Increased cardiovascular mortality after early bilateral oophorectomy

Area of Science:

• Reproductive Endocrinology
• Cardiovascular Disease Epidemiology
• Surgical Menopause

Background:

• Oophorectomy, the surgical removal of ovaries, can induce premature menopause.
• Cardiovascular disease (CVD) is a leading cause of mortality in women.
• The long-term effects of oophorectomy on CVD mortality require further investigation.

Purpose of the Study:

• To examine CVD mortality rates in women who underwent premenopausal oophorectomy.
• To assess the impact of estrogen treatment on CVD mortality following oophorectomy.

Main Methods:

• A long-term cohort study in Olmsted County, MN, included women undergoing unilateral or bilateral oophorectomy before natural menopause (1950-1987).
• Oophorectomy patients were age-matched with a control group of women who did not undergo oophorectomy.
• Mortality data for cardiovascular disease was analyzed for 1,274 unilateral oophorectomy, 1,091 bilateral oophorectomy, and 2,383 referent women.

Main Results:

• Unilateral oophorectomy was associated with reduced CVD mortality (HR, 0.82; P=0.04).
• Bilateral oophorectomy before age 45 significantly increased CVD mortality (HR, 1.44; P=0.04).
• This increased risk in bilateral oophorectomy patients was pronounced in those not receiving estrogen therapy (HR, 1.84; P=0.001) but not in estrogen-treated women (HR, 0.65; P=0.28).

Conclusions:

• Premenopausal bilateral oophorectomy before age 45 is linked to elevated cardiovascular mortality, especially cardiac mortality.
• Estrogen replacement therapy appears to reduce the increased cardiovascular mortality risk associated with bilateral oophorectomy.
• These findings highlight the importance of considering hormone therapy post-oophorectomy to mitigate cardiovascular risks.