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EBBIE STEWART: Most people don't realize that less than 10% of hysterectomies are done for cancers or pre-cancers. Moreover, most women that undergo a hysterectomy for these non-cancerous diseases are young. They're in their 30s or 40s, which means that any long-term consequences can take place over 30, 40, or even 50 years.

Our research and the research of others is suggesting that the long-term consequences of hysterectomy can be substantial. Hi, I'm Ebbie Stewart. I'm a professor of Obstetrics and Gynecology at Mayo Clinic in Rochester, Minnesota. And I'm here to discuss the findings of our article entitled, "Moving Beyond Reflexive and Prophylactic Gynecologic Surgery." This article appears in the February 2021 issue of Mayo Clinic Proceedings.

My clinical work and my research work involves benign gynecologic diseases, like uterine fibroids, adenomyosis, and endometriosis. And many women choose to undergo a hysterectomy for these non-cancerous conditions. Women suffer a lot with these conditions. They have a lot of pain and abnormal uterine bleeding. And I think the magnitude of the effect of these diseases on their daily life is way underestimated. And it's for that reason that hysterectomy, and related surgical procedures like removal of the ovaries and removal of the Fallopian tubes, are widely used to bring an end to the symptoms of these diseases.

However, I and a number of my colleagues, including Dr. Missmer and Dr. Rocca, who co-authored this article with me, has led us to look at the long-term consequences of hysterectomy. People have known for a number of years that certain things, like weight gain and early menopause and problems with bladder dysfunction after hysterectomy occur. But our research and that of others is showing that common diseases, like mood disorders, including anxiety and depression, and cardiovascular disease, such as coronary artery disease, are substantially increased in women following hysterectomy when they're compared to women that have not had this kind of surgery.

And the risk appears to be greater the younger you are when you have this kind of surgery. So most of the studies that we're looking at now have looked between 7 and 20 years after hysterectomy. But the peak increase of coronary artery disease comes many years after menopause for women. So if we're only looking, say, in women in their 50s and 60s, the risk may be even higher once those women reach their 80s and their 90s.

So this article reviews the key research that is being done in the field and tries to make the argument that we use evidence to guide gynecologic surgery. Traditionally, there has been work in the field that suggests we should do prophylactic surgery to prevent future problems. And so many women in the past had their ovaries taken out to prevent breast or ovarian cancer.

But again, research has shown that while it does that, it also substantially increases other serious risks, and more common risks, like heart disease. And in fact, one study showed women had an increased risk of death after removal of the ovaries. So we're extending those findings to hysterectomy and trying to make a plea that before a woman undergoes a surgery that she clearly ask, and that her provider clearly ask, what are the long-term consequences of this decision? Is this something that is truly required? Or are there other minimally invasive options or observation options that could give similar results with less long-term risk?

We hope that this article will be useful, not only to clinicians that work in the area, but women themselves. We want every gynecologic surgery to be clearly indicated and to provide women with the symptom relief that they deserve, without long-term unintended consequences.

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