Study: Removing ovaries before age 50 may increase the risk of chronic conditions for some women
Removal of ovaries and fallopian tubes prevents ovarian cancer, but it may come with other health risks. Experts recommend removal of ovaries and fallopian tubes in women at high risk for ovarian cancer due to inherited mutations in BRCA or other genes linked to ovarian cancer risk. For these high-risk women the benefit of ovarian cancer prevention outweighs the risk of long-term complications. Based on a recent study, some researchers feel that for women who are not at increased risk for cancer, the risk for some chronic conditions is too high to consider removal of both ovaries. (11/1/16)
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:
- 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 (osteoporosis).
- 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).
- Women who received 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 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
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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.
The National Comprehensive Cancer Network (NCCN) provides guidelines for the management of gynecologic cancer risk in people with BRCA1 and BRCA2 mutations.
Prevention
- Risk-reducing removal of ovaries and fallopian tubes, (known as risk-reducing salpingo-oophorectomy or ) is recommended between ages 35-40 for BRCA1 and 40-45 for BRCA2 and upon completion of childbearing.
- Research shows that removing the ovaries can increase survival for women with BRCA1 or BRCA2 mutations.
- 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 BRCA1 or BRCA2 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, although it increases the risk for uterine cancer. Women who still have their uterus are typically given hormone replacement with both estrogen and progesterone.
- Adding progesterone to estrogen hormone replacement can protect against uterine cancer. However, the combination of these hormones may increase the risk for breast cancer more than estrogen alone.
- A medical history of fibroids or other uterine or cervical issues may justify a hysterectomy.
- Oral contraceptives (birth control pills) have been shown to lower the risk for ovarian cancer in women with BRCA mutations. Research on the effect 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 fallopian tubes 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 salpingectomy are ongoing. Whether salpingectomy lowers the risk for ovarian cancer in high-risk women remains unknown.
- Consider enrolling in a research study looking at this procedure to lower cancer risk.
Screening
- There are no proven benefits to routine ovarian cancer screening using transvaginal and a blood test. These tests are not currently recommended.
- After RRSO, a very small risk remains for a related cancer known as primary peritoneal cancer (PPC). There is no effective screening for PPC after RRSO
- Women should be aware of the symptoms of gynecologic cancer and report abnormalities to their doctors, particularly if they persist for several weeks and are a change from normal. These symptoms can include:
- pelvic or abdominal pain
- bloating or distended belly
- difficulty eating
- feeling full sooner than normal
- increased urination or pressure to urinate
Updated: 01/29/2025
The National Comprehensive Cancer Network (NCCN) provides the following guidelines for the management of gynecologic cancer risk in people with inherited mutations that are 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.
BRIP1, RAD51C or RAD51D mutation
- Recommend risk-reducing salpingo-oophorectomy between the ages of 45-50.
Lynch syndrome
- Be aware of endometrial and ovarian cancer symptoms.
- Consider endometrial biopsy every 1-2 years beginning at ages 30-35.
- For postmenopausal women, consider transvaginal after discussion with your doctor.
- Consider risk-reducing hysterectomy; discuss risk-reducing removal of ovaries and fallopian tubes 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 postmenopausal women, consider transvaginal ultrasound after a discussion with your doctor.
- Consider risk-reducing hysterectomy.
Updated: 02/23/2023
The National Comprehensive Cancer Network (NCCN) has cancer risk management guidelines for people with inherited mutations linked to cancer. The NCCN panel's guidelines on risk management for women at high risk for ovarian cancer states:
- Some research shows that hormone replacement after RRSO does not negate the reduction in breast cancer risk associated with the surgery. However, the panel cautions those considering hormone replacement to consider the limitations of the existing research when making this decision.
- Individuals who undergo hysterectomy at the time of RRSO are candidates for estrogen-only hormone replacement therapy, which has been associated with a lower risk for breast cancer compared with combined estrogen and progesterone therapy. Individuals with an intact uterus are not candidates for estrogen-only therapy due to the increased risk of endometrial cancer.
The North American Menopause Society is a professional society of experts in the field of menopause.
