Study Reveals Prolonged Health Implications of Ovary Removal Prior to Menopause

A recent study has highlighted the potential long-term health risks associated with a surgical procedure known as premenopausal bilateral oophorectomy (PBO), which involves the removal of both ovaries in individuals who have not yet gone through menopause. This procedure is often performed during a hysterectomy and may also be recommended to reduce the risk of ovarian cancer in high-risk individuals.

However, experts are increasingly cautioning that in individuals who are not at high risk for ovarian cancer, the removal of ovaries before menopause may be unnecessary and can lead to lasting health complications.

The study, conducted by lead author Michelle Mielke, PhD, a professor of epidemiology and prevention at the Wake Forest School of Medicine in Winston-Salem, North Carolina, aims to empower women to make informed decisions regarding their health and weigh the pros and cons of ovary removal. It’s important to note that the risk-benefit discussion may differ for women at higher risk of ovarian cancer.

The research, published on September 13, 2023, in the journal Menopause, involved a comparison of medical records and cognitive tests of over 500 women from the same county in Minnesota. Approximately half of them had undergone a PBO either with or without a hysterectomy, while the other half had not.

The study revealed that individuals who had both ovaries removed before the age of 46 were more likely to experience health issues such as arthritis, asthma, obstructive sleep apnea, and bone fractures. Those who underwent a PBO between ages 46 and 49 had a higher incidence of arthritis and obstructive sleep apnea. However, there were no differences in cognitive function observed between those who had their ovaries removed and those who did not, nor among different age groups within the PBO group.

While not all of the health problems may be directly linked to PBO, experts have long recognized that removing a woman’s ovaries before menopause can have significant negative effects on various aspects of health, including cardiovascular and bone health.

The ovaries play a crucial role in producing hormones like estrogen, progesterone, and small amounts of testosterone. These hormones influence not only the menstrual cycle and pregnancy but also have far-reaching effects on the cardiovascular system and bones. Estrogen, in particular, helps maintain bone density and has a protective impact on the cardiovascular system. The sudden loss of estrogen due to ovary removal can have profound consequences, leading to rapid bone density loss and potentially increasing the risk of cardiovascular disease.

Surgical menopause, induced by the removal of the ovaries, can have a more pronounced impact than natural menopause, which involves a gradual decline in hormone levels.

Research from Denmark, published in May 2023 in the journal Annals of Internal Medicine, found that women who had their ovaries removed before age 45 had a higher likelihood of hospitalization for cardiovascular disease than those who retained their ovaries or had them removed later in life. These women also had a higher 10-year cumulative risk of hospitalization for cardiovascular disease.

However, it’s important to note that individuals at high risk of ovarian cancer may need to make a different calculation when considering ovary removal as a preventive measure. Early detection of ovarian cancer is challenging, and there is no effective screening test for the disease. As a result, prevention has traditionally been the primary option.

Genetic testing can help identify individuals at higher risk for ovarian cancer, enabling them to assess their options. For those at high risk, ovary removal or even removal of the fallopian tubes (which can also be a site of ovarian cancer) may be recommended. 

Hormone therapy can help mitigate the effects of ovary removal in certain cases.

In summary, the decision regarding ovary removal before menopause should take into account individual risk factors, including genetic mutations and family history. It’s a complex decision that requires careful consideration of both the potential benefits and risks associated with the procedure.