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J. Kyle Mathews, MD, DVM  
Male, 56
Plano, TX

Specialties: Urogynecolog, Pelvic Reconstructive Medicine

Interests: Women's Health, Bladder Diseases
Plano Urogynecology Associates
Obstetrics and Gynecology
972-781-1444
Plano, TX
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Hysterectomy and Risk of Heart Attack and Stroke

May 10, 2011 - 10 comments
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hysterectomy

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Stroke

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Hysterectomy for benign, non cancerous, indications is one of the commonest surgical procedures in women, but the association between the procedure and the increase risk of cardiovascular disease (CVD), heart attack and stroke is not fully understood.

Hysterectomy has traditionally been considered the method of choice for treating a variety of benign, non-cancerous, gynecological disorders due to the low surgical complication rate and definite cure of these diseases.  Incidence rates of hysterectomy in the USA and in western European countries have remained relatively stable despite recent years introduction of minimally invasive treatment options, such as endometrial ablation, for conditions, such as heavy periods and fibroids.

The majority of hysterectomies are preformed in women before menopause and the removal of ovaries after the age of 40 is common.  The removal of ovaries is often recommended as a measure to reduce the risk of developing ovarian cancer.  A number of studies have suggested that hysterectomy with the removal of ovaries prior to age 50 may increase the risk for heart attack and stroke.  Given the fact that cardiovascular disease is the leading cause of death in women, and hysterectomy is such a common surgery, further investigation was warranted.  

A recent European study published in the European Heart Journal has helped bring this issue to the forefront.  This large study looked at 800,000 women under the age of 50.  The authors conclusions were: “Hysterectomy in women aged 50 and younger substantially increases the risk for cardiovascular disease later in life and removal of ovaries further adds to the risk of both coronary heart disease and stroke.”  Erik Ingelsson  

J. Kyle Mathews, MD
Plano OB Gyn Associates
Plano Urogynecology Associates
www.drjkm.com


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by optimus22mac, May 11, 2011
Thank you very much for the information.  I am 35, and awaiting surgery that will deal with multiple pelvic organ prolapse, so my uterus will be taken out, the neck of my bladder will be repaired, and my bladder will be lifted, the anterior vaginal wall will be removed due to ulcerations, and the vaginal floor will be supported with mesh as well as the bladder and the vaginal walls, and all will be anchored to my sacrum.  I'm not sure about the posterior wall of my vagina....I do have a rectocele, but was told the vaginal wall is good, though there may be plans for my rectum.  
So...my surgery is pretty necessary, and my uterus is very low, with my cervix frequently exiting my vagina.  
I am assuming that my ovaries will stay with me, but I'll make sure to ask at my next appt in a few weeks....when the surgery will be scheduled.  I had been waiting for clearance from my neurosurgeon due to a pineal cyst that had to be watched for growth, that now is staying unchanged, so my prolapse surgery will go ahead soon.  I do have some more questions now for my gynecologist now that you have posted this interesting information, so thank you very much.
I am assuming that I should be cautious and watch for cardiovascular issues even moreso now, as I may be at greater risk as explained in your post.

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by lizzee901, May 18, 2011
am 50 years old, had a hysterectomy (ovaries/uterus/cervix removed)  I have pelvic congestion syndrome pain for a year. I had this dibilitating pain before and after my hysterectomy.  Has become much severe that I have to stay laying down all day, I cannot work any longer. I cannot find a surgeon that will help me with the chronic condition, my pelvic area, groins and legs have great pain and pressure, In my vaginal the pain and pressure is like delivering a child I CANNOT LIVE LIKE THIS ANYMORE!! I was told from my ct scan and ultra sound that I have this pelvic congestion syndrome (varicose vein in pelvic). My legs now feel heavy and there is throbbing pain. When I lay down the pressure goes but my legs tingle and when I get up in the moring I find my hands now get numb.  Each day when I get up, this nighmare starts all over again.  The pressure and stabbing pain in vaginal area pelvic, in my right groin is worse and its painful to walk.   I have been in and out of emergency with this horrible pain, no one can seem to help.  I now take sleeping pills ROUND THE CLOCK so I don't have to deal with the pain-nothing else stops the pain.

There has to be someone that can please help me restore my life my health,   I have seen radiologists, they all tell me, that because I do not have my ovaries I cannot be operated, they tell me to go see a Gynaecologist - so I do and they all turn me away and say you have had a hysterectomy, there is nothing we can do.  I  am left trying to find the right surgeon/doctor that can help me. Please, if you can or know of a dr-surgeon that can help me, please let me know so that I don't have to continue living this way.

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by LivingInHope, May 27, 2011
I had my ovaries removed (besides my uterus), as I had severe endometriosis, including an endometrioma putting painful pressure inside one ovary.  Though it was not known until they time of the hysterectomy, a cause of  some of my severe bladder symptoms was the dome of it being folded & stuck to my uterus with endometriosis.  I was in my early thirties at the time.  The year prior to the complete hysterectomy, I had an emergency laporotomy (torqued hemmorhagic cyst made it emergency, though surgery was planned due to large fibroid pressing in on my bladder).  So, it was the year prior it was discovered I had severe endometriosis.  

