Accelerated Accumulation of Multimorbidity After Bilateral Oophorectomy: A Population-Based Cohort Study

Abstract

Objective To study the association between bilateral oophorectomy and the rate of accumulation of multimorbidity. Patients and Methods In this historical cohort study, the Rochester Epidemiology Project records-linkage system was used to identify all premenopausal women who underwent bilateral oophorectomy before age 50 years between January 1, 1988, and December 31, 2007, in Olmsted County, Minnesota. Each woman was randomly matched to a referent woman born in the same year (± 1 year) who had not undergone bilateral oophorectomy. We studied the rate of accumulation of 18 common chronic conditions over a median of approximately 14 years of follow-up. Results Although women who underwent bilateral oophorectomy already had a higher multimorbidity burden at the time of oophorectomy, they also experienced a significantly increased risk of subsequent multimorbidity (P=.XX). After adjustments for 18 chronic conditions present at baseline, race/ethnicity, education, body mass index, smoking, age at baseline, and calendar year at baseline, women who underwent oophorectomy before age 46 years experienced an increased risk of depression, hyperlipidemia, cardiac arrhythmias, coronary artery disease, arthritis, asthma, chronic obstructive pulmonary disease, and osteoporosis. In addition, they experienced an accelerated rate of accumulation of the 18 chronic conditions considered together (hazard ratio, 1.22; 95% CI, 1.14–1.31; P<.001). Several of these associations were reduced in women who received estrogen therapy. Conclusion Bilateral oophorectomy is associated with a higher risk of multimorbidity, even after adjustment for conditions present at baseline and for several possible confounders. However, several of these associations were reduced in women who received estrogen therapy.

Factors associated with deciding between risk-reducing salpingo-oophorectomy and ovarian cancer screening among high-risk women enrolled in GOG-0199: An NRG Oncology/Gynecologic Oncology Group study

“…In addition to inaccurate understanding of their own OC risk estimates, genuine ambiguity regarding the long-term non-oncologic sequelae of RRSO in high-risk women compounds the complexity of the decision-making process. Among women at population risk of OC, large observational studies have shown conflicting results in terms of cardiovascular disease and overall mortality associated with bilateral salpingo-oophorectomy among women undergoing hysterectomy for benign indications [38–40]; however, the effects of RRSO on non-oncologic morbidity in high-risk women is unclear and the benefits of OCS remain unproven. While these uncertainties, ambiguities and limitations cannot be fully eliminated at present, their existence warrants thoughtful discussion as patients weigh their management options.…”

Salpingo-oophorectomy at the Time of Benign Hysterectomy

“…Evidence of accelerated aging comes from both biological markers (epigenetic clock) and from clinical measures (accelerated accumulation of multimorbidity). 5,6 …”

“…The clinical recommendation should be simple and clear: In the absence of a documented high-risk genetic variant predisposing to ovarian cancer (eg, BRCA mutations), bilateral oophorectomy before the age of 50 years (or before menopause) is never to be considered and should not be offered as an option to women. 5,6 The possible alternative strategy of salpingectomy with ovarian conservation remains to be tested scientifically.…”

The role of menopausal hormone therapy in women with or at risk of ovarian and breast cancers: Misconceptions and current directions

“…Interestingly, these effects were reduced by initiating estrogen only MHT at time of oophorectomy and continuing to age 51 or 52 to coincide with natural menopause. These observations argue for MHT as close to the onset of hormone deficiency as possible for cardiovascular, bone, and nervous system protection …”