AbstractPurpose: Results from previous studies on the relationship between female reproductive hormones, especially oestrogen, and the incidence of cataracts are limited. This study sought to evaluate the effects of hysterectomy on the risk of lens opacity in Korean women.Methods: This retrospective cohort utilized data collected from 2007 to 2020 from the Korean National Health Insurance database. A total of 255 576 postmenopausal women were included. Participants were divided into those who did and did not undergo hysterectomy. The hysterectomy group was further divided into two subgroups according to the adnexal surgery performed. Comparison of the prevalence of cataract between the control group, hysterectomy alone group, and hysterectomy with adnexal surgery group was performed.Results: The control group included 137 999 participants who did not undergo hysterectomy. The treatment group consisted with 93 719 women who underwent hysterectomy alone or hysterectomy with adnexal surgery. The control group showed a higher incidence of cataracts than the treatment group, as analysed by the 1:1 propensity score matching method and adjusted for variables.Conclusions: All participants in the treatment group had a lower incidence of cataract than those in the control group. These findings may help physicians identify the role of female reproductive hormones in cataract development.