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A Prospective Study of Weight Gain
after Premenopausal Hysterectomy
Patricia G. Moorman, Ph.D.,
1
Joellen M. Schildkraut, Ph.D.,
1
Edwin S. Iversen, Ph.D.,
3
Evan R. Myers, M.D.,
2
Margaret Gradison, M.D.,
1
Nicolette Warren-White, M.S.,
1
and Frances Wang, M.S.
1
Abstract
Purpose: Many women who have had hysterectomies have the perception that they gained weight after surgery
that cannot be attributed to changes in diet or physical activity. The purpose of this analysis was to assess weight
gain in premenopausal women in the first year after hysterectomy compared with a control group of women
with intact uteri and ovaries.
Methods: As part of a prospective cohort study designed to assess the risk for ovarian failure after pre-
menopausal hysterectomy, weight was measured at baseline and 1-year follow-up in 236 women undergo-
ing hysterectomy and 392 control women. Changes in measured weight and reported weight were assessed.
Unconditional logistic regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals
(CIs) for weight gains of >10 pounds.
Results: Women with hysterectomies weighed more and had a higher mean body mass index (BMI) than
control women at baseline. Mean weight gain was 1.36 kg (*3 pounds) for women with hysterectomies vs.
0.61 kg (*1.3 pounds) for control women ( p¼0.07). Weight gain of >10 pounds occurred in 23% of women with
hysterectomies compared with 15% of control women (multivariable OR ¼1.61, 95% CI 1.04 ¼2.48).
Conclusions: Women undergoing hysterectomies appear to be at higher risk for weight gain in the first year after
surgery. Heavier women and women who have had weight fluctuations throughout adulthood may be at
greater risk for postsurgical weight gain, suggesting that lifestyle interventions to maintain or lose weight may
be particularly helpful for these women in the months following hysterectomy.
Introduction
Hysterectomy is the most common nonobstetrical sur-
gical procedure among women, with approximately
600,000 surgeries performed annually in the United States.
1,2
Approximately one third of women will have a hysterec-
tomy during their lifetime, and one quarter of women will
have a hysterectomy before menopause.
3
Among premeno-
pausal women, most hysterectomies are performed for benign
conditions, with the most frequent indications being leio-
myomas, dysfunctional bleeding, endometriosis, and pelvic
organ prolapse.
1,2
The vast majority of women undergoing hysterectomies
experience relief of the symptoms that led to the surgery and
report a high level of satisfaction with the procedure.
4–8
Al-
though most women are happy with the surgical outcomes,
weight gain is a frequent complaint posthysterectomy.
4
An-
ecdotal reports from clinicians as well as on-line message
boards suggest that many women who have had hysterecto-
mies have the perception they gained weight that cannot be
attributed to changes in diet or exercise habits.
Despite the high frequency of hysterectomy, there are few
data on the relation between hysterectomy and weight gain.
Cross-sectional data indicate that women who have had a
hysterectomy without bilateral oophorectomy weigh more,
have higher body mass index (BMI), and are more likely to
be obese than women with intact uteri and ovaries.
9–11
Post-
surgical weight gain has been reported in one prospective
follow-up study of women undergoing hysterectomy,
4
but
the lack of a control group of women without hysterec-
tomy precludes concluding the weight gain was related to the
surgery.
1
Department of Community and Family Medicine and
2
Department of Obstetrics and Gynecology, Duke University Medical Center,
Durham, North Carolina.
3
Department of Statistical Science, Duke University, Durham, North Carolina.
JOURNAL OF WOMEN’S HEALTH
Volume 18, Number 5, 2009
ªMary Ann Liebert, Inc.
DOI: 10.1089=jwh.2008.1019
699
As part of an ongoing prospective cohort study designed to
evaluate the risk for ovarian failure among premenopausal
women undergoing hysterectomy without bilateral oopho-
rectomy, we compared weight change among women having
hysterectomies in the first year after their surgery with that of
a control group of women with intact uteri.
Materials and Methods
Data were obtained from women enrolled in the Pro-
spective Research on Ovarian Function (PROOF) study, a
cohort study designed to evaluate hormonal changes in wo-
men undergoing premenopausal hysterectomy for benign
conditions. Women undergoing hysterectomy at hospitals in
the Durham, North Carolina, area in 2004–2006 were identi-
fied through referrals from gynecology practices and review
of operating room schedules at the hospitals. Eligible women
were aged 30–47 years, undergoing hysterectomy for a non-
cancerous condition, and were expected to have at least one
ovary remaining after surgery. Potential participants were
sent a letter from their physicians describing the study and
inviting their participation. The letter was followed by a
phone call from a study interviewer who verified eligibility
and confirmed that the woman was premenopausal as evi-
denced by at least one menstrual period in the past 3 months,
had no history of cancer (except nonmelanoma skin cancer),
and was able to complete an interview in English. If the wo-
man agreed to participate, an appointment was scheduled for
an interview and blood draw before her surgery. Most inter-
views and blood draws were performed in conjunction with
the woman’s preoperative visit, but some were conducted at
the woman’s home or another mutually convenient location.
