Global epidemiology of hysterectomy: possible impact on gynecological cancer rates

Hammer, Anne; Rositch, Anne F.; Kahlert, Johnny; Gravitt, Patti E.; Blaakær, Jan; Søgaard, Mette

doi:10.1016/j.ajog.2015.02.019

Cited by 115 publications

(96 citation statements)

References 38 publications

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“…39 Accordingly, women in India who underwent hysterectomy in their late thirties are at risk of menopause considerably earlier than the estimated global median age at natural menopause, 51 years. 6 Over one-half of women who underwent hysterectomy reported excessive menstrual bleeding as a medical indication. 6 Over one-half of women who underwent hysterectomy reported excessive menstrual bleeding as a medical indication.…”

Section: Interpretation In Light Of Other Evidencementioning

confidence: 99%

Patterns of hysterectomy in India: a national and state‐level analysis of the Fourth National Family Health Survey (2015–2016)

Desai

Shukla

Nambiar

et al. 2019

BJOG

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Objective The National Family Health Survey‐4 in India provided the first nationally representative estimates of hysterectomy among women aged 15–49. This paper aims to examine the national and state‐level age‐specific prevalence of hysterectomy, individual and household level factors associated with the procedure, and state‐level indicators that may explain variation across states. Design Cross‐sectional, nationally representative household survey. Setting National Family Health Survey was conducted across all Indian states and union territories between 2015 and 2016. Population The survey covered 699 686 women between the ages of 15 and 49 years. Methods Descriptive analyses and multivariate logistic regression. Main outcome measures Women who reported ever having a hysterectomy and age at hysterectomy. Results Age‐specific prevalence of hysterectomy was 0.36% (0.33,0.39) among women aged 15‐29; 3.59% (3.45,3.74) among women aged 30‐39; and 9.20% (8.94,9.46) among women 40‐49 years. There was considerable variation in prevalence by state. Four states reported age‐specific prevalence similar to high‐income settings. Approximately two‐thirds of hysterectomies were conducted in private facilities, with similar patterns across age groups. At the national level, higher age and parity (at least two children); not having had formal schooling; rural residence (adjusted odds ratio [AOR] 1.36; 95% CI 1.27,1.45; P < 0.01) and higher wealth status were associated with higher odds of hysterectomy. Previously sterilised women had lower odds (AOR 0.64; 95% CI 0.61,0,68; P < 0.01) of reporting hysterectomy. Exploratory analyses suggest state‐level factors associated with prevalence of hysterectomy include caesarean section, female illiteracy, and women's employment. Conclusions Hysterectomy patterns among women aged 15–49 in India indicate the critical need to ensure treatment options for gynaecological morbidity and to address hysterectomy among young women in particular. Funding This study was part of the RASTA initiative of the Population Council's India country office under the Evidence Project supported by USAID. Tweetable abstract Hysterectomy patterns in India highlight the need for alternatives to treat gynaecological morbidity among younger women.

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Section: Interpretation In Light Of Other Evidencementioning

confidence: 99%

Patterns of hysterectomy in India: a national and state‐level analysis of the Fourth National Family Health Survey (2015–2016)

Desai

Shukla

Nambiar

et al. 2019

BJOG

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“…It is possible that women with older ages at hysterectomy may experience quite different symptom patterns. It is worth noting that the incidence of hysterectomy, in more economically developed countries, is highest in women aged 40-50 years [4]. Of the women who reported having a hysterectomy over the seven surveys in ALSWH, 68% reported having their hysterectomy at baseline.…”

Section: Discussionmentioning

confidence: 99%

“…For women who have a hysterectomy with ovarian conservation (one or both ovaries retained) the reported associations are less consistent [6][7][8]. The proportion of women who retain one or both ovaries at the time of hysterectomy varies by country, ranging from 46% to 82% [4], highlighting the need to increase our understanding of the symptom experiences of these women.…”

Section: Introductionmentioning

confidence: 93%

“…Between 20 and 40% of women in more economically developed countries have a hysterectomy by the time they are 60 years old [2,3], and this surgery remains one of the most common gynaecological procedures performed worldwide [4]. Women who have a hysterectomy with bilateral oophorectomy (both ovaries removed) are consistently reported to have a higher risk of more frequent and/or severe hot flushes and night sweats, which is thought to be related to the abrupt decline in oestrogen levels post-surgery [5].…”

