The former started in 1976, with a cohort of over 120,000 women aged 30 – 55yo. These women were surveyed every two years, and self-reported their health outcomes. The latter commenced in 1989, and followed up over 110,000 women aged 25 – 42yo. The resultant data has been utilised in many studies to analyse a variety of risk factors and health outcomes.<\/p>\n\t\t\t
Methods of Thao et al’s study<\/h3>\t\t\t\n\t\t\t\t\n- Retrospective analysis of data from 239,907 women; average follow-up 34 years<\/li>\n
- Groups: No surgery (control group) versus: hysterectomy alone; or hysterectomy with bilateral oophorectomy (HBSO) (intervention groups).<\/li>\n
- Patients with CVD pre-dating their index operation were excluded.<\/li>\n
- Primary outcomes: rates of CVD (myocardial infarction, coronary artery intervention and stroke)<\/li>\n
- Analysis: Pooled analysis of both Nurses Health studies’ cohorts. Data were: analysed by multivariable Cox proportional hazards models; controlled for potential confounders; and stratified by age<\/li>\n<\/ul>\n\t\t\t
Key Findings:<\/h3>\t\t\t\n\t\t\t\t
88,779 (37%) of participants had had a hysterectomy \u00b1 oophorectomy.<\/p>\n
Adjusted hazard ratios (aHR) with 95% confidence intervals (CI) by age at index surgery and exogenous estrogen status<\/p>\n\t\t\t\t![\"TABLE](\"https:\/\/escope.ages.com.au\/october-2025\/wp-content\/uploads\/sites\/11\/2025\/05\/TABLE-2-1.png\" "\\"TABLE")
\n\t\t\t\t
Table 1: Risk of CVD by age of index operation (hysterectomy +\/- bilateral oophorectomy), compared to the ‘no surgery’ control group. Statistically-significant findings in bold.<\/p>\n
\n- For women between 46 – 55yo without exogenous estrogen, ovarian retention was protective against CVD.<\/li>\n
- Patients who had HBSO < 60yo without exogenous estrogen experienced the greatest increase in CVD risk: a 20 – 34% increased risk, compared with no surgery.<\/li>\n
- Women < 46yo who had hysterectomy \u00b1 oophorectomy experienced at least a 20% increased CVD risk. Although estrogen was associated with reduced risk in women who had retained ovaries, this was not the case in HBSO women.<\/li>\n
- For 51 – 60yo women with HBSO, exogenous estrogen mitigated their CVD risk.<\/li>\n
- The only women who showed no increase in CVD risk following HBSO \u00b1 exogenous estrogen were those > 60yo.<\/li>\n<\/ul>\n\t\t\t
Critical Appraisal<\/h3>\t\t\t\n\t\t\t\t
Strengths:<\/u><\/p>\n\n- Large sample size (> 230,000 women) with excellent long-term follow-up fosters greater confidence in data estimates.<\/li>\n
- Validated outcomes, with myocardial infarction, stroke, and revascularisation confirmed against medical records.<\/li>\n
- Robust statistical adjustment for many confounders.<\/li>\n
- Comparing hysterectomy versus HBSO, further stratified by estrogen use, allows for clinically relevant conclusions.<\/li>\n<\/ul>\n
Limitations:<\/u><\/p>\n\n- Limited generalisability to diverse populations, as participants were largely Caucasian, educated, and health literate.<\/li>\n
- The dichotomous outcome of MHT as ‘ever use’ versus ‘never used’ limits understanding of the direction of causation.<\/li>\n
- Indication for hysterectomy not reported, which excludes important confounders such as malignancy.<\/li>\n
- The 1970s – 80s surgical approach to hysterectomy may not be equivalent to modern day outcomes.<\/li>\n<\/ul>\n\t\t\t
Conclusion<\/h3>\t\t\t\n\t\t\t\t
This study makes an important contribution to our understanding of long-term CVD risk after hysterectomy. Increased CVD risk in some groups (particularly those having oophorectomy < 50yo) is not completely prevented by estrogen use. Hence, informed consent and shared decision-making regarding ovarian conservation are vital.<\/p>\n\t\t\t
References <\/h3>\t\t\t\n\t\t\t\t
Thao V, Borah B, Stewart EA, Farland LV, Laughlin-Tommaso SK, Khan Z, Coutinho TD, Cohen Rassier SL. Cardiovascular Disease After Hysterectomy in the Nurses’ Health Study and Nurses’ Health Study II.<\/em> Obstet Gynecol. 2025;146:85-93. doi:10.1097\/AOG.0000000000005902.<\/p>\n\t\t\t\t![\"escope-2025-10__author-al-001\"](\"https:\/\/escope.ages.com.au\/october-2025\/wp-content\/uploads\/sites\/11\/2025\/10\/escope-2025-10__author-al-001.avif\" "\\"escope-2025-10__author-al-001\\"")
\n\t\t\t\tDr Alison Bryant-Smith
MBBS\/BA MPH MSurgEd MRCOG FRANZCOG
Consultant gynaecologist
Northern Health
Melbourne<\/p>\n\t\t\t\t![\"escope-2025-10__author-laura-001\"](\"https:\/\/escope.ages.com.au\/october-2025\/wp-content\/uploads\/sites\/11\/2025\/10\/escope-2025-10__author-laura-001.avif\" "\\"escope-2025-10__author-laura-001\\"")
\n\t\t\t\t
Dr Lucy Richards
<\/em>BScAdv\u00a0MBBS FRANZCOG\u00a0
AGES Fellow, Gynaecology Unit 2\u00a0
The Royal Women’s Hospital\u00a0
