Weight Gain After Hysterectomy
Yes, women can gain weight after hysterectomy, with the risk and magnitude of weight gain significantly influenced by whether the ovaries are removed. Women who undergo hysterectomy with bilateral oophorectomy (removal of both ovaries) experience accelerated weight gain compared to those who have hysterectomy with ovarian conservation or natural menopause, with BMI increasing at 0.21 kg/m² per year after bilateral oophorectomy versus 0.08 kg/m² per year after natural menopause 1.
Weight Gain Risk by Surgical Type
Hysterectomy with Ovarian Conservation
Women undergoing hysterectomy with intact ovaries have a 61% increased risk of gaining more than 10 pounds in the first year after surgery compared to women with intact uteri (multivariable OR = 1.61,95% CI 1.04-2.48) 2.
The mean weight gain in the first year is approximately 3 pounds (1.36 kg) for hysterectomy patients versus 1.3 pounds (0.61 kg) for control women 2.
Even with bilateral ovarian conservation, hysterectomy alone is associated with elevated risk of subsequent mood disorders and cardiovascular disease, suggesting subtle hormonal alterations that may contribute to metabolic changes 3, 4.
Hysterectomy with Bilateral Oophorectomy (Removal of Both Ovaries)
Women who have both ovaries removed experience the most pronounced weight gain, with BMI increasing more rapidly (0.21 kg/m² per year) following bilateral oophorectomy compared to natural menopause (0.08 kg/m² per year), representing a statistically significant difference (P=0.03) 1.
This accelerated weight gain following bilateral oophorectomy may increase risk for obesity-related chronic diseases 1.
Both premenopausal and postmenopausal women depend on their ovaries as a critical source not only of estrogen but also of testosterone, and even when ovaries are spared during hysterectomy, their function may be compromised 5.
Clinical Risk Factors for Post-Hysterectomy Weight Gain
Heavier women and women who have had weight fluctuations throughout adulthood are at greater risk for post-surgical weight gain 2.
Women undergoing hysterectomy tend to weigh more and have higher baseline BMI than control women even before surgery 2.
Mechanism and Hormonal Considerations
The ovaries produce both estrogen and testosterone in premenopausal and postmenopausal women, and removal of ovarian tissue eliminates this critical hormonal source 5.
Estrogen plays a crucial role in fat distribution in women, particularly in the regulation of subcutaneous fat accumulation, and changes in estrogen levels during different life stages influence obesity risk 6.
Many women develop symptoms of testosterone deficiency following hysterectomy/oophorectomy that go unrecognized and untreated, which may contribute to metabolic changes 5.
Prevention and Management Strategies
Lifestyle interventions to maintain or lose weight may be particularly helpful for women in the months following hysterectomy, especially for heavier women and those with a history of weight fluctuations 2.
For women undergoing bilateral oophorectomy, estrogen-only hormone replacement therapy (HRT) is recommended, with transdermal 17β-estradiol (50-100 micrograms daily) preferred as it avoids hepatic first-pass effect and has a better safety profile than oral formulations 4.
Testosterone supplemental therapy should be considered for women following hysterectomy/oophorectomy, as it can improve quality of life and may contribute to cardiovascular protection and prevention of osteoporosis 5.
Important Caveats
The relationship between hysterectomy and weight gain is complex and multifactorial, involving hormonal changes, metabolic alterations, and behavioral factors 2, 1.
Women should be counseled preoperatively about the risk of weight gain, particularly if bilateral oophorectomy is planned, and provided with strategies for weight management 2, 1.
Premenopausal women considering bilateral oophorectomy should be advised that while it protects against ovarian cancer, this benefit comes at the cost of increased cardiovascular disease risk, higher rates of other cancers, and higher overall mortality 7.