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Walter A. Rocca - One of the best experts on this subject based on the ideXlab platform.
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CKD in Patients with Bilateral Oophorectomy.
Clinical journal of the American Society of Nephrology : CJASN, 2018Co-Authors: Andrea G. Kattah, Brandon R Grossardt, Liliana Gazzuola Rocca, Carin Y. Smith, Vesna D. Garovic, Walter A. RoccaAbstract:Background and objectives Premenopausal women who undergo bilateral Oophorectomy are at a higher risk of morbidity and mortality. Given the potential benefits of estrogen on kidney function, we hypothesized that women who undergo bilateral Oophorectomy are at higher risk of CKD. Design, setting, participants, & measurements We performed a population-based cohort study of 1653 women residing in Olmsted County, Minnesota who underwent bilateral Oophorectomy before age 50 years old and before the onset of menopause from 1988 to 2007. These women were matched by age (±1 year) to 1653 referent women who did not undergo Oophorectomy. Women were followed over a median of 14 years to assess the incidence of CKD. CKD was primarily defined using eGFR (eGFR 90 days apart). Hazard ratios were derived using Cox proportional hazards models, and absolute risk increases were derived using Kaplan–Meier curves at 20 years. All analyses were adjusted for 17 chronic conditions present at index date, race, education, body mass index, smoking, age, and calendar year. Results Women who underwent bilateral Oophorectomy had a higher risk of eGFR-based CKD (211 events for Oophorectomy and 131 for referent women; adjusted hazard ratio, 1.42; 95% confidence interval, 1.14 to 1.77; absolute risk increase, 6.6%). The risk was higher in women who underwent Oophorectomy at age ≤45 years old (110 events for Oophorectomy and 60 for referent women; adjusted hazard ratio, 1.59; 95% confidence interval, 1.15 to 2.19; absolute risk increase, 7.5%). Conclusions Premenopausal women who undergo bilateral Oophorectomy, particularly those ≤45 years old, are at higher risk of developing CKD, even after adjusting for multiple chronic conditions and other possible confounders present at index date. Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_10_11_CJASNPodcast_18_1
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Bilateral Oophorectomy and Accelerated Aging: Cause or Effect?
The journals of gerontology. Series A Biological sciences and medical sciences, 2017Co-Authors: Walter A. Rocca, Brandon R Grossardt, Lynne T. Shuster, Liliana Gazzuola Rocca, Carin Y. Smith, Stephanie S. Faubion, James L. Kirkland, Elizabeth A. Stewart, Virginia M. MillerAbstract:Background The cause-effect relationship between bilateral Oophorectomy and accelerated aging remains controversial. We conducted new analyses to further address this controversy. Methods The Rochester Epidemiology Project records-linkage system was used to identify all premenopausal women who underwent bilateral Oophorectomy for a noncancerous condition before age 50 years between 1988 and 2007 in Olmsted County, MN. Each woman was randomly matched to a referent woman born in the same year (±1 year) who had not undergone bilateral Oophorectomy. We studied the rate of accumulation of 18 common chronic conditions over a median of approximately 14 years of follow-up (historical cohort study). Analyses were restricted to women free of any of the 18 chronic conditions at the time of Oophorectomy (or index date). Results After adjustments for race/ethnicity, education, body mass index, smoking, and age and calendar year at the index date, women who underwent Oophorectomy before age 46 years experienced an accelerated rate of accumulation of the 18 chronic conditions considered together (hazard ratio = 1.24; 95% confidence interval: 1.12, 1.37; p < .001). The single-year incidence rate of new conditions was most different in the first 6 years after Oophorectomy but the difference attenuated thereafter. Findings did not vary by surgical indication for the Oophorectomy. Conclusions Bilateral Oophorectomy is associated with a higher risk of multimorbidity among women who did not have any of the 18 selected conditions at baseline. The association did not vary by surgical indication for Oophorectomy. Our findings suggest that bilateral Oophorectomy is causally linked to accelerated aging.
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Hysterectomy, Oophorectomy, Estrogen, and the Risk of Dementia
Neuro-degenerative diseases, 2012Co-Authors: Walter A. Rocca, Brandon R Grossardt, Lynne T. Shuster, Elizabeth A. StewartAbstract:Background: The long-term cognitive effects of hysterectomy and Oophorectomy remain controversial. Objective: To explore the association of hysterectomy and Oophorectomy with the subsequent risk of cognitive impairment or dementia. Methods: We combined the results from two cohort studies graphically and conducted additional analyses. Results: Combined results from the Mayo Clinic Cohort Study of Oophorectomy and Aging and from a Danish nationwide cohort study suggest that the extent of gynecologic surgery may correlate with a stepwise increase in the risk of cognitive impairment or dementia. Compared with women with no gynecologic surgeries, the risk of cognitive impairment or dementia was increased in women who had hysterectomy alone, further increased in women who had hysterectomy with unilateral Oophorectomy, and further increased in women who had hysterectomy with bilateral Oophorectomy. The risk increased with younger age at the time of the surgery. Conclusion: We hypothesize that both hysterectomy and Oophorectomy may have harmful brain effects via direct endocrinological mechanisms or other more complex mechanisms. Estrogen deficiency appears to play a key role in these associations, and estrogen therapy may partly offset the negative effects of the surgeries.