The comparison group of women without hysterectomy was
recruited using brochures in gynecology and family prac-
tice offices and advertisements in publications placed in the
clinics and doctors’ offices from which the women undergo-
ing hysterectomy were identified. Eligibility requirements
were similar to those for the women undergoing hysterec-
tomy, plus they could not be currently pregnant. The study
protocol was approved by the Institutional Review Board at
Duke University Medical Center.
During the baseline study visit, the interviewer obtained
written informed consent, administered a questionnaire ap-
proximately 45 minutes in length, drew a blood sample,
and took anthropometric measurements (height, weight, and
waist and hip circumferences). Height was measured to the
nearest centimeter and weight to the nearest kilogram. BMI
was calculated as kg=m
2
. Study participants were recontacted
1 year later, at which time another serum specimen was ob-
tained, questionnaire information was updated, and anthro-
pometric measurements were performed.
Data obtained with the questionnaire included demo-
graphic characteristics, reproductive history (menstrual
characteristics, pregnancy history, infertility treatment, con-
traceptive use), medical and gynecological history, gyneco-
logical history of mothers and sisters, menopausal symptoms,
and lifestyle characteristics (smoking, alcohol consumption,
limited diet history, physical activity). Women were queried
about their usual frequency of strenuous and moderate physi-
cal activity over the past 2 years, at baseline, and over the past
year at follow-up. Strenuous activity was defined as activity
that increases one’s heart rate or makes one breathe heavily,
such as running or sports at a competitive level. Moderate
physical activity was defined as activities, such as brisk
walking or sports at a social level. Women also reported trends
in their weight during adulthood (weigh less than as a young
adult, weight was stable 10 pounds throughout adulthood,
weigh more than as a young adult, or weight fluctuates with
gains and losses of >10 pounds on two or more occasions) and
their perception of how their weight changed in the year be-
tween baseline and 1 year follow-up. Women undergoing
hysterectomy also signed a consent form allowing access to the
medical records related to their surgery to confirm that a
hysterectomy without bilateral oophorectomy had been per-
formed and to obtain information on the preoperative and
postoperative diagnoses, type of hysterectomy, and patho-
logical diagnoses. Types of hysterectomies were categorized as
abdominal (total or supracervical), laparoscopic (complete
laparoscopic or laparoscopic-assisted vaginal), or vaginal.
Many women had multiple diagnoses (e.g., fibroids, menor-
rhagia, and pelvic pain) listed on their operative reports. For
the purposes of our analyses, the category fibroids includes all
women with a diagnosis of fibroids, whether or not other di-
agnoses were mentioned. The category menorrhagia includes
women with menorrhagia or related terminology, such as
dysfunctional uterine bleeding or metromenorrhagia, with no
mention of fibroids. The Other category includes such condi-
tions as pelvic organ prolapse, stress incontinence, endome-
triosis, or cervical dysplasia, which were diagnosed in a small
number of women and could not be assessed individually.
The current analysis is based on 236 women who under-
went hysterectomy and 392 control women who completed
their baseline and 1-year follow-up visits and had height and
weight measurements from both interview visits. Follow-up
rates were 91% among the women with hysterectomies and
95% among the control women. Among the control group, we
excluded those who were currently pregnant at follow-up or
had delivered in the year between the baseline and follow-up
interviews.
Statistical analysis
Baseline characteristics of the women undergoing hyster-
ectomy and the control women were compared using chi-
square tests or Fisher’s exact test for categorical variables
and Student’s ttests for continuous variables. Comparisons of
changes in weight and BMI between baseline and follow-up
were evaluated with analysis of covariance (ANCOVA),
controlling for baseline values of these variables. Multiple
linear regression was used to estimate change in weight
or BMI by hysterectomy status, controlling for baseline char-
acteristics. We also assessed the dichotomous outcome of
weight gain >10 pounds, using unconditional logistic regres-
sion to calculate odds ratios (ORs) and 95% confidence in-
tervals (CIs) associated with hysterectomy status, controlling
for potential confounding variables. Variables evaluated as
potential confounders in the multivariable linear and logistic
regression models included age, baseline weight, race, marital
status, educational level, number of full-term pregnancies,
smoking status, current alcohol drinker, physical activity,
weight change as an adult, and history of tubal ligation.
