- Hysterectomy is the second most common surgery for women in the U.S.
- Researchers from CHU de Rennes in France have found a link between hysterectomy and an increased risk for type 2 diabetes, especially in women under 45 years old.
- The research team also found typical type 2 diabetes risk factors like high BMI and a sedentary lifestyle did not change the increased risk.
Hysterectomy is the second most common surgery for women in the United States. About 600,000 hysterectomies — the surgical removal of part or all of a woman’s uterus — are performed in the U.S. each year.
Previous research has linked hysterectomies to an increased risk of cardiovascular disease, incident hypertension, and thyroid cancer.
Now, researchers from CHU de Rennes in Renne, France, have discovered a correlation between hysterectomy and increased risk for developing type 2 diabetes, especially among women under 45 years of age.
The research, which has not yet been peer reviewed and published, was recently presented at the 2022 European Association for the Study of Diabetes (EASD) Annual Meeting in Stockholm, Sweden.
What is a hysterectomy?
A woman’s uterus is either partially or completely removed during a hysterectomy. The uterus holds a fertilized egg until it develops into a fetus in preparation for birth. This organ also plays an active role in the menstrual cycle.
Following a hysterectomy, the menstrual cycle stops and pregnancy is no longer possible. Additionally, a 2021 review notes that having a hysterectomy can increase the risk of experiencing early menopause.
Some of the most common reasons a person may elect to have a hysterectomy include:
- heavy menstrual periods
- uterine fibroids
- uterine prolapse
- cancer of the uterus or other parts of the reproductive system
Depending on the reasons for a woman’s hysterectomy, sometimes other parts of the reproductive system are removed in addition to the uterus, including the ovaries and fallopian tubes. An oophorectomy refers to the surgical removal of one or both ovaries.
What is type 2 diabetes?
Type 2 diabetes is a chronic disease that renders the body unable to effectively use the insulin the pancreas produces, thus becoming insulin resistant.
About 1 in 10 Americans has diabetes, 90–95% of cases of which are type 2 diabetes.
Although it can occur at any age, type 2 diabetes generally occurs in adults ages 45 and older. Research from 2016 shows that older men are generally at a higher risk than older women.
Main risk factors for developing type 2 diabetes include:
- sedentary lifestyle
- family history of diabetes
Type 2 diabetes is normally treated through:
- a specialized diet
- physical activity
- weight loss
- Medications, insulin shots, or a combination of both
- Routine medical care and blood testing
Examining the link between hysterectomy and type 2 diabetes
Study author Dr. Fabrice Bonnet, PhD, from the CHU de Rennes, Renne, France, and The Centre for Research in Epidemiology and Population Health, Villejuif, France, told Medical News Today that he and his team decided to look at the possible link between hysterectomies and type 2 diabetes because long-term consequences of hysterectomies in women remains a public health issue and are not well understood.
“Previous studies suggested that women with past hysterectomy had an increased risk of cardiovascular disease — if (the) hysterectomy was period before the age of 50 — and our group published last year that hysterectomy is associated with an increased risk of incident hypertension in the same E3N French cohort.”
– Dr. Fabrice Bonnet, PhD, study author
“As diabetes and hypertension are interrelated, this is quite logical to assess whether hysterectomy may modulate the risk of diabetes,” Dr. Bonnet continued.
“Furthermore, there were three previous publications — two in the U.S. [from 2014 and 2017] and one in Taiwan [from 2021] — which showed a positive association between hysterectomy and the risk of diabetes.”
For the study, Dr. Bonnet and his team examined data from about 83,500 French women ages 45 to 60 who were medically followed for an average of 16 years. The women are also participants in the French E3N study investigating risk factors between cancer and other major non-communicable diseases.
Through the study, researchers found women who had a hysterectomy before the age of 45 had a 52% increased risk of developing type 2 diabetes.
“We raise the hypothesis that hysterectomy at an early age puts women at (a) greater risk of future type 2 diabetes mainly because of reduced ovarian function for a long period of time, which may contribute to (an increased) risk of diabetes,” Prof. Bonnet said.
Additionally, diabetes risk increased by just 13% in women who had a hysterectomy that left both ovaries intact. However, researchers did find women were at an even greater risk for developing type 2 diabetes — 26% — when both ovaries were removed.
Dr. Bonnet explaind that the higher diabetes risk after having both ovaries removed was “because ovaries removal lead to complete reduction of estrogen secretion by (the) ovaries and estrogen plays a (beneficial) role in glucose homeostasis.”
Weight, lifestyle, and emotional factors
In addition to age and oophorectomy, Dr. Bonnet and his team examined other potential factors that might increase a woman’s risk of developing type 2 diabetes following a hysterectomy.
Although obesity and a sedentary lifestyle are risk factors for type 2 diabetes, researchers reported diet quality and physical activity level did not change the correlation between hysterectomy and type 2 diabetes. They also found no association between a higher BMI and increased diabetes risk.
The scientists also found women who underwent a hysterectomy were more often depressed. A 2019 study shows a link between depression and an increased risk of developing type 2 diabetes.
“There (is) a number of epidemiological evidence showing an association between depressive traits and an (increased) risk of incident diabetes,” Dr. Bonnet explained. “It may be linked to lifestyle modifications, but also increased stress hormone levels, such as cortisol, for instance.”
MNT also spoke about the new research with Dr. G. Thomas Ruiz, OB-GYN Lead at MemorialCare Orange Coast Medical Center in Fountain Valley, CA. He said he found the study’s link between hysterectomy and type 2 diabetes “surprising” due to the currently understood role of the uterus.
“The uterus is essentially smooth muscle — it doesn’t have any endocrine function that we know of,” Dr. Ruiz said.
“It would be pure speculation as to why that correlation exists. (It) makes you think that there’s something being produced within the uterus which may be protective against hyperglycemia that we haven’t discovered yet, or something that prevents insulin resistance that we just don’t understand.”
– Dr. G. Thomas Ruiz, OB-GYN
As for this study and its findings, Dr. Ruiz said he would like to see further research to help further explain why this correlation exists and how the ovaries are involved.
“I’m sure there’s going to be someone who’s going to take a look at this and say, okay, there’s something in the uterus producing substances, basically some kind of hormone or endocrine substance, that we don’t realize or know about that somehow affects glycemic control,” he said.
“You really need to get in-depth, basic science-backed research to see if there is something specifically produced by the uterus that we did not previously identify that is somehow affecting insulin function or resistance.”
For women who have had or are considering a hysterectomy, Dr. Ruiz said there is no question that diet and exercise are the best way to help decrease a person’s risk for developing diabetes and that weight management is key.
“You don’t want to have a BMI of over 30,” he explained.
“If you have a family history of type 2 diabetes, you might want to consider diets [that] do not increase your glucose level. My favorite recommended diet is a Mediterranean diet because it seems to have the right balance of grains, fruits, vegetables, leafy greens, and then a lot of protein comes from fish (and) chicken, so you limit your red meat intake. Those are the things that we know will help decrease your risk of type 2 diet diabetes.”
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