Women with No Ovaries at Higher Risk for Diabetes

Diabetes risk increased in postmenopausal women who have had their ovaries and uterus removed

(RxWiki News) Diabetes is a common condition for postmenopausal women and is associated with heart disease risk. 

A recent study found that women who had gotten a hysterectomy plus oophorectomy (surgical removal of the uterus and ovaries) had an increased risk of developing diabetes after menopause, compared to women who had gone through natural menopause or had just a hysterectomy (only the uterus removed).

The researchers suggested that risk of diabetes should be considered when deciding whether or not to get an oophorectomy.

"Talk to a doctor about your hysterectomy options."

The lead author of this study was Duke Appiah, PhD, MPH, from the Department of Epidemiology and Population Health at the University of Louisville in Louisville, Kentucky.

The study included 2,597 postmenopausal women. Some of these women had gone through menopause naturally, some had gotten a hysterectomy, and some had gotten a hysterectomy plus oophorectomy.

All participants had previously been enrolled in the NHANES I Epidemiologic Follow-up Study. None of the participants had diabetes, heart disease, or gynecological cancer at the beginning of the study. The average age of the participants was 60 years old, and 87 percent of them were white.

The researchers gathered information on the participants' sociodemographic characteristics (age, race, education level), smoking status, reproductive and medical history, body measurements (weight, height, waist), level of physical activity, blood pressure, family medical history, cholesterol level, age of first menstrual period, and whether or not they had a hysterectomy.

After the initial screening, there was a follow-up period after an average of 8.7 years.

The researchers found that 40 percent of the women had gotten a hysterectomy, and 47 percent of the hysterectomies included oophorectomy. The average age at oophorectomy was 41.9 years old.

The findings showed that the women who had gone through surgical menopause (hysterectomy with or without oophorectomy) reported more miscarriages and hormone therapy use than the women who went through natural menopause.

In addition, the women with surgical menopause began menstruating at an earlier age (average of 12.9 years old) than the women with natural menopause (average of 13.2 years old).

The women with surgical menopause also reported having a shorter reproductive lifespan than the women with natural menopause, reporting an average of 28.9 years versus 35.7 years. There was no difference between the groups in waist or BMI (height and weight ratio) measurements.

The researchers also discovered that women who had a hysterectomy with no oophorectomy reported less instances of hypertension (high blood pressure) than either the natural group or the oophorectomy group. Among the women who had a hysterectomy, those who had an oophorectomy were more likely to have a non-physically active lifestyle and more likely to never have had children compared to the women who did not get an oophorectomy.

After follow-up, the researchers found that 176 participants, or 7 percent, had developed diabetes.

The findings showed that the rate of diabetes among the participants who had not undergone a hysterectomy was 7.4 cases of diabetes per 1,000 person-years (amount of participants multiplied by the number of follow-up years).

For women who had a hysterectomy alone, the rate was 8.2 cases per 1,000 person-years. And for the participants who had a hysterectomy plus oophorectomy, the rate was 8.5 cases per 1,000 person-years.

After considering all factors, the researchers determined that women who had both a hysterectomy and oophorectomy had a 57 percent increased risk of developing diabetes compared to those with a natural menopause.

The other groups did not have a statistically significant risk of developing diabetes.

In addition, the findings showed that women who went through menopause — both naturally and surgically — at a young age had a higher risk of developing diabetes than those who went through menopause at an older age.

The researchers found that there was an 83 percent increased risk of diabetes for women who went through menopause before 40, a 2 percent increased risk for those who went through menopause between 40 and 44, an 11 percent decreased risk for those who stopped menstruating from 45 to 49, and a 36 percent decreased chance for those who stopped menstruating after the age of 55.

The length of time a woman menstruated over her lifetime was found to be associated with diabetes risk.

The women who had a reproductive lifespan of 20 years or fewer had an almost 15-fold increased risk. Women who had a reproductive lifespan between 21 and 25 years had an increased risk of almost 5.5-fold. Those with a reproductive lifespan between 26 and 30 years had a doubled risk.

Women with a reproductive lifespan between 36 and 40 years had a 49 percent decreased risk, and those with a reproductive lifespan over 40 years had a 69 percent decreased risk of diabetes.

The researchers concluded that women who have had a hysterectomy plus oophorectomy might be at risk for developing diabetes sometime after menopause — regardless of factors associated with old age or health habits.

"Women would do well to be informed and reminded about the risk factors for the major causes of death in the United States," said Ronald de la Peña, MD, gynecologist at Los Robles Hospital in Thousand Oaks, CA.

"The development of diabetes (elevated blood sugar) increases a woman's risk for having a heart attack or stroke. The earlier onset of menopause, naturally or by removal of both ovaries, causes more diabetes. If pre-menopausal women are recommended for surgery such as a hysterectomy (removal of womb or uterus) that may involve the ovaries, she should have a thorough discussion with her gynecologist regarding the risks, benefits and alternatives of care. Retaining one or both ovaries can result in less diabetes," said Dr. de la Peña.

The authors noted a few limitations of their study.

First, rates of hysterectomy and oophorectomy were self-reported and not confirmed by medical records. Second, BMI, waist measurement and smoking status were not assessed at the onset of menopause. Third, there was not a test to make sure that none of the participants had undiagnosed diabetes at the beginning of the study.

This study was published online on November 5 in Diabetes Care.

Review Date: 
November 13, 2013