Terms were included in the model using the categorizations
described in Table 1. All analyses were performed with SAS
statistical software, version 9.1.3 (Cary, NC).
700 MOORMAN ET AL.
Table 1. Selected Characteristics of Women with Hysterectomies and Control Women
Women with
hysterectomies
(n¼236)
Control women
(n¼392)
Mean SD Mean SD pvalue
Age (years) at interview 40.4 4.0 40.3 4.6 0.8
Number of pregnancies 2.6 1.7 2.3 2.0 0.01
Number of full-term pregnancies 1.8 1.3 1.4 1.4 0.002
n%n %
Age at interview (years) 0.08
30–34 15 6.4 42 10.7
35–39 75 31.8 113 28.8
40–44 106 44.9 151 38.5
45–47 40 17.0 86 21.9
Race 0.02
White 113 47.9 231 58.9
African American 116 49.2 147 37.5
All other 7 3.0 14 3.6
Marital status 0.03
Married=living as married 147 62.3 213 54.3
Single, never married 38 16.1 98 25.0
Divorced=separated=widowed 51 21.6 81 20.7
Educational level <0.0001
Up to high school graduate 152 64.4 174 44.4
College graduate 61 25.9 117 29.9
Graduate=professional school 23 9.8 101 25.8
Number of full-term pregnancies 0.001
None 44 18.6 130 33.2
One 50 21.2 75 19.1
Two or three 125 53.0 164 41.8
Four or more 17 7.2 23 5.9
History of infertility 0.7
Yes 43 18.2 77 19.6
No 193 81.8 315 80.4
Oral contraceptive use 0.4
Ever 218 92.4 354 90.3
Never 18 7.6 38 9.7
Tubal ligation <0.0001
Yes 107 45.3 104 26.5
No 129 54.7 288 73.5
Smoking status 0.08
Never smoker 142 60.2 258 65.8
Former smoker 43 18.2 77 19.6
Current smoker 51 21.6 57 14.5
Currently drink alcohol 0.2
No 79 33.5 110 28.1
Yes 157 66.5 282 71.9
Strenuous physical activity <0.0001
Never or <once a month 119 50.4 123 31.4
Up to 1 time a week 34 14.4 95 24.2
2–6 times a week 73 30.9 161 41.1
7 times a week 10 4.2 13 3.3
Moderate physical activity 0.01
Never or <once a month 39 16.5 34 8.7
Up to 1 time a week 55 23.3 98 25.0
2–6 times a week 110 46.6 216 55.1
7 times a week 32 13.6 44 11.2
Physical activity in occupation 0.02
Mainly sitting 94 39.8 198 50.5
Mainly standing or walking 44 18.6 69 17.6
Mainly active to very active 67 28.4 74 18.9
Do not work outside the home 31 13.1 51 13.0
(continued)
WEIGHT GAIN AFTER HYSTERECTOMY 701
Results
Descriptive characteristics of the women undergoing hys-
terectomies and the control women are presented in Table 1.
The mean age at baseline was approximately 40 years for both
groups. Compared with the control group, the women who
had hysterectomies were more likely to be African American,
be married, have lower educational achievement, have had
more pregnancies, and have had a tubal ligation. Women with
hysterectomies reported lower levels of both strenuous and
moderate physical activity but higher levels of occupational
physical activity. They also were somewhat more likely to be
current smokers, although the difference was not statistically
significant.
In Table 2 we present data on weight and BMI at baseline
and follow-up. The mean BMI was quite high for both the
women undergoing hysterectomy and the control group (30.8
and 29.2 kg=m
2
, respectively), and more than half of the wo-
men with hysterectomies and 38% of the control women
would be considered obese (BMI>30). The women undergo-
ing hysterectomy had statistically significantly higher BMI
and weight at both baseline and 1-year follow-up. The mean
changes in BMI were 0.51 kg=m
2
and 0.22 kg=m
2
(p¼0.06),
and the mean changes in weight were 1.36 kg (*3 pounds)
and 0.61 kg (*1.3 pounds) ( p¼0.07) for women with hys-
terectomies and control women, respectively.
We also examined weight change in pounds and com-
pared reported weight change to measured weight change.
Thirty-six percent of women who had hysterectomies had a
measured weight gain of >5 pounds compared with 29% of
control women. The differences in weight gains between the
groups were more prominent when considering larger weight
gains, with 23% of women with hysterectomies and 15% of
control women having gained >10 pounds. The proportion of
women with measured weight loss of >5 pounds was similar
in both groups (17%).
