- Hysterectomy is the second most common operation among women in the USA
- Researchers at CHU de Rennes in France have found a link between hysterectomy and an increased risk of type 2 diabetes, particularly among women under 45 years of age.
- The research team also found that typical risk factors for type 2 diabetes, such as a high BMI and a sedentary lifestyle, did not change the increased risk.
Hysterectomy is the second most common surgery among women in the United States. In the USA, around 600,000 hysterectomies — the surgical removal of part or all of a woman’s uterus — are performed each year.
Previous research has linked hysterectomies to an increased risk of cardiovascular disease, high blood pressure, and thyroid cancer.
Now, researchers at CHU de Rennes in Renne, France, have discovered a link between hysterectomy and an increased risk of developing type 2 diabetes, particularly in women under 45 years of age.
The study, which has not yet been reviewed and published by experts, was recently presented at the annual meeting of the European Association for the Study of Diabetes (EASD) 2022 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.
After a hysterectomy, the menstrual cycle stops and pregnancy is no longer possible. In addition, a 2021 review states that a hysterectomy may increase the risk of early menopause.
Some of the most common reasons why a person chooses to have a hysterectomy include:
- heavy menstrual periods
- uterine fibroids
- uterine prolapse, uterine cancer
- or other parts of the reproductive system
Depending on the reasons for a woman’s hysterectomy, sometimes, in addition to the uterus, other parts of the reproductive system are removed, 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 prevents the body from using insulin produced by the pancreas effectively and thus becomes insulin-resistant.
About one in ten Americans have diabetes, 90— 95% of cases are type 2 diabetes.
Although type 2 diabetes can occur at any age, type 2 diabetes generally occurs in adults aged 45 and over. Research from 2016 shows that older men are generally at higher risk than older women.
The main risk factors for developing type 2 diabetes include:
- sedentary lifestyle
- Family history of diabetes
Type 2 diabetes is usually treated by:
- a special diet
- physical activity
- weight loss
- medicines, insulin syringes, or a combination of
- routine medical care and blood tests
Investigating the relationship between hysterectomy and type 2 diabetes
Study author Dr. Fabrice Bonnet, PhD, from CHU de Rennes, Renne, France, and Center for Epidemiological and Population Research Health, Villejuif, France, told Medical News Today that he and his team have decided to investigate the possible link between hysterectomies and type 2 diabetes as the long-term consequences of hysterectomies in women remain a public health issue and are not well understood.
“Previous studies suggested that women with previous hysterectomy had an increased risk of cardiovascular disease — if (the) hysterectomy was performed before age 50 — and our group published last year that hysterectomy had an increased risk of prolapse with hypertension in the same French E3N -Cohort.”
— Dr. Fabrice Bonnet, PhD, study author
“Since diabetes and high blood pressure are interrelated, it is entirely logical to assess whether a hysterectomy can modulate the risk of diabetes,” Dr. Bonnet continued.
“In addition, there were three previous publications — two in the USA [from 2014 and 2017] and one in Taiwan [from 2021] — that showed a positive link between hysterectomy and diabetes risk.”
For the study, Dr. Bonnet and his team examined data from around 83,500 French women aged 45 to 60 years, who were medically observed for an average of 16 years. The women are also taking part in the French E3N study, which looks at risk factors between cancer and other major noncommunicable diseases.
Through the study, researchers found that women who had a hysterectomy before age 45 had a 52% increased risk of developing type 2 diabetes.
“We hypothesize that a hysterectomy at an early age (a) represents a higher risk of future type 2 diabetes, primarily due to impaired ovarian function over a long period of time, which may contribute to an (increased) risk of diabetes,” said Prof. Bonnet.
In addition, the risk of diabetes in women with a hysterectomy, which left both ovaries intact, only increased by 13%. However, researchers found that women had an even higher risk of developing type 2 diabetes — 26% — if both ovaries were removed.
Dr. Bonnet explained that the higher risk of diabetes after removal of both ovaries was “that removal of the ovaries results in a complete reduction in 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 investigated other potential factors that could 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 that dietary quality and physical activity did not change the correlation between hysterectomy and type 2 diabetes. They also found no link between a higher BMI and an increased risk of diabetes.
The scientists also found that women who had undergone a hysterectomy were more likely to be depressed. A 2019 study shows a link between depression and an increased risk of developing type 2 diabetes.
“There (is) a range of epidemiological evidence that shows a link between depressive characteristics and an (increased) risk of diabetes incidents,” explained Dr. Bonnet. “It can be related to lifestyle changes, but also to elevated levels of stress hormones, such as cortisol.”
MNT also spoke about the new research with Dr. G. Thomas Ruiz, Director of Gynecology at MemorialCare Orange Coast Medical Center in Fountain Valley, California. He said he found the study’s link between hysterectomy and type 2 diabetes “surprising” because of the role of the uterus that is currently understood.
“The uterus consists primarily of smooth muscles—it has no endocrine function known to us,” said Dr. Ruiz.
“It would be pure speculation as to why this correlation exists. (It) makes you believe that something is being produced in the uterus that protects against hyperglycemia, which we haven’t yet discovered, or something that prevents insulin resistance that we simply don’t understand.”
— Dr. G. Thomas Ruiz, Gynecology With regard to
This study and its findings told Dr. Ruiz he’d like to see more research to further explain why this correlation exists and how the ovaries are involved.
“I’m sure there will be someone who will look at this and say okay, there’s something in the uterus that produces substances, basically a type of hormone or endocrine substance that we don’t know or know is somehow affecting blood sugar control,” he said.
“You really have to do in-depth research, backed by basic research, to determine whether something specifically produced by the uterus that we haven’t identified before and that somehow affects insulin function or resistance.”
For women who have undergone or are considering a hysterectomy, there is no question that diet and exercise are the best way to reduce a person’s risk of 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, consider diets [that] don’t increase your glucose levels. My favorite recommended diet is a Mediterranean diet because it seems to have the right balance of grains, fruits, vegetables, and leafy greens and then lots of protein comes from fish (and) chicken, so you limit your intake of red meat. We know this will help reduce the risk of type 2 diet diabetes.”