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Prophylactic bilateral Oophorectomy jeopardizes long-term health
Sexuality Reproduction and Menopause, 2010Co-Authors: Lynne T. Shuster, Brandon R Grossardt, Bobbie S. Gostout, Walter A. RoccaAbstract:Disclosures The authors report no commercial or financial relationships relevant to this article. Approximately 4.5 million women in the United States have undergone bilateral Oophorectomy before reaching natural menopause, yet accumulating evidence indicates that surgical removal of the ovaries increases the risk of long-term deleterious outcomes. Bilateral Oophorectomy refers to the simultaneous or sequential removal of both ovaries. The surgery may be performed for a malignancy, benign disease of the ovaries (eg, endometriosis or a cyst), or prophylaxis against cancer. Oophorectomy is most commonly performed along with hysterectomy. Although age-adjusted rates of prophylactic Oophorectomy have decreased over time, the proportion of hysterectomies accompanied by prophylactic Oophorectomy in the United States has actually increased, from 29% in 1979 to 45% in 2004. Women who experience the premature loss of ovarian function as a result of bilateral Oophorectomy performed before the onset of natural menopause are at increased risk for death, cardiovascular disease, stroke, lung cancer, cognitive impairment or dementia, parkinsonism, osteoporosis, depressive or anxiety symptoms, and sexual dysfunction. The risks appear to be greater for women who are younger at the time of Oophorectomy. Some studies, however, show that even women who underwent Oophorectomy after the onset of natural menopause had an increased risk of deleterious outcomes. Health care practitioners who advise women about bilateral Oophorectomy need to be aware of the riskbenefit balance and counsel patients accordingly. For premenopausal women who are not at markedly increased risk for ovarian or breast cancer, prophylactic Oophorectomy should be discouraged (FIGURE).
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Effect of bilateral Oophorectomy on women's long-term health
Women's health (London England), 2009Co-Authors: William H Parker, Donna Shoupe, Vanessa L. Jacoby, Walter A. RoccaAbstract:Bilateral Oophorectomy at the time of hysterectomy for benign disease is commonly practiced in order to prevent the subsequent development of ovarian cancer or other ovarian pathology that might require additional surgery. At present, bilateral Oophorectomy is performed in 78% of women aged between 45 and 64 years having a hysterectomy, and a total of approximately 300,000 prophylactic oophorectomies are performed in the USA every year. Estrogen deficiency resulting from pre- and post-menopausal oophorectomies has been associated with higher risks of coronary heart disease, stroke, hip fracture, Parkinsonism, dementia, cognitive impairment, depression and anxiety in many studies. While ovarian cancer accounts for 14,800 deaths per year in the USA, coronary heart disease accounts for 350,000 deaths per year. In addition, 100,000 cases of dementia may be attributable annually to prior bilateral Oophorectomy. At present, observational studies suggest that bilateral Oophorectomy may do more harm than good. In...
Joann E Manson - One of the best experts on this subject based on the ideXlab platform.
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Salpingo-Oophorectomy at the Time of Benign Hysterectomy: A Systematic Review.
Obstetrics and gynecology, 2017Co-Authors: William H Parker, Michael S Broder, Jonathan S Berek, Joann E MansonAbstract:The authors of the systematic review of benefits and risks of salpingo-Oophorectomy did an excellent job of identifying and reviewing the literature on this important topic.1 We are perplexed, however, by the approach used for grading the evidence. Suggesting that bilateral salpingo-Oophorectomy to
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long term mortality associated with Oophorectomy compared with ovarian conservation in the nurses health study
Obstetrics & Gynecology, 2013Co-Authors: William H Parker, Diane Feskanich, Michael S Broder, Eunice Chang, Donna Shoupe, Cindy Farquhar, Jonathan S Berek, Joann E MansonAbstract:OBJECTIVE: To report long-term mortality after Oophorectomy or ovarian conservation at the time of hysterectomy in subgroups of women based on age at the time of surgery, use of estrogen therapy, presence of risk factors for coronary heart disease, and length of follow-up. METHODS: This was a prospective cohort study of 30,117 Nurses’ Health Study participants undergoing hysterectomy for benign disease. Multivariable adjusted hazard ratios for death from coronary heart disease, stroke, breast cancer, epithelial ovarian cancer, lung cancer, colorectal cancer, total cancer, and all causes were determined comparing bilateral Oophorectomy (n516,914) with ovarian conservation (n513,203). RESULTS: Over 28 years of follow-up, 16.8% of women with hysterectomy and bilateral Oophorectomy died from all causes compared with 13.3% of women who had ovarian conservation (hazard ratio 1.13, 95% confidence interval 1.06–1.21). Oophorectomy was associated with a lower risk of death from ovarian cancer (four women with Oophorectomy compared with 44 women with ovarian conservation) and, before age 47.5 years, a lower risk of death from breast cancer. However, at no age was Oophorectomy associated with a lower risk of other cause-specific or all-cause mortality. For women younger than 50 years at the time of hysterectomy, bilateral Oophorectomy was associated with significantly increased mortality in women who had never used estrogen therapy but not in past and current users: assuming a 35-year lifespan after Oophorectomy: number needed to harm for all-cause death58, coronary heart disease death533, and lung cancer death550. CONCLUSIONS: Bilateral Oophorectomy is associated with increased mortality in women aged younger than 50 years who never used estrogen therapy and at no age is Oophorectomy associated with increased survival.