Differences between the women undergoing hysterec-
tomy and the control women were larger when based on re-
ported weight change rather than measured weight change
(p¼0.001 for reported change vs. p¼0.07 for measured
weight change). Both groups of women tended to underesti-
mate weight gain, although the proportion of women who
underreported weight gain was smaller among the women
having hysterectomies than among the control women
(Table 2).
We examined weight gain by categories of baseline BMI
to assess whether heavier women were more likely to gain
weight (Table 3). Among women with hysterectomies, wo-
men with higher baseline BMI had larger increases in weight
and BMI, but this pattern was not observed among the control
women. When considering categories of weight gain, the
proportion of women reporting a >10 pound gain increased
with increasing baseline BMI in both the women with hys-
terectomies and the control women. However, within each
BMI category, the proportion of women reporting a weight
gain of >10 pounds was larger for women with hysterecto-
mies than for control women.
We performed multivariable linear regression analyses
assessing changes in weight and BMI controlling for the
possible confounders listed in Table 1. A linear regression
model adjusted for age and baseline weight showed that
women with hysterectomies gained 0.75 kg (*1.7 pounds)
more than the control women ( p¼0.07), whereas a model
fully adjusted for all potential confounders in Table 1 showed
a difference in weight gain of 0.89 kg (*2.0 pounds, p¼0.04).
The corresponding models for BMI change between women
undergoing hysterectomy and control women were 0.29
kg=m
2
(p¼0.07) and 0.33 kg=m
2
(p¼0.04), respectively.
Because the differences between women with hysterecto-
mies and controls appeared to be more prominent for larger
weight gains and weight gains of >10 pounds would have
more clinical relevance, we used logistic regression analyses
to assess the association between hysterectomy status and the
dichotomous outcome of measured weight gain >10 pounds
(approximately 4.5 kg) when controlling for possible con-
founders. In unadjusted analyses, women who had a hyster-
ectomy were 1.68 (95% CI 1.12-2.53) times as likely to have a
weight gain of >10 pounds as the control women (Table 4).
Table 1. (Continued)
Women with
hysterectomies
(n¼236)
Control women
(n¼392)
Mean SD Mean SD pvalue
Weight pattern during adulthood 0.2
Stable (10 pounds) or weigh less 67 28.4 130 33.5
Weigh more now 87 36.9 150 38.7
Weight fluctuates 82 34.7 108 27.8
Missing 4
Change in strenuous physical activity
between baseline and follow-up
0.6
Unchanged 135 57.2 211 53.8
Decreased 56 23.7 107 27.3
Increased 45 19.1 74 18.9
Change in moderate physical activity
between baseline and follow-up
0.1
Unchanged 100 42.4 192 49.0
Decreased 53 22.5 90 23.0
Increased 83 35.2 110 28.1
702 MOORMAN ET AL.
Other factors statistically significantly associated with weight
gain >10 pounds in bivariate analyses were higher baseline
weight, African American race, single or divorced marital
status, lower educational level, current smoking, no alcohol
consumption, and weight gain or weight fluctutations during
adulthood. In multivariable analyses including age and all
variables that were significantly associated with weight gain
in bivariate analysis, hysterectomy remained a statistically
significant predictor of weight gain >10 pounds (OR ¼1.61,
95% CI 1.04 - 2.48). It is noteworthy that reported physi-
cal activity, whether at baseline or change between baseline
and follow-up, was not a statistically significant predictor of
weight gain in bivariate analyses, and inclusion of terms for
physical activity in the multivariable model had essentially no
effect on the OR.
We repeated the analyses excluding women who had been
pregnant in the year preceding their baseline interview (5 of
the women having hysterectomies and 15 of the controls).
Results were very similar, with a multivariable OR of 1.67
(95% CI 1.09-2.56). We also performed analyses using re-
ported weight gain of >10 pounds as the outcome. In multi-
variable analyses, the association with hysterectomy status
was stronger (OR ¼2.08, 95% CI 1.24 - 3.49) than for measured
weight gain, whereas associations with potential confounders
showed largely the same pattern as for measured weight gain
(data not shown).
Among the women with hysterectomies, we examined
weight changes by the type of surgery and the indication
for surgery. As shown in Table 5, we compared measured
weight and BMI at baseline and follow-up for women who
had abdominal, laparoscopic, or vaginal hysterectomies.
Mean baseline and follow-up weights and BMIs were highest
in women who had abdominal hysterectomies and lowest
among those who had laparoscopic hysterectomies, with sta-
tistically significant differences between groups in regard
to BMI but not weight. There were statistically significant
changes in weight and BMI between baseline and follow-up
among the women who had abdominal hysterectomies,
whereas the changes were not significant for women having
either vaginal or laparoscopic surgery.
