Study: Removing ovaries before age 50 may increase the risk of chronic conditions for some women

Printer Friendly Page

Read the article that we reviewed

Contents

At a glance In-depth
Findings     Limitations                
Clinical trials Resources
Questions for your doctor  


STUDY AT A GLANCE

This study is about:

Whether there is a connection between women who had their ovaries removed before age 50 and an increased risk of common chronic conditions, such as depression, asthma, coronary artery disease, and .

Why is this study important?

Researchers want to better understand the risks and benefits of ovary removal before age 50. Preventing ovarian cancer is a benefit of this procedure. However, ovaries produce hormones and removing ovaries at a young age can increase the risk for other diseases. Women need to understand the benefits and risks of ovary removal in order to make informed decision about the procedure. For women with an average chance for developing ovarian cancer, the risks that result from losing these sex hormones may not outweigh the benefit. 

Study findings: 

  1. Women who had their ovaries removed before age 46 were at increased risk of depression, hyperlipidemia (high cholesterol and/or triglycerides in the blood), heart disease, coronary artery disease, arthritis, lung issues such as asthma and chronic obstructive pulmonary disease, and bone loss ().
  2. Women who had their ovaries removed between ages 46 and 49 were at increased risk for depression, anxiety, hyperlipidemia, diabetes, arthritis, and cancer (all types).
  3. Women who received estrogen therapy were able to reduce some of these increased risks. 

What does this mean for me?

While the results of this study suggest that having ovaries removed before age 50 may increase a woman’s risk of some chronic conditions, it is important to note that the women in this study were not at increased risk for ovarian cancer. Generally, more work needs to be done to confirm and understand these findings. Women should work with their doctors to weigh their personal risks for ovarian cancer and determine whether or not they want to remove their ovaries, and if so, at what age. Women should also speak with their healthcare team to decide if they are candidates for estrogen replacement therapy. 

Women diagnosed with breast cancer before age 50 meet national guidelines for genetic counseling and testing to see if they have an inherited mutation that increases breast and/or ovarian cancer risk. These guidelines recommend removing the ovaries and for women who have a mutation in or . Women with mutations in , , , and the genes associated with should consider removal of their ovaries.

Posted 11/1/16

Share your thoughts on this XRAYS article by taking our brief survey.
 

Reference

Rocca WA, Gazzuola-Rocca, L, Smith CY, et al, “Accelerated Accumulation of Multimorbidity After Oophrectomy: A Population-Based Cohort Study.” Mayo Clinic Proceedings. Published online first in 2016.  
 

Disclosure

FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

This article is relevant for:

Women under 50 years of age who have had or are considering removing their ovaries

This article is also relevant for:

Previvors

BRCA mutation carriers

People with a genetic mutation linked to cancer risk

Breast cancer survivors

Women under 45

Be part of XRAY:

Expert Guidelines Expert Guidelines

The National Comprehensive Cancer Network (NCCN) provides guidelines for management of gynecologic cancer risk in people with and mutations. 

Prevention 

  • Risk-reducing removal of ovaries and , (known as salpingo-oophorectomy) is recommended between ages 35-40 for and 40-45 for and upon completion of childbearing.
    • Research studies have shown that removing the ovaries can increase how long women with  mutations live. 
    • Women should talk with their doctors about the effects of early menopause and options for managing them.
  • Women should talk with their doctors about the risks and benefits of keeping or removing their uterus (hysterectomy), including:
    • Women with a  mutation have an increased risk for a rare form of aggressive uterine cancer; hysterectomy removes this risk. 
    • For women considering hormone replacement after surgery, the presence or absence of a uterus can affect the choice of hormones used.
      • Estrogen-only hormone replacement is less likely to increase the risk for breast cancer. However, estrogen-only hormone replacement increases the risk for uterine cancer. Women who still have their uterus are typically given estrogent and progesterone hormone replacement.
      • Adding progesterone to estrogen hormone replacement can protect against uterine cancer. However, the combination of these hormones may increase the risk for breast cancer than estrogen alone. 
    • Any medical history of fibroids or other uterine or cervicak issues may justify a hysterectomy. 
  • Oral contraceptives (birth control pills) have been shown to lower the risk for ovarian cancer in women with  mutations. Research on the affect of oral contraceptives on breast cancer risk has been mixed. Women should discuss the benefits and risks of oral contraceptives for lowering ovarian cancer risk with their doctors. 
  • Removal of the  only () is being studied as an option for lowering risk in high-risk women who are not ready to remove their ovaries. Studies on the effects of  have not been completed. At this time it is not known if  lowers the risk for ovarian cancer in high risk women. 
    • Consider enrolling in a research study looking at this procedure to lower cancer risk.