- In 2017, the organization 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 for women who have removed both ovaries is indicated 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 BRCA1 or BRCA2 mutations who have removed their ovaries to lower their cancer risk:
- For women with BRCA1 or BRCA2 mutations who have not been diagnosed with breast cancer, some evidence suggests that hormone therapy after oophorectomy does not further increase the risk for breast cancer.
- Considerations should be made regarding the benefits of estrogen to prevent health risks caused by surgical menopause.
- Considerations should be made (based on limited data) about hormone therapy until age 52, with discussions about longer use based on the individual patient.
- In 2018, the organization released a joint position statement with the International Society for the Study of Women's Sexual Health regarding the management of genitourinary syndrome of menopause (GSM) in women who have or are at high risk for breast cancer, including 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 when nonhormonal options do not work. Local therapy should be individualized, taking into account the risk 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 RRSO, vaginal hormone therapy is likely to be safe.
Updated: 08/13/2024
- 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 BRCA 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?
The following studies of menopause and menopause management are for survivors and previvors.
- NCT04439370: Autonomic Regulation of Blood Pressure in Premature and Early Menopausal Women. This research studies how early menopause effects blood pressure.
- NCT03572153: A Mind-Body Intervention for Hot Flash Management. The main goal of this study is to test whether self-administered hypnosis can reduce hot flashes more effectively than self-administered white noise hypnosis over 6 weeks of home practice.
- NCT04821141: Phase IIB Trial of Bazedoxifene Plus Conjugated Estrogens. Women at increased risk for breast cancer who experience hot flashes will receive either bazedoxifene plus conjugated estrogens (similar to the drug Duavee) for 6 months or a control (no drug). Researchers will measure breast density with and needle biopsy that identifies biomarkers.
- NCT06112756: A Study to Learn About How Elinzanetant Works and How Safe it is in Women Having Sleep Disturbances Associated with Menopause (NIRVANA). This study looks at treatment the safety and efficacy of treatment with Elinzanetant for symptoms like hot flashes caused by hormonal changes associated with menopause that can impact sleep disturbances.
Updated: 02/03/2024
FORCE offers many peer support programs for people with inherited mutations.
- Our Message Boards allow people to connect with others who share their situation. Once registered, you can post on the Diagnosed With Cancer board to connect with other people who have been diagnosed.
- Our Peer Navigation Program will match you with a volunteer who shares your mutation and situation.
- Our moderated, private Facebook group allows you to connect with other community members 24/7.
- Check out our virtual and in-person support meeting calendar.
- Join one of our Zoom community group meetings.
Updated: 08/06/2022
The following resources can help you locate an expert near you or via telehealth.
Finding menopause experts
- The Menopause Society has a tool to help you find a qualified menopause expert in your area.
Related experts
Other experts may manage some symptoms of menopause. People experiencing menopause symptoms may benefit from a consultation with the following experts:
Sexual health experts
- The Sexual Medicine Society of North America has a search tool to find experts in your area who provide sexual health care services.
- The American Association of Sexuality Educators, Counselors and Therapists maintains a tool to help people find a sexual health expert near them.
Acupuncture experts
- The National Certification Commission for Acupuncture and Oriental Medicine has a searchable directory of licensed acupuncturists.
Sleep experts
- The American Academy of Sleep Medicine maintains the public-facing website sleepeducation.org, which includes a section on finding a sleep center by location.
Bone density experts
- The Bone Health and Osteoporosis Foundation has a searchable database for finding experts.
Other ways to find experts
- Register for the FORCE Message Boards and post on the Find a Specialist board to connect with other people who share your situation.
- National Cancer Institute (NCI)-designated comprehensive cancer centers have specialists to manage the symptoms and side effects of cancer prevention or treatment.
Updated: 09/11/2024
Who covered this study?
Science Daily
Ovarian removal to prevent ovarian cancer should not be an option for premenopausal women, research finds
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Ovarian Cancer News Today
Preventative ovary removal in premenopausal women should be discontinued, researchers warn
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CNN
Study: Removing both ovaries speeds aging in premenopausal women
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