We also examined weight gain by indications for hyster-
ectomy. Baseline weight and BMI were similar in the women
with diagnoses of fibroids or menorrhagia and were some-
what higher than for women with other diagnoses. There
were statistically significant weight gains between baseline
and follow-up among the women with fibroids or menor-
rhagia, whereas women with other diagnoses showed a slight
weight loss.
Table 2. Weight and Body Mass Index (BMI) Characteristics Comparing Women
with Hysterectomies and Control Women
Women with hysterectomies (n¼236) Control women (n¼392)
Mean SD Mean SD pvalue
BMI (kg=m
2
) at baseline 30.8 (7.1) 29.2 (7.8) 0.008
BMI (kg=m
2
) at 1 year follow-up 31.3 (7.5) 29.4 (7.8) 0.003
Change in BMI 0.51 (2.2) 0.22 (1.7) 0.06
a
Weight (kg) at baseline 82.8 (19.6) 78.7 (20.9) 0.01
Weight (kg) at 1 year follow-up 84.2 (20.8) 79.3 (21.2) 0.005
Change in weight (kg) 1.36 (5.7) 0.61 (4.5) 0.07
a
n % n % p value
BMI (kg=m
2
) at baseline
<18.5 2 (0.9) 4 (1.0) 0.01
18.5–<25 59 (25.0) 134 (34.2)
25–<30 54 (22.9) 105 (26.8)
>30 121 (51.3) 149 (38.0)
Measured change in weight
between baseline and follow-up
>20 pound gain 15 (6.4) 8 (2.0) 0.07
>10–20 pound gain 40 (17.0) 52 (13.3)
>5–10 pound gain 31 (13.1) 53 (13.5)
Stable (5 pounds) 111 (47.0) 213 (54.3)
>5–10 pound loss 17 (7.2) 34 (8.7)
>10–20 pound loss 14 (5.9) 24 (6.1)
>20 pound loss 8 (3.4) 8 (2.0)
Reported change in weight
between baseline and follow-up
>20 pound gain 16 (6.8) 11 (2.8) 0.001
>10–20 pound gain 30 (12.7) 29 (7.4)
>5–10 pound gain 28 (11.9) 48 (12.3)
Stable (5 pounds) 112 (47.5) 242 (61.9)
>5–10 pound loss 17 (7.2) 32 (8.2)
>10–20 pound loss 20 (8.5) 17 (4.4)
>20 pound loss 13 (5.5) 12 (3.1)
Missing 1
a
Controlling for baseline BMI or weight.
WEIGHT GAIN AFTER HYSTERECTOMY 703
Discussion
Our study population of women aged 30–47 years showed
differences in risk factors between women undergoing hys-
terectomy and control women that are consistent with reports
from other populations.
12–16
Women undergoing hysterec-
tomy had more pregnancies, were more likely to have had a
tubal ligation, and were of lower socioeconomic status as
measured by educational level.
12–14
The mean BMI of women
undergoing hysterectomy was significantly higher than that
of the control women, which is consistent with obesity being a
risk factor for uterine fibroids,
15,16
the most common indica-
tion for hysterectomy among premenopausal women.
Weight gain was a very common occurrence in our overall
study population, with 32% of women having a measured
weight gain of >5 pounds and 18% having a weight gain of
>10 pounds during the first year of follow-up. Our data show
that women who had hysterectomies were at higher risk for
weight gain, with nearly one quarter of them having weight
gains of >10 pounds. Multivariable analyses showed they
were 1.62 times as likely as control women to have a weight
gain this large, even when accounting for a number of factors,
such as baseline weight, race, marital status, educational level,
smoking status, and weight change as an adult, as potential
confounders.
Weight gain is a common complaint after hysterectomy,
with many women having the perception that weight gain
occurred even though they did not change their diet or exer-
cise patterns; therefore, we were interested in comparing per-
ceived weight changes with measured weight changes. Both
the control women and the women undergoing hysterec-
tomy tended to underreport weight gain, but underreporting
of weight gain was more common among the controls. This
may reflect that women who had hysterectomies were more
aware of their weight and reported it more accurately, or they
were more likely to acknowledge weight gain if they believed
there was a plausible reason for it (i.e., their surgery).
To our knowledge, there are no other published reports of
prospective studies of weight changes after hysterectomy that
included a comparison group of women with intact uteri. Our
results are consistent with a report from the prospective
Maine Women’s Health Study, which listed weight gain as
one adverse outcome of hysterectomy.
4
This study did not
quantify weight gain, however, and because it did not include
controls, it was not possible to conclude that the observed
weight gain was greater than what would be expected in an
age-matched group of women. Our data indicate that weight
gain, although common in this age range, is more likely to
occur in women undergoing hysterectomy.