Screening

  • Routine ovarian cancer screening using transvaginal  and a  blood test has not shown benefit. However, some doctors still recommend screening, starting at age 30-35.
  • Women should be aware of the symptoms of gynecologic cancer and report abnormalities to their doctors. 

Updated: 02/05/2022

Expert Guidelines Expert Guidelines

The National Comprehensive Cancer Network (NCCN) provides guidelines for management of gynecologic cancer risk in people with inherited mutations linked to endometrial or ovarian cancer. We recommend that you speak with a genetics expert who can look at your personal and family history of cancer and help you to determine the best risk management plan. 

, or mutation

  • Consider risk-reducing salpingo-oophorectomy between the ages of 45-50.

  • Be aware of endometrial and ovarian cancer symptoms.
  • Consider endometrial biopsy every 1-2 years beginning at age 30-35.
  • For post-menopausal women, consider transvaginal after discussion with your doctor. 
  • Consider risk-reducing hysterectomy; discuss risk-reducing removal of ovaries and with your doctor (, , and ).
  • Discuss the benefits and risks of oral contraceptives.

mutation

  • Be aware of endometrial cancer symptoms.
  • Consider endometrial biopsy every 1-2 years beginning at age 35.
  • For post-menopausal women, consider transvaginal after discussion with your doctor. 
  • Consider risk-reducing hysterectomy. 

Updated: 12/27/2021

Expert Guidelines Expert Guidelines

The National Comprehensive Cancer Network (NCCN) provides cancer risk management guidelines for people with inherited mutations linked to cancer. In their guidelines on risk management for women at high risk for ovarian cancer, the NCCN panel states: 

  • Some research has shown that in women who have , hormone replacement does not negate the reduction in breast cancer risk associated with the surgery. However they caution those considering hormone replacement to consider the limitations of the existing research when making this decision.
  • Individuals who undergo hysterectomy at the time of are candidates for estrogen-only hormone replacement therapy, which has been associated with a lower risk for breast cancer compared with combination estrogen + progesterone therapy. Individuals with an intact uterus are not candidates for estrogen-only therapy due to the increased risk for endometrial cancer. 

The North American Menopause Society is a professional society of experts in the field of menopause.

  • In 2017 they released a position statement on hormone replacement therapy, which includes the following: 
    • Menopause symptoms and a variety of diseases are more likely to occur in women who have surgical menopause from ovary removal. These symptoms can have a major effect on quality of life and potential adverse effects on the cardiovascular system, bone, mood, sexual health and cognition, which have been shown in observational studies to be lessened by estrogen therapy. 
    • Unless contraindications are present, estrogen therapy is indicated for women who have removed both ovaries, to reduce their risk of sexual side effects, bone loss, heart disease and decline. For women who retain their uterus, endometrial protection (progesterone) is indicated.
  • Specific to women with or mutations who have removed their ovaries to lower their risk for cancer:
    • For women with or mutations who have not been diagnosed with breast there is some evidence suggesting that that hormone therapy use after does not increase the risk for breast cancer any further.
    • Considerations should be made about the benefits of estrogen to prevent health risks caused by surgical menopause.
    • Considerations should be made (based on a limited amount of data) about hormone therapy until age 52 with discussions about longer use based on the individual patient.
  • In 2018, they released a joint position statement with the International Society for the Study of Women's Sexual Health on management of genitourinary syndrome of menopause (GSM) in women with or at high risk for breast cancer, which included the following:
    • People with, or at high risk for breast cancer should discuss treatment options for GSM with their healthcare providers using a shared decision-making approach. 
    • For women diagnosed with breast cancer:
      • Vaginal moisturizers and lubricants are recommended as initial treatment options. 
      • Local (vaginal) hormone treatment may be considered for women for whom nonhormonal options do not work. Local therapy should be individualized, taking into account the risks of disease recurrence and severity of vaginal symptoms. 
      • Intravaginal estrogens in women on tamoxifen may be less of a concern than intravaginal estrogens in women on aromatase inhibitors. 
    • For high risk women without breast cancer who have undergone , vaginal hormone therapy is likely to be safe. 

Updated: 03/16/2022

Questions to Ask Questions to Ask Your Doctor

  • I I had breast cancer before age 50. Should I consider genetic testing to see if I am at increased risk of ovarian cancer?
  • How do I know if I am at increased risk for ovarian cancer?
  • I tested negative for a mutation in despite having breast cancer before age 50.  Should I be concerned about my ovarian cancer risk?
  • What are my options for preventing ovarian cancer or detecting it early?
  • I had my ovaries removed to reduce my risk for ovarian cancer. What steps can I take to prevent or reduce long-term complications?
  • Can you refer me to a menopause expert?

