Effect of Bilateral Oophorectomy on Women's Long-Term Health

Abstract

Bilateral oophorectomy at the time of hysterectomy for benign disease is commonly practiced in order to prevent the subsequent development of ovarian cancer or other ovarian pathology that might require additional surgery. At present, bilateral oophorectomy is performed in 78% of women aged between 45 and 64 years having a hysterectomy, and a total of approximately 300,000 prophylactic oophorectomies are performed in the USA every year. Estrogen deficiency resulting from pre- and post-menopausal oophorectomies has been associated with higher risks of coronary heart disease, stroke, hip fracture, Parkinsonism, dementia, cognitive impairment, depression and anxiety in many studies. While ovarian cancer accounts for 14,800 deaths per year in the USA, coronary heart disease accounts for 350,000 deaths per year. In addition, 100,000 cases of dementia may be attributable annually to prior bilateral oophorectomy. At present, observational studies suggest that bilateral oophorectomy may do more harm than good. In women who are not at high risk of developing ovarian or breast cancer, removing the ovaries at the time of hysterectomy should be approached with caution.

Non-cancer endpoints in BRCA1/2 carriers after risk-reducing salpingo-oophorectomy

“…The latter is of particular concern since bilateral oophorectomy is associated with an increased risk of fractures, although the greatest risk appears to be for those with oophorectomy prior to age 45 [24,25]. An increased risk of heart disease and stroke, as well as excess mortality, has been associated with oophorectomy prior to age 45 in the general population, most apparent in those who did not take HRT after oophorectomy [7,19,[26][27][28][29][30]. In B1/2 mutation carriers, the risk:benefit analysis of oophorectomy is undoubtedly different, as the major causes of mortality without oophorectomy are breast and ovarian cancers.…”

Modifiers of breast and ovarian cancer risks for BRCA1 and BRCA2 mutation carriers

“…However, these are invasive, have side effects and are associated with adverse psychosocial effects (recently reviewed in (Hartmann & Lindor 2016)). Most women opt for RRSO, which results in premature menopause and is associated with adverse effects such as increased risks of cardiovascular disease and osteoporosis, as well as cognitive impairment and mortality from neurological diseases (Parker et al 2009, Rivera et al 2009a. Moreover, young mutation carriers make decisions about RRSO/RRM at a time in their lives that often coincides with family planning.…”

Challenging and Complex Decisions in the Management of the BRCA Mutation Carrier

“…Notably, dyspareunia, low sexual desire, and decreased sexual satisfaction are more frequent after RRSO and may not be relieved by ET. 16,93,94 Extensive evidence, including that from large, wellcharacterized cohorts of women including the Nurses' Health Study (NHS) and the Olmsted County Study of Oophorectomy and Aging (OCSOA), as well as the National Health and Nutrition Examination Survey, links early menopause and BO to an increased risk of mortality, 95,96 cardiovascular disease, 96,97 stroke, 98 cognitive decline, 99 depressive or anxiety symptoms, 100 osteoporosis, 101 and worse physical function. 98,102 The risks are greater with an earlier age of oophorectomy, and are partly ameliorated by taking ET until at least age 45.…”