Because weight was measured only at baseline and after 1
year of follow-up, it was not possible for us to determine the
trajectory of weight gain. We could not determine, for ex-
ample, if the weight gain occurred steadily over the year or if
the women having hysterectomies gained weight primarily
during the weeks immediately after the surgery, when they
were recovering but were restricted in their activities. Our
data on weight gain by type of hysterectomy suggested that
women with abdominal hysterectomies had larger weight
gains than those who had laparoscopic or vaginal hysterec-
tomies. The average recovery period from abdominal hys-
terectomies is longer than the recovery period for other types
of hysterectomies.
17
Thus, our data are consistent with a hy-
pothesis that weight gain may be associated with longer
periods of activity limitations. Women with abdominal hys-
terectomies also weighed more at baseline, suggesting they
were predisposed to weight gain independent of the type of
hysterectomy they had or the length of recovery.
Analysis of weight gain by indication for hysterectomy
showed greater weight gain for women with diagnoses of
fibroids or menorrhagia compared with other diagnoses. It is
well established that obesity is a risk factor for fibroids,
18
and
the greater weight gain we observed among women with fi-
broids may be a reflection of their higher baseline weight. It is
more difficult to speculate on the reasons for differences in the
observed weight gain among the women with menorrhagia or
other diagnoses. Menorrhagia is not so much a precise diag-
nosis as a description of a symptom that may be caused by
diverse etiologies. Similarly, the Other category includes mul-
tiple diagnoses, some of which (e.g., endometriosis) may be
inversely associated with weight. It is likely that the observed
Table 3. Change in Weight and BMI by Baseline BMI in Women with Hysterectomies and Controls
Women with hysterectomies (n¼236) Control women (n¼391)
BMI <25
(n¼60)
BMI 2530
(n¼55)
BMI >30
(n¼121)
BMI <25
(n¼138)
BMI 25–30
(n¼105) BMI >30 (n¼148)
Weight change from
baseline to 1-year
follow-up
n (%) n (%) n (%) n (%) n (%) n (%)
>10 pound gain 6 (10.0) 14 (25.5) 35 (28.9) 11 (8.0) 18 (17.1) 31 (21.0)
>5–10 pound gain 9 (15.0) 5 (9.1) 17 (14.1) 21 (15.2) 12 (11.4) 20 (13.5)
Stable (5 pounds) 38 (63.3) 23 (41.8) 50 (41.3) 93 (67.4) 54 (51.4) 66 (44.6)
>5–10 pound loss 5 (8.3) 4 (7.3) 8 (6.6) 10 (7.3) 10 (9.5) 14 (9.5)
>10 pound loss 2 (3.3) 9 (16.4) 11 (9.1) 3 (2.2) 11 (10.5) 17 (11.5)
Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD)
Weight change (kg) 1.08 (3.4) 1.11 (5.2) 1.65 (6.8) 0.72 (2.7) 0.70 (4.9) 0.45 (5.6)
BMI change 0.39 (1.3) 0.40 (1.95) 0.62 (2.56) 0.27 (1.0) 0.25 (1.8) 0.16 (2.1)
704 MOORMAN ET AL.
differences in weight gain for various diagnoses are related to
baseline weight, but the inability to look at more precise cat-
egorizations of diagnoses other than fibroids makes it difficult
to make a firm conclusion about these associations.
Further follow-up of this cohort, which is continuing, will
provide insight into the long-term patterns of weight change
among women in their 30s and 40s. We will be able to de-
termine if the pattern of greater weight gain among women
who had hysterectomies continues or if it is a phenomenon
limited to the time shortly after surgery. We also will be able
to examine how the weight changes correlate with hormonal
changes related to the menopausal transition.