Melbourne\u00a0<\/p>\n\n","protected":false},"excerpt":{"rendered":"A study exploring the long-term relationship between age, hysterectomy with or without ovarian conservation, and long term cardiovascular disease risk.<\/p>\n","protected":false},"author":1,"featured_media":72,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"site-sidebar-layout":"no-sidebar","site-content-layout":"","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[1],"tags":[],"class_list":["post-57","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorised"],"acf":[],"_links":{"self":[{"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/posts\/57","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/comments?post=57"}],"version-history":[{"count":6,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/posts\/57\/revisions"}],"predecessor-version":[{"id":358,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/posts\/57\/revisions\/358"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/media\/72"}],"wp:attachment":[{"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/media?parent=57"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/categories?post=57"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/tags?post=57"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Key Findings:<\/h3>\t\t\t\n\t\t\t\t
88,779 (37%) of participants had had a hysterectomy \u00b1 oophorectomy.<\/p>\n
Adjusted hazard ratios (aHR) with 95% confidence intervals (CI) by age at index surgery and exogenous estrogen status<\/p>\n\t\t\t\t\n\t\t\t\t
Table 1: Risk of CVD by age of index operation (hysterectomy +\/- bilateral oophorectomy), compared to the ‘no surgery’ control group. Statistically-significant findings in bold.<\/p>\n
- \n
- For women between 46 – 55yo without exogenous estrogen, ovarian retention was protective against CVD.<\/li>\n
- Patients who had HBSO < 60yo without exogenous estrogen experienced the greatest increase in CVD risk: a 20 – 34% increased risk, compared with no surgery.<\/li>\n
- Women < 46yo who had hysterectomy \u00b1 oophorectomy experienced at least a 20% increased CVD risk. Although estrogen was associated with reduced risk in women who had retained ovaries, this was not the case in HBSO women.<\/li>\n
- For 51 – 60yo women with HBSO, exogenous estrogen mitigated their CVD risk.<\/li>\n
- The only women who showed no increase in CVD risk following HBSO \u00b1 exogenous estrogen were those > 60yo.<\/li>\n<\/ul>\n\t\t\t
Critical Appraisal<\/h3>\t\t\t\n\t\t\t\t
Strengths:<\/u><\/p>\n
- \n
- Large sample size (> 230,000 women) with excellent long-term follow-up fosters greater confidence in data estimates.<\/li>\n
- Validated outcomes, with myocardial infarction, stroke, and revascularisation confirmed against medical records.<\/li>\n
- Robust statistical adjustment for many confounders.<\/li>\n
- Comparing hysterectomy versus HBSO, further stratified by estrogen use, allows for clinically relevant conclusions.<\/li>\n<\/ul>\n
Limitations:<\/u><\/p>\n
- \n
- Limited generalisability to diverse populations, as participants were largely Caucasian, educated, and health literate.<\/li>\n
- The dichotomous outcome of MHT as ‘ever use’ versus ‘never used’ limits understanding of the direction of causation.<\/li>\n
- Indication for hysterectomy not reported, which excludes important confounders such as malignancy.<\/li>\n
- The 1970s – 80s surgical approach to hysterectomy may not be equivalent to modern day outcomes.<\/li>\n<\/ul>\n\t\t\t
Conclusion<\/h3>\t\t\t\n\t\t\t\t
This study makes an important contribution to our understanding of long-term CVD risk after hysterectomy. Increased CVD risk in some groups (particularly those having oophorectomy < 50yo) is not completely prevented by estrogen use. Hence, informed consent and shared decision-making regarding ovarian conservation are vital.<\/p>\n\t\t\t
References <\/h3>\t\t\t\n\t\t\t\t
Thao V, Borah B, Stewart EA, Farland LV, Laughlin-Tommaso SK, Khan Z, Coutinho TD, Cohen Rassier SL. Cardiovascular Disease After Hysterectomy in the Nurses’ Health Study and Nurses’ Health Study II.<\/em> Obstet Gynecol. 2025;146:85-93. doi:10.1097\/AOG.0000000000005902.<\/p>\n\t\t\t\t
\n\t\t\t\tDr Alison Bryant-Smith
MBBS\/BA MPH MSurgEd MRCOG FRANZCOG
Consultant gynaecologist
Northern Health
Melbourne<\/p>\n\t\t\t\t\n\t\t\t\tDr Lucy Richards
<\/em>BScAdv\u00a0MBBS FRANZCOG\u00a0
AGES Fellow, Gynaecology Unit 2\u00a0
The Royal Women’s Hospital\u00a0
Melbourne\u00a0<\/p>\n\n","protected":false},"excerpt":{"rendered":"A study exploring the long-term relationship between age, hysterectomy with or without ovarian conservation, and long term cardiovascular disease risk.<\/p>\n","protected":false},"author":1,"featured_media":72,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"site-sidebar-layout":"no-sidebar","site-content-layout":"","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[1],"tags":[],"class_list":["post-57","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorised"],"acf":[],"_links":{"self":[{"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/posts\/57","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/comments?post=57"}],"version-history":[{"count":6,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/posts\/57\/revisions"}],"predecessor-version":[{"id":358,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/posts\/57\/revisions\/358"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/media\/72"}],"wp:attachment":[{"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/media?parent=57"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/categories?post=57"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/tags?post=57"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}