Skip to content

Sarrel and colleagues [1] calculated the mortality toll due to avoiding estrogen in hysterectomized women aged 50–59 between 2002 and 2011. The calculation was motivated by the Women’s Health Initiative (WHI) estrogen-only trial report in 2011 [2] which indicated an excess mortality in women in this age group who [b]did not[/b] take estrogen, i.e. received placebo. The excess mortality was 13/10,000 women/year. Twelve of the 13 deaths were due to cardiovascular disease. An increase in deaths from invasive breast cancer was also seen in the women who received placebo [3]. The Yale research team calculated the best point estimates for the total excess mortality for hysterectomized women aged 50–59 in the United States from 2002 through 2011 to be between 40,292 and 48,835.


A calculation was made for each of the years using the excess mortality rate of 13/10,000/year, annual US Census population estimates, hysterectomy rates as reported in the peer-reviewed literature, and percent decline in estrogen use each year compared to 2001, as reported in the WHI paper [2]. Adjustment was made for different pre-2002 rates of estrogen use depending on whether or not ovaries had been retained at the time of hysterectomy. The best point estimates represent the aggregate of all the years taking into account all the assumptions.


  • Philip M. Sarrel
    Professor Emeritus of Obstetrics and Gynecology and Professor Emeritus of Psychiatry, Yale University, New Haven, Connecticut, USA


  1. Sarrel PM, Njike Y, Vinante V, Katz DL. The mortality toll of estrogen avoidance: an analysis of excess deaths among hysterectomized women age 50 to 59. Am J Pub Health 2013 July 18. Epub ahead of press. doi: 10.2105/AJPH.2013.301295
  2. LaCroix AZ, Chlebowski RT, MansonJE, et al. Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy: a randomized controlled trial. JAMA 2011;305:1305-14.
  3. Chlebowski RT, Anderson GL. Changing concepts: menopausal hormone therapy and breast cancer. J Natl Cancer Inst 2012;104:517-27.
  4. Writing Group for the Womens Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Womens Health Initiative randomized controlled trial. JAMA 2002;288:321-33.
  5. Sprague BL, Trentham-Dietz A, Cronin KA. A sustained decline in postmenopausal hormone use: results from the National Health and Nutrition Examination Survey, 1999-2010. Obstet Gynecol 2012;120:595-603.
  6. Chubaty A, Shandro MT, Schuurmans N, Yuksel N. Practice patterns with hormone therapy after surgical menopause. Maturitas 2011;69:69-73.
  7. Brown S. Shock, terror and controversy: how the media reacted to the Womens Health Initiative. Climacteric 2012;15:275-80.
International Menopause Society

Install International Menopause Society - DEV

Install this application on your home screen for quick and easy access when you’re on the go.

Just tap then “Add to Home Screen”