A new study suggests that premenopausal bilateral oophorectomy (PBO), with or without hysterectomy, may cause more chronic medical conditions and decreased physical function in late midlife.
Summary Aim We examined the long-term effects of premenopausal bilateral oophorectomy (PBO) with or without concurrent or prior hysterectomy on physical and cognitive function and on the odds of chronic diseases. Methods We enrolled 274 women with PBO with or without concurrent or prior hysterectomy and 240 referents aged 55 years or older who were residents of Olmsted County, MN at the PBO or index date. Chronic conditions were assessed by abstracting medical records. Cognitive diagnoses were based on neurocognitive testing. An assessment of physical function included measures of strength and mobility. Multivariable regression models compared the characteristics of women with PBO <46 years, PBO 46-49 years, and reference women with adjustment for age and other confounders. Results Clinic visits (mean age, 67 years) were a median of 22 years after PBO or index date. Of 274 women on PBO, 161 (59%) were <46 years on PBO and 113 (41%) were between 46 and 49 years old. Compared with controls, women with a history of PBO <46 years had higher odds of arthritis (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.06–2.55), asthma (OR, 1.74; 95% CI, 1.03–2.93), obstructive sleep apnea (OR, 2.00; 95% CI, 1.23–3.26), and bone fractures (OR , 2.86; 95% CI, 1.17–6.98), and walked a shorter mean distance in the 6-minute walk test (b = −18.43; P = 0.034). Compared with their referents, women with a history of OBP between 46 and 49 years of age were more likely to have arthritis (OR, 1.92; 95% CI, 1.16–3.18) and obstructive sleep apnea (OR, 2.21; 95% CI, 1.33–3.66). ). There were no significant differences in the cognitive status of women with PBO compared to their referents. Conclusions Women with a history of premenopausal bilateral oophorectomy (PBO) with or without concurrent or previous hysterectomy, especially at age <46 years, have more chronic diseases in midlife compared with their controls. |
Comments
Growing concerns about the potentially harmful long-term effects of premenopausal bilateral oophorectomy (PBO) have led to a decrease in the number of women choosing to proactively remove both ovaries as a precautionary measure to protect against ovarian cancer.
A new study identified specific chronic medical conditions, such as asthma and arthritis, associated with the procedure. The results of the study are published in Menopause , the journal of The Menopause Society .
Hysterectomy is the second most frequently performed surgical operation in women after cesarean section. Historically, it is estimated that 23% of women aged 40 to 44 years and 45% of women aged 45 to 59 years have undergone PBO at the time of hysterectomy for the prevention of subsequent ovarian cancer. Many of these women were considered to be at average risk for ovarian cancer .
Recent studies on the possible negative effects of PBO suggest that the additional risks may not always outweigh the potential benefits, especially in women with an average baseline risk of ovarian cancer. As a result, PBO rates have begun to decline, but only in some geographic areas.
In addition to their reproductive function, the ovaries also affect multiple organs and systems throughout the body. Because they secrete hormones both before and after menopause, removal of the ovaries can cause endocrine disruption in multiple tissues and organs, including the brain, muscles, bones, blood vessels, heart, and gastrointestinal tract.
Some previous research has also suggested there could be an association with cardiovascular disease, cognitive decline or dementia. Most of these studies noted that the risk was higher for women who underwent PBO before age 46 .
However, these previous studies relied on passive collection of results primarily by extracting medical records. In this new study involving more than 500 women , just over half of whom had undergone PBO, in-person assessments were completed, on average, 22 years after PBO.
Compared with women who had not undergone PBO, those who underwent the procedure when they were younger than 46 years old had a higher risk of arthritis, asthma, obstructive sleep apnea, and bone fractures. They also walked a shorter distance during a 6-minute walk. Women with a history of PBO between 46 and 49 years of age had an increased risk of arthritis and obstructive sleep apnea.
No significant differences in cognitive status were identified between the two groups of women. The researchers recommend that longitudinal studies with long follow-up be conducted to evaluate whether additional differences in cognitive and physical function emerge at older ages.
The results of the study are published in the article " Long-term effects of premenopausal bilateral oophorectomy with or without hysterectomy on physical aging and chronic medical conditions ."
"These results highlight the potential long-term negative effects of premenopausal bilateral oophorectomy and are important for women at average risk for ovarian cancer to consider when weighing the risks and benefits of bilateral oophorectomy with or without hysterectomy before menopause." says Dr. Stephanie Faubion. , medical director of The Menopause Society.
