professor Kim Byung-kyu of the Department of Cardiology at Inje University Sanggye Paik Hospital, and Professor Yuk Jin-sung of Obstetrics and Gynecology recently published research results on the association between early hysterectomy in Korean women and the risk of cardiovascular disease. The paper was published in the American Medical Association journal, JAMA Network Open.

From the left, Professor Byung-Kwon Lee, Department of Cardiology, Gangnam Severance Hospital, Yonsei University · Professor Byung-Kyu Kim, Department of Cardiology, Sanggye Paik Hospital, Inje University · Professor Jin-Sung Yook, Department of Obstetrics and Gynecology

Cerebrovascular and cardiovascular diseases, experienced by 36% of women worldwide, are considered a leading cause of female mortality. In particular, cardiovascular disease is known to increase sharply in postmenopausal women. This is because, as menstruation ceases, hematocrit levels (the volume percentage of red blood cells) and stored iron levels increase, causing the blood to become more viscous and sticky. This can lead to thrombosis caused by red blood cell aggregation, resulting in atherosclerosis.

The research team reported that menstruation acts as a form of “regular bloodletting,” providing a protective effect against cerebrovascular and cardiovascular diseases in women of reproductive age. They compared and analyzed the incidence of cardiovascular disease in women who underwent surgical hysterectomy, another cause of early menopause. They evaluated 135,575 women aged 40 to 49 from January 1, 2011, to December 31, 2014, assessing 55,539 matched pairs in the hysterectomy group and the non-hysterectomy group, respectively. These participants were followed up until December 31, 2020. The research team based their study on data from the National Health Insurance health care database.

After approximately eight years of follow-up, the incidence rate of cerebrovascular and cardiovascular diseases was 115 cases per 100,000 population per year in the hysterectomy group and 96 cases in the non-hysterectomy group. The risk of cerebrovascular and cardiovascular disease was about 25% higher in the hysterectomy group. The incidence rates of myocardial infarction and coronary artery revascularization were similar between the groups, but the risk of stroke was about 30% higher in the hysterectomy group. The average age of these women was 45 years.

Professor Lee Byung-kwon stated, “This study suggests that the continuous maintenance of menstruation has a protective effect against cerebrovascular and cardiovascular diseases in women,” adding, “When menstruation stops, changes in blood flow characteristics, that is, hemorheological changes, occur, leading to an increased incidence of cardiovascular disease. This aligns with previous studies showing that adults who regularly donate blood have a much lower incidence of cerebrovascular and cardiovascular diseases, not only women.” He continued, “If large-scale additional research supports that regular blood donation reduces the risk of hemorheological factors, it would not only help reduce the risk of cerebrovascular and cardiovascular diseases but also contribute to solving the global blood shortage crisis.”