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A recent publication reported a study conducted by the Nurses’ Health Study (NHS) which tried to compare the impacts of bilateral oophorectomy and of ovarian conservation in benign gynecologic cases where hysterectomy was carried out [1]. The research was a prospective 28-year, long-term observational study, which continued the analysis of the previous NHS research, already reviewed in 2008 with a follow-up period of 24 years. In the results of the first-stage research, it was concluded that bilateral oophorectomy during hysterectomy would decrease the risks of ovarian and breast cancer but, on the other hand, it would be accompanied by an increase in the incidences of coronary heart disease, stroke, lung cancer, total cancers, and mortality from all causes. The previous report also showed that, over a 24-year follow-up period, oophorectomy was associated with a 12% increase in all-cause mortality and significant increases in the risk of death from coronary artery disease (28%), lung cancer (31%), and all cancers (17%). The risk of death was the highest for women who had surgery before they reached 50 years old; they had a 40% increase in the risk of all-cause mortality. Oophorectomy was associated with a 28% increase in risk of death from coronary artery disease in all women, whether they used estrogens or not. The study also found that women who had oophorectomy without estrogen replacement had twice the risk of myocardial infarction compared with age-matched premenopausal women. The surgery was associated with an 85% increase in the risk of stroke in women who did not use hormones after menopause.

 

In the further analysis of updated data from the NHS, the authors focused on all-cause and cause-specific mortality and specifically examined bilateral oophorectomy compared with ovarian conservation in women aged 60 years or older to determine whether there was an age at which oophorectomy conferred a survival benefit. Subgroup analysis was also conducted in the women who, from the authors’ hypothesis, would experience a more elevated mortality after bilateral oophorectomy, including women who underwent hysterectomy prior to age 50 years who never used estrogen therapy; women with known risk factors for cardiovascular disease; women with a family history of breast or ovarian cancer; and women who smoked. The aim of the study was to report long-term mortality after oophorectomy ([i]n[/i] = 16,914) or ovarian conservation ([i]n[/i] = 13,203) at the time of hysterectomy. The study was a prospective cohort study involving 30,117 participants in the NHS undergoing hysterectomy for benign disease. 

 

The result of the study showed that 2850 (16.8%) women with bilateral oophorectomy died from all causes compared with 1749 (13.3%) women who had ovarian conservation. Forty-four women with ovarian conservation and four with oophorectomy died from ovarian cancer over 28 years of follow-up (hazard ratio (HR) 0.06, 95% confidence interval (CI) 0.02–0.17). Oophorectomy was associated with higher mortality from coronary heart disease (multivariable HR 1.23, 95% CI 1.00–1.52), lung cancer (HR 1.29, 95% CI 1.04–1.61), colorectal cancer (HR 1.49, 95% CI 1.02–2.18), total cancers (HR 1.16, 95% CI 1.05–1.29), and all causes (HR 1.13, 95% CI 1.06–1.21). The results were not statistically different from any of the mortality outcomes when stratified by age at hysterectomy. The authors also found that, even though the number was insufficient to analyze some cause-specific deaths in women aged 60 years and older, the risk estimates associated with bilateral oophorectomy remained elevated for all-cause mortality, total cancer mortality, and cardiovascular disease mortality in these older women. Among women with hysterectomy prior to the age of 50 years, oophorectomy was associated with significant increases in risk of deaths from coronary heart disease, colorectal cancer, total cancers, and all causes. The conclusions of their research were that bilateral oophorectomy was associated with increasing mortality in women aged younger than 50 years old who had never used estrogen therapy and that oophorectomy was associated with increasing survival in no analysis or age group.

Author(s)

  • M. Sjarief Darmasetiawan
    Senior Consultant of Division of Reproductive Endocrinology and Fertility, Department of Obstetrics and Gynecology, Gatot Soebroto Central Army Hospital, Faculty of Medicine of Pembangunan National Veteran University, Jakarta, Indonesia; Chairman of Board of Trustees of Indonesian Menopause Society (PERMI)

Citations

  1. Parker WH, Broder MS, Chang E, et al. Ovarian conservation at the time of hysterectomy and long-term health outcomes in the Nurses Health Study. Obstet Gynecol 2009;113:1027-37.
    http://www.ncbi.nlm.nih.gov/pubmed/19384117
  2. Brown S. Press release. Further evidence in favour of HRT in early menopause. Menopause Int; November 2, 2006.
    http://www.thebms.org.uk/newsitem.php
  3. Shuster LT, Gostout BS, Grossardt BR, Rocca WA. Prophylactic oophorectomy in premenopausal women and long-term health. Menopause Int 2008;14:11116
    http://www.ncbi.nlm.nih.gov/pubmed/18714076
  4. Koushik A, Parent ME, Siemiatyck J, et al. Characteristics of menstruation and pregnancy and the risk of lung cancer in women. Int J Cancer 2009;125:242833
    http://www.ncbi.nlm.nih.gov/pubmed/19585503
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    http://www.ncbi.nlm.nih.gov/pubmed/15929081
  6. Rocca WA, Grossardt BR, de Andrade M, Malkasian GD, Melton LJ 3rd. Survival patterns after oophorectomy in premenopausal women: a population-based cohort study. Lancet Oncol 2006;7:821.
    http://www.ncbi.nlm.nih.gov/pubmed/17012044
  7. Rivera CM, Grossardt BR, Rhodes DJ, et al. Increased cardiovascular mortality after early bilateral oophorectomy. Menopause 2009;16:15-23.
    http://www.ncbi.nlm.nih.gov/pubmed/19034050
  8. Atsma F, Bartelink ML, Grobbee DE, van der Schouw YT. Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis. Menopause 2006;13:265-79
    http://www.ncbi.nlm.nih.gov/pubmed/16645540
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