• Posted September 14, 2023

Early-Life Removal of Ovaries Could Bring Faster Aging

Premenopausal women who have surgery to remove the ovaries (oophorectomy) and fallopian tubes may face chronic medical conditions and a decline in physical functioning, new research warns.

“The study is important because it emphasizes information that we already know, and that is that …premenopausal bilateral oophorectomy [PBO] is not good for women's health, and it's associated with increased odds of a number of chronic diseases,” said Dr. Stephanie Faubion, director of women's health at the Mayo Clinic, which led the study.

Ovaries may be removed for a number of reasons, including cysts and endometriosis, a condition caused by uterine cells growing in other parts of the body. Women who test positive for the a certain BRCA gene mutation (which raises cancer risk) may choose to have them removed to prevent ovarian cancer. The new findings may help inform their decision, experts said.

For the study, researchers led by Michelle Mielke, of Wake Forest University School of Medicine in Winston-Salem, N.C., followed 274 women who had a PBO with or without a hysterectomy (removal of the uterus).

Women who had a PBO between 46 to 49 years of age had a greater risk of arthritis and obstructive sleep apnea, the study found. Women who had the procedure before age 46 had increased risk of arthritis, asthma, obstructive sleep apnea and broken bones. The youngest group also went a shorter distance on a six-minute walk.

“It was very important that they were seeing more adverse outcomes in terms of the six-minute walk test, because that is a predictor of several other adverse outcomes in the future,” including premature death and physical function, said Dr. JoAnn Manson, a hospital chief at Brigham and Women's Hospital and a professor at Harvard Medical School, who reviewed the findings. She led a previous groundbreaking study that also found higher rates of coronary heart disease and premature death among nurses who had PBOs before age 50.

The new study found no significant age-related difference in cognitive status after the PBO surgery. But Dr. Mary Jane Minkin, a professor at the Yale School of Medicine who reviewed the findings, said it's important to know about other studies these same researchers have conducted.

“If you're under the age of 45, they showed in a previous paper from the Mayo Clinic that if you have women taking out their ovaries under the age of 45 and they did not get estrogen, they had about a threefold increased risk of development of dementia later on in life,” she said.

The ovaries make most of a woman's estrogen, which is key for regulating the menstrual cycle and affects the urinary tract, heart and blood vessels, bones, breasts, skin, hair, mucous membranes, pelvic muscles and the brain.

“Basically, the whole series of papers that they've done along these lines is to really show that estrogen is important for people," Minkin said. "That's really what it boils down to.”

For women who are thinking about having their ovaries removed, Minkin summed up the current medical thinking.

“Most people would advocate leaving the ovaries in until 60 or 65 -- don't take them out even in somebody who's quote unquote postmenopausal. Leave them in there,” she said. “When we have women who are clearly under the age of 50, what are we doing for these young women? Taking out ovaries is not necessarily the greatest thing in the world for their other medical health.”

The exception, Minkin said, is women who are at high risk for ovarian cancer. In that case, ovaries should be removed, she believes.

"We would then advocate giving the patient estrogen replacement therapy if she's very young, which we can do, even in [women who are BRCA positive]," Minkin said. "In general, we do give them estrogen as long as they haven't been diagnosed with a previous breast cancer or something like that because we know it's good for them.”

The new study was published Sept. 12 in Menopause: The Journal of The North American Menopause Society.

More information

For more on bilateral oophorectomies, visit the Emory School of Medicine.

SOURCES: Mary Jane Minkin, MD, professor, Yale University School of Medicine, and co-director, Sexuality, Intimacy and Menopause Program, Smilow Cancer Hospital at Yale New Haven, Conn.; Stephanie Faubion, MD, MBA, director, Office of Women's Health, Mayo Clinic, Jacksonville, Fla., and medical director, The Menopause Society, Pepper Pike, Ohio; JoAnn Manson, MD, DrPH, chief, preventive medicine, Brigham and Women's Hospital, Boston, professor, medicine and women's health, Harvard Medical School, Boston; Menopause: The Journal of the American Menopause Society, Sept. 12, 2023