Early Ovary Removal May Accelerate Aging

Ovary removal significantly reduces the risk of developing ovarian cancer. However, in some women, procedure-related health risks may outweigh potential benefits, as ovary removal is linked to multiple chronic conditions, including asthma and arthritis.

Hysterectomy — a surgery to remove all or part of the uterus — is the second-most-frequently performed surgical operation for women after cesarean delivery.

An estimated 23% of women aged 40 to 44 years and 45% of women aged 45 to 59 years have undergone ovary removal, a procedure called premenopausal bilateral oophorectomy (PBO), at the time of hysterectomy to prevent ovarian cancer.

While effective in cancer prevention — surgery removing both ovaries and fallopian tubes reduces the risk of ovarian cancer by 98% — the procedure induces a drop in estrogen levels similar to what occurs in menopause, causing hot flashes and sexual dysfunction.

Mounting evidence suggests that PBO may have negative health effects beyond those associated with menopause. The risks may outweigh the potential benefits of ovary removal, especially in women with an average risk for ovarian cancer. Rising concerns over possible harms resulted in the decline of PBO rates, but only in some geographic areas.

The new study, published in the journal Menopause, included 514 women, of which more than half had undergone PBO. Their in-person assessments were completed, on average, 22 years after ovary removal.

Those who underwent the procedure before turning 46 had a higher risk of arthritis, asthma, obstructive sleep apnea, and bone fractures than women who had not had PBO. They also performed worse in a six-minute walk to assess aerobic capacity and endurance.

Women who had ovary removal aged 46 to 49 were at increased risk of arthritis and obstructive sleep apnea. However, no significant differences in cognitive status were identified between the two groups, contrary to what some previous studies suggested.

These results highlight the potential negative long-term 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.

- Stephanie Faubion, medical director for The Menopause Society

Ovaries play a crucial role not only in the reproductive system but also affect multiple organs and systems throughout the body. Because they secrete hormones both before and after menopause, the removal of the ovaries can cause an endocrine disruption to numerous tissues and organs, including the brain, muscles, bones, blood vessels, heart, and the gastrointestinal tract.

Previous research has linked ovary removal to cardiovascular disease, cognitive impairment, dementia, and Parkinson’s disease, especially in women who underwent PBO before the age of 46 years.

About 19,710 women in the United States will receive a new diagnosis of ovarian cancer in2023, the American Cancer Society estimates. Ovarian cancer primarily affects older women, as about half of those diagnosed are 63 years or older.

Ovarian cancer is often detected only when it is in an advanced stage. It is also the number one cause of death from gynecologic cancer in the U.S., projected to claim 13,270 lives in this year.

The American College of Obstetricians and Gynecologists recommends surgical removal of ovaries and fallopian tubes for cancer prevention "for women with BRCA1 or BRCA2 mutations between ages 35 to 45, or when childbearing is complete."

The guidelines read, "It may also be recommended for women with Lynch syndrome. This operation reduces the risk of ovarian cancer. When it is done before menopause, it also reduces the risk of getting breast cancer."

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