This study is a systematic review and meta-analysis designed to evaluate the long-term outcomes of hysterectomy with bilateral salpingo-oophorectomy. The study updated a previous systematic review by searching PubMed, Web of Science, and Embase for publications between January 2015 and August 2022. The study included observational studies of long-term outcomes for women who had a hysterectomy with bilateral salpingo-oophorectomy. The study included data from 38 studies, comprising sample sizes ranging from 2,900 to over 5 million women. Primary outcomes were incidence of cancer (ovarian, breast, colorectal, thyroid, renal), cardiovascular diseases, and overall mortality. Secondary outcomes were neuropsychiatric outcomes, such as dementia/depression, metabolic outcomes, and MSK outcomes. 

It was found that a hysterectomy with bilateral salpingo-oophorectomy is associated with a reduced risk of ovarian cancer at any age and a reduced risk of breast cancer when performed at a young age. There was an increased risk of cardiovascular diseases, including coronary heart disease and stroke, especially in women younger than 50 years old. Elevated risks of hyperlipidemia, diabetes mellitus, and hypertension are associated with this surgery, regardless of the age at which it is performed. There is an increased risk of osteoporosis, though the risk of hip fractures did not show significant association. 

The evidence regarding the efficacy of HRT in modifying the adverse outcomes associated with the procedure is conflicting. Variations in HRT formulations, doses, and durations among different studies limit the power to draw definitive conclusions. More research is necessary to evaluate the effectiveness of HRT in mitigating adverse outcomes following the premature cessation of estrogen production due to this surgery​. 

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