Study Finds Elevated Cardiovascular Risk After Early Hysterectomy

• Getting hysterectomies at a younger age increases the risk — The researchers observed that women who underwent hysterectomy before age 50 were more likely to experience major cardiovascular events, such as heart attack, stroke, or bypass surgery, compared to women who didn’t have the surgery. Women who had a hysterectomy before age 46 and didn’t use estrogen had a 21% higher risk of cardiovascular disease (CVD) compared to those with no surgery.

• Estrogen use doesn’t fully offset surgical effects — Women who undergo ovary removal or early hysterectomy are often prescribed estrogen to compensate for the sudden drop in hormone production. It’s believed to ease menopausal symptoms and lower some of the health risks linked to hormone loss.

However, the study revealed that even among women who used estrogen after hysterectomy and oophorectomy, those under age 46 still had a 26% increased risk, and those between 46 and 50 faced a slightly lower but still elevated risk. The researchers wrote:

“Younger age at time of hysterectomy, with or without oophorectomy, is associated with higher risk of CVD. Notably, use of estrogen does not appear to mitigate deleterious effects of hysterectomy with oophorectomy before age 50 years.”⁶

• The risk extends across different age groups — Among women who did not use estrogen and underwent both surgeries, cardiovascular risk was elevated at all ages except in those over 60. Most in this older group were already postmenopausal, which likely explains the difference. These findings suggest a vital window during midlife when the body is especially sensitive to hormonal disruption.

• The pattern points to more than just estrogen loss — While estrogen deficiency has often been blamed for cardiovascular decline after natural or surgical menopause, this study challenges that view. Other pathways, including shifts in hormone ratios, metabolic signaling, and inflammatory responses, may be at play.

• Early hysterectomy was linked to a higher risk of serious cardiovascular events — In a cohort of over 135,000 women followed for nearly eight years, those who had a hysterectomy before age 50 were more likely to experience major cardiovascular events, including stroke. The incidence rate was 115 per 100,000 person-years in the hysterectomy group, compared to 96 in the control group.

After adjusting for confounding factors, hysterectomy was linked to a 25% increased risk of overall CVD. “These findings suggest that the uterus may have a cardiovascular protective effect in women, independent of female sex hormones,” the authors noted.

• Stroke emerged as the most consistently elevated risk — Even minimally invasive procedures like laparoscopic hysterectomy were associated with a 32% increased risk of stroke compared to those who did not undergo surgery. The consistency of this finding across surgical approaches indicates that simply removing the uterus, regardless of technique, is enough to trigger vascular changes.

• Increased risk persisted despite controlling for other factors — The elevated stroke risk remained significant even after adjusting for common cardiovascular risk variables, including hypertension, diabetes, cholesterol, and hormone therapy. This reinforces the idea that hysterectomy itself may directly influence cardiovascular physiology, rather than just amplifying existing health issues.

• Mechanisms involve disrupted ovarian signaling and changes in blood viscosity — The study outlined two main pathways that may explain the increased cardiovascular risk, even when the ovaries are left in place:

“It has been previously proposed that one of the possible mechanisms is disruption of ovarian blood flow from ovarian ligaments during hysterectomy, which may result in premature ovarian failure. Decreased ovarian blood flow and low ovarian sex steroid levels have been noted after hysterectomy.

… Another possible mechanism is that the loss of menstruation after hysterectomy may result in a hemorheologic deleterious effect. After menopause, an increase in hematocrit levels occurs.

Elevated hematocrit levels are associated with increased blood viscosity, leading to endothelial injury, rupture of plaques by increasing shear stress on the vessel wall, and thrombus formation by red blood cell aggregation, thereby increasing the risk of adverse cardiovascular events.”⁸

• Hysterectomy without oophorectomy still led to increased health risks — The study followed more than 2,094 women in Minnesota who had hysterectomies for benign conditions between 1980 and 2002. According to a Mayo Clinic news release:¹⁰

“They found that women undergoing hysterectomy with ovarian conservation were more likely to develop hyperlipidemia, hypertension, obesity, cardiac arrhythmias and coronary artery disease.

Most striking, researchers found that women who underwent hysterectomy with ovarian conservation at or before age 35 had an increased risk of congestive heart failure (4.6-fold increase) and coronary artery disease (2.5-fold increase).”

Dr. Shannon K. Laughlin-Tommaso, the study’s lead author, also added that women between the ages 36 and 50 who had a hysterectomy with their ovaries preserved showed a 1.3-fold increased risk of coronary artery disease, which is an estimated 6% increase in absolute risk.

• The divergence in cardiovascular health didn’t emerge immediately — Instead, differences became clear 20 to 25 years post-surgery, which is around the time most women would naturally reach menopause. This suggests that hysterectomy may set off a slow-moving shift in the body’s regulatory systems, altering the trajectory of aging and disease.

• Ovarian preservation didn’t prevent hormonal disruption — According to Dr. Laughlin-Tommaso, “One theory is that the loss of collateral blood flow to the ovaries caused by a hysterectomy results in decreased ovarian reserve and its sequelae. Or the uterus itself could have a direct, unknown effect on the ovaries.”

• Late-onset effects underscore the need for long-term perspective — Because CVD often develops gradually, the study’s long follow-up period was essential in capturing risk that shorter studies may have missed. Its findings highlight how surgical decisions made in one’s 30s or 40s have ripple effects decades later, altering how and when age-related diseases emerge.

