Is Adiposity Across Life Associated With Subsequent Hysterectomy Risk? Findings From the 1946 British Birth Cohort Study

Abstract

Because overweight and obese women are at increased risk of developing fibroids, endometrial and other gynecological cancers, and menstrual problems than are women of normal weight, it is plausible that increased adiposity predisposes to hysterectomy. The explanation given most often is increased exposure to unopposed estrogen. These possible associations were examined in 1790 women taking part in the Medical Research Council National Survey of Health and Development study, conducted in England, Scotland, and Wales. Dating back to 1946, it is the oldest British birth cohort. Adiposity was assessed by calculating the body mass index (BMI) at intervals from age 2 through age 53 years. From age 20 years onward, women classified as being underweight had lower rates of hysterectomy than normal-weight women. From age 36 onward, overweight women had higher hysterectomy rates. Women who were obese in the adolescent and early adult years had lower hysterectomy rates than normal-weight women, but relatively few women at these age levels were classified as obese. Women who were obese in later adulthood subsequently had higher rates of hysterectomy. Higher rates of surgery in later adulthood were associated with greater increases in weight between ages 36 and 53 years. There was no indication from this study of significant associations between childhood BMI and subsequent rates of hysterectomy. None of these findings was accounted for by parity, age at menarche, education, or father's occupational class. One potential result of the ongoing global increase in overweight and obesity might be an increased prevalence of gynecological disorders for which hysterectomy is a major treatment option.