What We Know about the Long-Term Risks of Hysterectomy for Benign Indication-A Systematic Review

Abstract

Hysterectomy is the most common treatment option in women with uterine fibroids, providing definitive relief from the associated burdensome symptoms. As with all surgical interventions, hysterectomy is associated with risk of complications, short-term morbidities, and mortality, all of which have been described previously. However, information on the potential long-term risks of hysterectomy is only recently becoming available. A systematic literature review was performed to identify studies published between 2005 and December 2020 evaluating the long-term impact of hysterectomy on patient outcomes. A total of 29 relevant studies were identified. A review of the articles showed that hysterectomy may increase the risk of cardiovascular events, certain cancers, the need for further surgery, early ovarian failure and menopause, depression, and other outcomes. It is important to acknowledge that the available studies examine possible associations and hypotheses rather than causality, and there is a need to establish higher quality studies to truly evaluate the long-term consequences of hysterectomy. However, it is of value to consider these findings when discussing the benefits and risks of all treatment options with patients with uterine fibroids to allow for preference-based choices to be made in a shared decision-making process. This is key to ensuring that patients receive the treatment that best meets their individual needs.

Keywords: adverse events; complications; long-term consequences of hysterectomy; patient engagement; uterine fibroid management; uterine fibroids.

Figure 1

Cumulative incidence curves for cardiovascular and metabolic conditions in women who underwent hysterectomy with ovarian conservation at 35 years or younger compared with age-matched referent women (stratified analyses). The hazard ratios (HRs) and corresponding 95% confidence intervals were calculated using Cox proportional hazards models with age as the time scale and adjusted using inverse probability weights. Reprinted from Menopause, Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study, 25: 483–492, ©2018, with permission from Wolters Kluwer Health, Inc. [34].

Figure 2

Age-specific rates of first urinary incontinence operation in women in the exposed and unexposed cohorts. Age-specific rates are shown with 95% CIs. Age intervals show attained age during follow-up period. Reprinted from The Lancet, 370, Altman et al., Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study, 1494–1499, ©2007, with permission from Elsevier [47].