• In women who have undergone hysterectomy, hormonal imbalance often begins with disrupted ovulation — Even when the ovaries are left intact, removing the uterus can alter ovarian blood flow and hormonal signaling, leading to less consistent ovulation or earlier ovarian decline. Since progesterone is produced only after ovulation, its levels fall first.¹¹ This creates a state of estrogen dominance as progesterone wanes.

• Unopposed estrogen disrupts tissue function and energy metabolism — Estrogen plays essential roles in the body, but without progesterone to moderate its effects, it alters cell behavior. It raises intracellular calcium, impairs mitochondria, and increases receptor sensitivity, which promotes oxidative stress, reduces metabolic flexibility, and strains cardiovascular function.

• Hormone ratios are key to understanding risk — A 2024 study in The Journal of Clinical Endocrinology & Metabolism found that women using estrogen-based hormone replacement therapy (HRT) had:¹²

• Fat tissue reveals a hidden layer of estrogen dominance — These findings suggest that estrogen-based HRT doesn’t just raise estrogen levels overall but also creates a strong estrogen-dominant environment specifically within fat tissue. This shift is especially pronounced in both subcutaneous and visceral fat and isn’t always visible through standard blood tests.

That matters because fat tissue plays an active role in regulating inflammation, insulin sensitivity, and blood vessel function. When estrogen overwhelms androgens locally, it alters how fat behaves in ways that affect metabolism and cardiovascular health. In other words, hormone balance inside fat, not just in blood, could be a key factor in understanding the long-term risks and benefits of HRT.

• Estrogen dominance occurs even without hormone therapy — Georgi Dinkov, a respected expert in metabolic health, provided commentary on the Journal of Clinical Endocrinology & Metabolism study. He noted that your progesterone-to-estrogen ratio should fall between 200 and 500 for optimal hormonal balance. Anything below 100 is considered estrogen-dominant.

Yet in the non-HRT group, Dinkov calculated strikingly low ratios — 16 in blood serum, 20 in subcutaneous fat, and 38 in visceral fat, which are all well within the range of estrogen dominance. He points out that if these numbers were found in premenopausal women, they would clearly indicate endocrine imbalance and warrant clinical intervention.¹³

These suggest that hormonal imbalance after hysterectomy or menopause may already be present before any treatment begins. Adding more estrogen through HRT may not restore balance, but instead deepen the mismatch. For women who have undergone hysterectomy, particularly at younger ages, this may help explain why estrogen therapy doesn’t fully protect against CVD and might even reinforce the underlying physiological stress.

1. Know your prolactin level — Many people assume they’re low in estrogen based on blood tests, when in reality, estrogen levels can be high within tissues and organs. That’s because serum measurements don’t reflect how much estrogen is stored or active at the tissue level. Estrogen may appear low in plasma but still be elevated in fat, liver, or other sites. Prolactin serves as a more reliable marker of estrogen activity.

Estrogen stimulates the pituitary gland to release prolactin, so elevated prolactin levels often indicate heightened estrogen receptor activation, whether from internal hormone production or external exposure to endocrine-disrupting chemicals (EDCs) found in plastics, cosmetics, and other pollutants. This becomes especially meaningful when paired with low thyroid function, making prolactin a valuable signal of broader hormonal imbalance.

2. Eliminate vegetable oils in your diet — Seed oils are high in linoleic acid (LA) and other polyunsaturated fatty acids (PUFAs), which mimic estrogen and disrupt mitochondrial function. These oils are prevalent in processed foods and restaurant meals. Aim to keep your LA intake below 5 grams per day — 2 grams or less is even better.

To monitor your intake, use an online nutrition tracker like my upcoming Health Coach app, which launches in early July. It features Seed Oil Sleuths™, a built-in tool that scans restaurant menus and grocery items, calculates your daily seed oil exposure to the nearest tenth of a gram, and helps you stay on track effortlessly. Scan the QR code below to join the early-access list and be first in line for smarter, cleaner eating.

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3. Become a conscious consumer of everyday products — Nearly 1,000 everyday items are laced with estrogen-mimicking compounds, including xenoestrogens. These endocrine disruptors are found in microplastics, personal care products, and common household cleaners.

To lower your exposure, opt for natural or organic personal care items and check labels for ingredients like parabens and phthalates. Replace conventional cleaners with simple, nontoxic options such as vinegar, baking soda, and essential oils.

Importantly, reduce your reliance on plastic, especially for food and beverages. Choose glass or stainless steel, and do not heat food in plastic containers; heat accelerates chemical leaching. Filter your tap water to remove microplastics. If you use bottled water, go for glass. For hard tap water, boiling it for five minutes significantly cuts down microplastic levels.

4. Reconsider estrogen-based therapies and contraceptives — Take a closer look at your use of estrogen-containing HRT or birth control pills, as they contribute to estrogen dominance. Consider alternatives that support your body’s natural hormonal balance. Even bioidentical estrogen, despite being labeled “natural,” still adds to your overall estrogen load.

5. Consider natural progesterone to counter estrogen — For those reaching perimenopause and menopause, whether naturally or due to hysterectomy, natural progesterone is a particularly helpful consideration. Progesterone acts as a natural antagonist to estrogen, helping to balance its effects. Given the tendency toward estrogen dominance, incorporating natural progesterone helps restore a more balanced hormonal ratio.