I think gyn doctors do need to be careful not only to try safe methods to prevent hysterectomies, but to realize when they should order an MRI.  An ultrasound did not reveal I had an endometrioma, but an MRI did... this radiologist diagnosis was confirmed by the lab post hysterectomy.  And also, gyn doctors need to have that fine balance of knowing when a complete hysterectomy is the right thing to do, despite a person's age.

I don't take HRT because of the risks, including I don't take unopposed estrogen, as I understand that may cause any remaining microscopic endometriosis missed by surgery to grow and even the potential would be there of the estrogen medication changing endometriosis to cancer.  

My understanding from reading up prior to the operation was that if a person left a lone ovary in, it typically would have to be removed within a few years time, meaning another surgery.  Plus leaving an ovary would allow for the production of more endometriosis growing estrogen.  

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by Tanya1981, Jul 10, 2011
I'm a 30 year old stay at home mom of 3 awesome kids. I had my last child in March 2007 and have not been to a dotocr  since my last birth ( I very rarely get sick).  In the last few months I have noticed that my left arm starts feeling numb and my finger tips feel tingly now my wrist hurts to when this happens,this now has moved up to my elbow,but tonight is at its worst I noticed a hard knot on the top of my arm near my elbow the pain has moved up to my left shoulder with this happening my shoulder feels like it is on fire. Why is this, is it important that I  go to a dotoc asap. I have been told  that I have alot of signs that may lead to a stroke

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by Looneytunes, Jul 27, 2011
I had a total hysterectomy when I was 48. I had endometriosis removed 7 years prior and it came back. I had the DaVinci procedure. I didn't go on HRT right away. After 4-5 months I had terrible mood swings, awful night sweats, some daytime hot flashes and no sex drive at all.. The night sweats were really bad and I couldn't sleep. So I went on HRT for about 1.5 years. It really helped alot. But then I saw something on a tv show that said to go off the HRT after 1 year. I'm no longer taking Estriadol and testosterone. But I am still on the progesterone. I do take an over the counter herbal Estroblend at night. That takes care of the night sweats and the progesterone helps me sleep. I need to check with my GYN to see if this is safe. While still on the HRT my blood pressure starting changing (both numbers). I'm now on Benicar blood pressure medication. I'm really concerned about this as I'm not even 50.

Looneytunes, July 27, 2011

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by a1kinobe, Jul 28, 2011
Dear Tanya,

I don't know about the stroke possibilities, but another thing to check for is pressure on your nerves. Childbirth changes the position of your hips, etc., and the type of pain and tingling you describe is typical for something pressing on a nerve. A good chiropractor can check for that.

--Ava

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by Linda355, Jul 28, 2011
Is there a link to the study?  Another clinical study says women have an increased risk of heart attack and stroke after menopause due to increased cholesterol levels.  I am wondering if the European study reached that conclusion due to an increase in cholesterol levels after a hysterectomy due to a woman's body being thrown into menopause.

My own experiences with perimenopause , my cholesterol went from a happy normal to 309, suddenly one day I went into complete anxiety mode which made my nice normal blood pressure skyrocket.  I am currently on HRT, cholesterol is coming down nicely with diet and exercise and my blood pressure and anxiety level dropped down to normal after one week on HRT.  

I do have a large uterine fibroid with many small ones, so may be facing a hysterectomy.

Too many questions left unanswered with the brief information supplied in the post.



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by MissFlora, Jul 30, 2011
I wish you had clarified in the title that it is not the hysterectomy that increases the risk, but the removal of ovaries!! Where I live it is more common tp remove the uterus, but not the cervix or the ovaries, unless there is a good medical reason. It is very frustrating to read articles about "hysterectomies" only to find, as in this case, it's the oophorectomy that is at issue.

Trying to educate myself about Menopause has been equally challenging because authors almost universally use hysterectomy to mean "no ovaries or uterus".

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by LivingInHope, Dec 27, 2011
Linda- Hope you can get off the HRT soon, as long term, that has its own life threatening risks.

Miss Flora- I've read when an ovary is left in, the woman winds up having to remove it within a few years time- I believe it was due to its basic demise as a functioning unit (also it eliminates the risk of ovarian cancer).  People should say complete or total hysterectomy when they are encompassing oophorectomy.  

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by Punto1963, Nov 22, 2013
Lizzie901, it sounds like we may have a similar condition.  I have horrible pelvic pain.  I have been diagnosed with chronic Pelvic pain,  I suffered from Stage IV endometriosis and had a radical hysterectomy at age 42.  Five years later the same familiar pain has returned but many doctors have stated it can't be endometriosis be ause my ovaries are gone but the pain is the same.  Since they cannot give a complete diagnosis my disability has now refused to pay.  Is our situation similar or does anyone reading this have a similar situation as mine? If so, I would lime to talk to you!

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