Section: Introductionmentioning

confidence: 99%

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Hot flushes and night sweats symptom profiles over a 17-year period in mid-aged women: The role of hysterectomy with ovarian conservation

et al. 2016

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flushes and night sweats symptom profiles over a 17-year period in mid-aged women: the role of hysterectomy with ovarian conservation.Maturitas http://dx.doi.org/10. 1016/j.maturitas.2016.05.011 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Highlights There has been limited longitudinal analysis of hysterectomy and vasomotor symptoms.  The present study found that hysterectomy with ovarian conservation is associated with persistent hot flushes and night sweats.  Obesity, smoking and a lower level of education/occupation are also associated with persistent symptoms.Hot flushes and night sweats symptom profiles over a 17-year period in mid-aged women: the role of hysterectomy with ovarian conservation. ABSTRACT OBJECTIVES:There is limited research on hot flushes and night sweats in women with a hysterectomy with ovarian conservation. We aimed to describe the patterns of these symptoms in a cohort of Australian women and to investigate the relationship between distinct symptom patterns and hysterectomy status. STUDY DESIGN AND OUTCOME MEASURES:Repeated-measures latent class analysis (LCA) was used to identify hot flushes and night sweats symptom patterns across seven surveys (over 17 years) in the mid-cohort of the Australian Longitudinal Study on Women"s Health. Multinomial logistic regression was used to assess the associations of the symptom patterns in women with a hysterectomy with ovarian conservation (n=1,129) versus women without a hysterectomy (n=4,977). RESULTS:A higher proportion of women with a hysterectomy than of those without experienced a constant pattern of hot flushes (15% versus 30%) and night sweats (9% versus 19%). Women with a hysterectomy had higher odds of constant hot flushes versus minimal hot flushes (OR = 1.97, 95% CI: 1.64, 2.35) and constant versus minimal night sweats (OR = 2.09, 95% CI: 1.70, 2.55). Smoking, a "lower level of education to non-professional occupation" pathway and body mass index (BMI) patterns of "always obese" and "increasingly obese" were also associated with a higher risk of constant symptoms. CONCLUSIONS:Women who have a hysterectomy (with ovarian conservation) have a higher risk of hot flushes and night sweats that persist over an extended period.

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“…Only a few studies have previously described the cervical cancer mortality in Denmark, and none have presented the hysterectomy‐corrected cervical cancer mortality. Not correcting for hysterectomy not only underestimates cervical cancer mortality rates but also compromises meaningful comparisons of cancer rates across countries and over calendar time, and may cause a misinterpretation of the impact of cervical cancer prevention programs . Thus, in the present study we aim to describe contemporary trends in hysterectomy‐corrected cervical cancer‐specific mortality rates by age and over calendar time in the population that is targeted by the prevention programs: adult women with an intact uterine cervix.…”

Section: Introductionmentioning

confidence: 99%

Hysterectomy‐corrected cervical cancer mortality rates in Denmark during 2002‐2015: A registry‐based cohort study

Hammer

Kahlert

Gravitt

et al. 2019

Acta Obstet Gynecol Scand

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Introduction We aimed to describe the cervical cancer mortality rates after correcting for hysterectomy and to evaluate trends over calendar time and by age. Material and methods Using data from nationwide registries, we calculated uncorrected and hysterectomy‐corrected cervical cancer mortality rates among women age ≥20 years in Denmark during 2002‐2015. We calculated hysterectomy‐corrected rates by subtracting post‐hysterectomy person‐years from the denominator, unless hysterectomy was performed due to cervical cancer. Results The age‐standardized hysterectomy‐corrected cervical cancer mortality rate of 5.8/100 000 was 18.4% higher than the corresponding uncorrected rate. The hysterectomy‐corrected cervical cancer mortality rate increased significantly with age, particularly in women aged 65+ (annual percent change +4.57), peaking at 26.1/100 000 person‐years in women aged ≥85. The hysterectomy‐corrected cervical cancer mortality declined significantly over calendar time, from 6.3/100 000 person‐years in 2002 to 4.5/100 000 person‐years in 2015 (annual percent change −0.22). This was mainly due to a significant decline in women aged 60 years and older, from 20.4/100 000 person‐years in 2003 to 9.3/100 000 person‐years in 2015 (annual percent change −0.75). Conclusions The mortality of cervical cancer increased significantly by age, particularly among women aged 65 years and older for whom routine cervical cancer screening is not recommended. Understanding reasons for the high mortality rate in older women is critical, as this may help identify interventions needed to ensure a continued decline in cervical cancer mortality in older Danish women.

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Global epidemiology of hysterectomy: possible impact on gynecological cancer rates

Cited by 115 publications

References 38 publications

Patterns of hysterectomy in India: a national and state‐level analysis of the Fourth National Family Health Survey (2015–2016)

Patterns of hysterectomy in India: a national and state‐level analysis of the Fourth National Family Health Survey (2015–2016)

Hot flushes and night sweats symptom profiles over a 17-year period in mid-aged women: The role of hysterectomy with ovarian conservation

Hysterectomy‐corrected cervical cancer mortality rates in Denmark during 2002‐2015: A registry‐based cohort study

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