Although our study clearly suggests an association be-
tween hysterectomy and weight gain, the limitations of our
Table 4. Odds Ratios (ORs) and 95% Confidence Intervals (CIs) for Measured Weight Gain of >10 Pounds
Comparing Women with Hysterectomies and Control Women
Bivariate models
a
Multivariable models
b
Variable Categories OR (95% CI) OR (95% CI)
Hysterectomy status No 1.00 1.00
Yes 1.68 (1.12–2.53) 1.61 (1.04–2.48)
Age at interview (years) 45–47 1.00 1.00
40–44 1.39 (0.79–2.43) 1.22 (0.68–2.20)
35–39 1.36 (0.75–2.47) 1.15 (0.61–2.16)
30–34 0.91 (0.38–2.22) 1.02 (0.40–2.61)
Baseline weight Continuous 1.02 (1.01–1.03) 1.01 (1.00–1.02)
Race White 1.00 1.00
African American 1.81 (1.20–2.74) 1.23 (0.76–1.98)
Other 0.98 (0.28–3.45) 0.94 (0.26–3.46)
Marital status Married=living as married 1.00 1.00
Single 2.15 (1.32–3.50) 1.88 (1.09–3.23)
Divorced=widowed 1.82 (1.10–3.02) 1.33 (0.78–2.27)
Educational level High school graduate 1.00 1.00
College graduate 0.56 (0.34–0.91) 0.74 (0.44–1.26)
Graduate degree 0.50 (0.28–0.91) 0.72 (0.37–1.38)
Number of full-term pregnancies 0 1.00
1 0.86 (0.47–1.58)
2–3 0.92 (0.56–1.49)
4 1.42 (0.63–3.20)
Smoking status Nonsmoker 1.00 1.00
Former smoker 1.61 (0.97–2.68) 1.83 (1.07–3.13)
Current smoker 1.85 (1.11–3.10) 1.66 (0.95–2.91)
Current alcohol drinker No 1.00 1.00
Yes 0.61 (0.40–0.92) 0.71 (0.45–1.11)
Strenuous physical activity Never or <once a month 1.00
Up to 1 time a week 0.86 (0.50–1.46)
2–6 times a week 0.59 (0.36–0.94)
7 times a week 0.75 (0.24–2.30)
Moderate physical activity Never or <once a month 1.00
Up to 1 time a week 0.84 (0.43–1.64)
2–6 times a week 0.70 (0.38–1.29)
7 times a week 0.50 (0.21–1.18)
Occupational physical activity Mostly sitting 1.00
Mostly standing=walking 1.24 (0.72–2.14)
Active 0.99 (0.59–1.68)
Not employed 0.95 (0.50–1.82)
Change in strenuous physical activity No change 1.00
(follow-up vs. baseline) Increased 0.77 (0.44–1.36)
Decreased 1.06 (0.66–1.69)
Change in moderate physical activity No change 1.00
(follow-up vs. baseline) Increased 1.07 (0.67–1.73)
Decreased 1.28 (0.78–2.13)
Weight change as adult Stable or weigh less 1.00 1.00
Gained weight 1.92 (1.11–3.31) 1.17 0.65–2.13
Weight fluctuates 2.47 (1.42–4.30) 1.67 0.93–3.00
Tubal ligation Yes 1.00
No 0.80 (0.54–1.21)
a
Models assessed risk for weight gain >10 lbs with each variable individually.
b
Multivariable model contained terms for age and all variables that had statistically significant associations in bivariate analyses.
WEIGHT GAIN AFTER HYSTERECTOMY 705
data must be acknowledged. The control women for the study
were recruited using brochures and advertisements placed
in clinics and doctors’ offices, and there were significant dif-
ferences between the controls and the women having hys-
terectomies in several baseline characteristics. Although the
control women were volunteers, they are representative of
the population from which the cases arose. The proportion
of African Americans in the control group is very similar to
the proportion in Durham county, North Carolina, where the
hospitals are located (37.5% and 37.8%, respectively).
19
The
prevalence of overweight or obesity among the controls (65%)
is close to the reported figures from the North Carolina Be-
havioral Risk Factor Surveillance Study indicating two thirds
of adults are overweight or obese. More specifically, among
North Carolina women aged 35–44, 49% of white women and
79% of African American women are overweight or obese.
20
The differences in race, weight, and other baseline character-
istics that we observed are consistent with risk factors for
hysterectomy reported in other studies.
12–16
Specifically, the
women having hysterectomies had more pregnancies and a
lower educational level, were more likely to have had a tubal
ligation, and had higher average BMI. The differences in
baseline BMI may be of most concern in a study evaluating
weight gain. However, because the prevalence of overweight
or obesity among the control women is very similar to re-
ported prevalence figures for North Carolina and the United
States,
21,22
it is unlikely that the control group represented a
group of women who were particularly health and weight
conscious. Furthermore, statistical adjustment for differences
in baseline characteristics had minimal effect on the ORs for
weight gain associated with hysterectomy.
Another possible limitation is that the dietary information
collected in the questionnaire was limited, making it impos-
sible for us to assess the extent to which weight gain was due
to increased energy intake. The diet questions assessed intake
of general categories of food, such as red meat, poultry, fish,
vegetables, fruit, and fruit juices, but in insufficient detail to
quantify total energy intake, which would be the most rele-
vant measure in regard to weight gain. We found no statis-
tically significant differences between the women undergoing
hysterectomies and the controls in intake of these food cate-
gories, with the exception of significantly higher fruit intake
among controls and significantly higher fruit juice intake
among women with hysterectomies. These dietary factors
were not significantly associated with weight gain. Based on
the similarity of the dietary data between the women with
hysterectomies and the controls as well as the known limita-
tions of data obtained from food frequency questionnaires,
23
we do not believe that our results would have been markedly
changed if we had more extensive dietary information.
