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Most premenopausal women should not undergo oophorectomy due to risks for chronic health conditions

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September 29, 2016

Premenopausal women who underwent bilateral oophorectomy demonstrated elevated risk for multiple chronic health conditions, according to results from a historical cohort study.

Consequently, the practice of ovary removal in premenopausal women to prevent ovarian cancer should be discontinued in women who are not at high risk for malignancy, Walter A. Rocca, MD, MPH, professor in the department of health sciences research at Mayo Clinic in Rochester, Minnesota, and colleagues wrote.

Rocca and colleagues performed their study to assess the association between bilateral oophorectomy receipt and the development of multimorbidity.

“This study was prompted by two important areas of uncertainty: the risk and benefits of bilateral oophorectomy for the prevention of ovarian cancer and the role of sex hormones in regulating the aging process,” the researchers wrote.

Rocca and colleagues used the Rochester Epidemiology Project records-linkage system to identify 1,653 premenopausal women aged younger than 50 years who underwent bilateral oophorectomy between 1988 and 2007. Investigators matched these women to an equal number of referent women born in the same year who had not undergone bilateral oophorectomy.

The researchers evaluated the rate at which the women developed 18 chronic conditions. These included five mental health conditions, seven cardiovascular or metabolic conditions, and six other somatic conditions.

Median follow-up was about 14 years.

Women who underwent bilateral oophorectomy demonstrated higher multimorbidity burden at the time of oophorectomy. However, these women also demonstrated elevated risk for subsequent multimorbidity.

An analysis adjusted for chronic conditions at baseline and several other factors — including BMI, smoking status, race/ethnicity and age at baseline — showed women who underwent oophorectomy before the age of 46 demonstrated increased risk for depression, arthritis, asthma, hyperlipidemia, cardiac arrhythmias, coronary artery disease, osteoporosis and chronic obstructive pulmonary disease.

This group also demonstrated an accelerated rate of accumulation of all 18 chronic conditions combined (HR = 1.22; 95% CI, 1.14-1.31). Many of the associations were reduced among those who underwent oophorectomy at younger ages, as well as those who received prior estrogen therapy.

“This study provides new and stronger evidence against the use of bilateral oophorectomy for prevention in young women,” Rocca said in a press release. “Bilateral oophorectomy should not be considered an ethically acceptable option for the prevention of ovarian cancer in the majority of women who do not carry a high-risk genetic variant.”

Given the potential clinical and public health implications, the researchers recommended additional research be conducted to clarify the role of estrogen and other ovarian hormones in the regulation of the aging process in women.

“The clinical recommendation is simple and clear,” Rocca added. “In the absence of a documented high-risk genetic variant, 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.” – by Kristie L. Kahl

Disclosure: Rocca reports no relevant financial disclosures. Please see the full study for a list of all researchers’ relevant financial disclosures.