Open Clinical Trials Open Clinical Trials

The following are studies on menopause and menopause management for survivors and previvors:

Updated: 12/27/2021

Peer Support Peer Support

FORCE offers many peer support programs for people with inherited mutations. 

Updated: 03/12/2022

Find Experts Find Experts

Updated: 03/16/2022

IN DEPTH REVIEW OF RESEARCH

Study background:

There are differing opinions on whether or not women with average (1.5%) lifetime risk of ovarian cancer should have (removal of the ovaries) before menopause. is recommended for women with a high (up to 50% lifetime risk) likelihood of developing ovarian cancer due to a mutation in , or other gene associated with increased ovarian cancer risk, because the benefit of cancer prevention far outweighs the chance of other health problems. However, some women have their ovaries removed for other reasons. For example, women undergoing hysterectomy (removal of their uterus) for other reasons will sometimes have their ovaries removed at the same time. For many years, experts debated whether women with an average risk of ovarian cancer benefit from removing their ovaries, or if the risk of other complications is too high. Previous research from the same team found that “for most women without a cancer indication, the long-term risks of oophorectomy performed before menopause are greater than the benefits.” However, others have argued more research is needed.

Walter Rocca and colleagues from Mayo Clinic published work in 2016 in the journal Mayo Clinic Proceedings that provides more data on risks of before menopause.     

Researchers of this study wanted to know:

Does removing ovaries before age 50 increase a woman’s risk of common chronic conditions associated with aging?

Population(s) looked at in the study:

This study followed 1,653 women with intact ovaries and 1,653 women who had both ovaries removed before age 50 for about 14 years (some women were followed for a longer period and some for a shorter period). The oophorectomies were performed between January 1, 1988 and December 31, 2007. Study participants who had their ovaries removed did so while also having their uterus removed (hysterectomy) for reasons other than cancer treatment or managing cancer risk. Women who had their ovaries removed to help treat breast cancer or reduce their high genetic risk of cancer due to a mutation in were excluded from this study. 

Study findings: 

  1. Women who had their ovaries removed before age 46 were at increased risk of depression, hyperlipidemia (high cholesterol and/or triglycerides in the blood), heart disease, coronary artery disease, arthritis, lung issues such as asthma and chronic obstructive pulmonary disease, and bone loss ().
  2. Women who had their ovaries removed between ages 46 and 49 were at increased risk for depression, anxiety, hyperlipidemia, diabetes, arthritis, and cancer (all types).
  3. Women who received estrogen therapy were able to reduce some of these increased risks. 

Limitations:

It is very important to note that this study looked only at women with an average risk for ovarian cancer; it did not include women with increased risk of ovarian cancer (such as mutation carriers) or women who had their ovaries removed to reduce their risk of breast cancer. As such, these findings do not apply to these women where the benefits likely outweigh the risks.

The study had other limitations as well. The authors acknowledge a potential underestimation of some of the conditions that they looked at because some participants may not have had symptoms or did not request medical attention. Additionally, the researchers recognize that there may be a surveillance bias—the women who had their ovaries removed may have more contact with their health care providers after their surgery. Finally, some of the women in this study had their ovaries removed about 20 years ago when the surgeries and estrogen therapies were different.

Conclusions:

This study suggests that having an before age 50 may increase a woman’s risk of some chronic conditions, including heart disease, lung disease, coronary artery disease, anxiety, and depression. There are many reasons women with breast cancer or high risk for breast cancer may consider removal of their ovaries, such as reduction of breast cancer risk, treatment for breast cancer, and reduction of ovarian cancer risk associated with inherited mutations. All women should discuss the risks and benefits of with their health care providers to determine which choice is best for them. 

It is important to remember that national guidelines recommend removal of ovaries and after completion of childbearing for women with mutations in and . Women with mutations in , , , and the genes associated with are advised to consider removing their ovaries and to reduce their ovarian cancer risk. Women with inherited mutations in these genes or who are undergoing for other indications should be told of the long-term risks of ovary removal, but reminded that the benefits of preventing ovarian cancer far outweigh the risks of long-term complications.  

Women at average risk of ovarian cancer should speak to their health care provider about considering risk when presented with the option to remove their ovaries.

Posted 11/1/16

Share your thoughts on this XRAYS article by taking our brief survey.

Back to XRAY Home