Our study also had the limitation of its observational de-
sign, which meant that physical activity was based on self-
report. The point estimates associated with high levels of
moderate physical activity and increases in moderate or
strenuous physical activity between baseline and follow-up
were suggestive that physically active women may be at
lower risk for weight gain, but these findings were not sta-
tistically significant. This could reflect either the moderate
sample size of this study or an attenuation of the true effects
because of misclassification inherent in self-reported data
such as these.
The weight distribution we saw in our population of wo-
men in their middle to late reproductive years is consistent
with the high reported prevalence of obesity in the United
States,
21,22
with a markedly higher prevalence among the
women who had hysterectomies. The weight gain we ob-
served is also in line with other follow-up studies of women
during midlife, which reported average weight gains of 1.2
pounds (*0.54 kg) over 12 months in one report
24
and 2.25 kg
(*5 pounds) over 3 years in another report.
25
The high pro-
portion of obese women and the high proportion of women
reporting weight gains of >10 pounds in a single year raise
serious concerns about the health of this population. The
medical consequences associated with obesity and weight
gain are myriad and include higher risks for overall mortal-
ity, cardiovascular disease, diabetes, osteoarthritis, certain
forms of cancer, and depression.
26,27
In addition, weight gain
is associated with lower physical functioning and health-
Table 5. Change in Weight and BMI by Type of Hysterectomy and Diagnosis
n
Baseline
weight
(kg)
Weight at
follow-up
(kg)
Weight
change
(kg) pvalue
a
Baseline
BMI
(kg=m
2
)
BMI at
follow-up
(kg=m
2
)
BMI change
(kg=m
2
)pvalue
a
Hysterectomy type
Abdominal 110 85.0 86.8 1.8 0.002 32.0 32.7 0.7 0.001
Vaginal 62 82.5 83.7 1.2 0.1 30.2 30.6 0.4 0.2
Laparoscopic 62 79.7 80.6 0.9 0.2 29.4 29.7 0.3 0.2
Missing 2
pvalue
b
0.2 0.2 0.6 0.05 0.03 0.5
Diagnosis
Fibroids 156 83.5 85.0 1.5 0.001 31.3 31.9 0.6 0.001
Menorrhagia 54 83.5 85.3 1.8 0.04 30.6 31.2 0.6 0.06
All others 24 77.9 77.7 0.2 0.9 28.0 28.0 0.1 0.9
Missing 2
pvalue
b
0.4 0.3 0.4 0.1 0.06 0.4
a
pvalue for change between baseline and follow-up.
b
pvalue for differences between groups (type of hysterectomy or diagnosis).
706 MOORMAN ET AL.
related quality of life.
28,29
Our data suggest that women un-
dergoing hysterectomy may be at particular risk for these
outcomes.
Hysterectomy is performed most commonly on women in
their 40s as they are approaching the menopausal transition,
a point in life when weight gain is very common. Thus, the
constellation of age, hormonal changes, and surgery may be
interrelated and contribute to challenges in weight manage-
ment. Our data showing that women undergoing hysterec-
tomy are at considerably higher risk for large weight gains
suggest that it would be very appropriate to target them for
lifestyle interventions designed to prevent weight gain. Wo-
men who are overweight or obese at the time of surgery or
those who have struggled with weight throughout their life,
as evidenced by weight fluctuations throughout adulthood,
may benefit especially from efforts designed to help them lose
weight or prevent further weight gain.
Conclusions
Data from this prospective cohort study suggest that pre-
menopausal women undergoing hysterectomy without bi-
lateral oophorectomy are at increased risk for weight gain
compared with women of similar age with intact uteri and
ovaries. Women who are heavier or have had weight fluctu-
ations throughout their life appear to be most at risk and may
benefit from lifestyle interventions to prevent weight gain
after surgery.
Acknowledgments
This research was supported by grants from the National
Institutes of Health, National Institute on Aging, RO1
AG020162, and National Center for Research Resources, UL1
RR024128-01.
Disclosure Statement
The authors have no conflicts of interest to report.
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Address reprint requests to:
Patricia G. Moorman, Ph.D.
Department of Community and Family Medicine
Box 2949, Duke University Medical Center
2424 Ervin Road, Suite 602
Durham, NC 27705
E-mail: patricia.moorman@duke.edu
708 MOORMAN ET AL.