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Oophorectomy hormone therapy and subclinical coronary artery disease in women with hysterectomy the women s health initiative coronary artery calcium study
Menopause, 2008Co-Authors: Matthew A Allison, Joann E Manson, Robert Langer, Jeffrey J Carr, Jacques E Rossouw, Mary Pettinger, Lawrence S Phillips, Barbara B Cochrane, Charles B Eaton, Philip GreenlandAbstract:Objective: Surgical menopause has been associated with an increased risk of coronary heart disease events. In this study, we aimed to determine the associations between coronary artery calcium (CAC) and hysterectomy, Oophorectomy, and hormone therapy use with a focus on the duration of menopause for which there was no hormone therapy use. Design: In a substudy of the Women's Health Initiative placebo-controlled trial of conjugated equine estrogens (0.625 mg/d), we measured CAC by computed tomography 1.3 years after the trial was stopped. Participants included 1,064 women with previous hysterectomy, aged 50 to 59 years at baseline. The mean trial period was 7.4 years. Imaging was performed at a mean of 1.3 years after the trial was stopped. Results: Mean age was 55.1 years at randomization and 64.8 years at CAC measurement. In the overall cohort, there were no significant associations between bilateral Oophorectomy, years since hysterectomy, years since hysterectomy without taking hormone therapy (HT), years since bilateral Oophorectomy, and years of HT use before Women's Health Initiative enrollment and the presence of CAC. However, there was a significant interaction between bilateral Oophorectomy and prerandomization HT use for the presence of any CAC (P = 0.05). When multivariable analyses were restricted to women who reported no previous HT use, those with bilateral Oophorectomy had an odds ratio of 2.0 (95% CI: 1.2-3.4) for any CAC compared with women with no history of Oophorectomy, whereas among women with unilateral or partial Oophorectomy, the odds of any CAC was 1.7 (95% CI: 1.0-2.8). Among women with bilateral Oophorectomy, HT use within 5 years of Oophorectomy was associated with a lower prevalence of CAC. Conclusions: Among women with previous hysterectomy, subclinical coronary artery disease was more prevalent among those with Oophorectomy and no prerandomization HT use, independent of traditional cardiovascular disease risk factors. The results suggest that factors related to Oophorectomy and the absence of estrogen treatment in oophorectomized women may be related to coronary heart disease.
Kelly A. Metcalfe - One of the best experts on this subject based on the ideXlab platform.
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effect of Oophorectomy on survival after breast cancer in brca1 and brca2 mutation carriers
JAMA Oncology, 2015Co-Authors: Charmaine Kimsing, Kelly A. Metcalfe, Nadine Tung, Henry T. Lynch, William D Foulkes, Olufunmilayo I Olopade, Andrea Eisen, Barry P Rosen, Carrie SnyderAbstract:Importance Women who carry a germline mutation in either the BRCA1 or BRCA2 gene face a lifetime risk of breast cancer of up to 70%, and once they receive a diagnosis of breast cancer, they face high risks of both second primary breast and ovarian cancers. Preventive bilateral salpingo-Oophorectomy is recommended to women with a BRCA mutation at age 35 years or thereafter to prevent breast and ovarian cancer, but it is unclear whether Oophorectomy has an impact on survival in women with BRCA -associated breast cancer. Objective To estimate the impact of Oophorectomy on survival in women with breast cancer with a BRCA1 or BRCA2 mutation. Design, Setting, and Participants Retrospective analysis of patients selected by pedigree review of families who received counseling at 1 of 12 participating clinical genetics centers. Patients were 676 women with stage I or II breast cancer and a BRCA1 or BRCA2 mutation who were observed for up to 20 years after receiving a diagnosis between 1975 and 2008. Survival experience was compared for women who did and who did not undergo Oophorectomy. Main Outcomes and Measures In all analyses, the primary end point was death due to breast cancer. Results Of the 676 women, 345 underwent Oophorectomy after the diagnosis of breast cancer and 331 retained both ovaries. The 20-year survival for the entire patient cohort was 77.4%. The adjusted hazard ratio for death attributed to breast cancer in women who underwent Oophorectomy was 0.38 (95% CI, 0.19-0.77; P = .007) for BRCA1 carriers and 0.57 (95% CI, 0.23-1.43; P = .23) for BRCA2 carriers. The hazard ratio for breast cancer–specific mortality was 0.76 (95% CI, 0.32-1.78; P = .53) for women with estrogen receptor–positive breast cancer and 0.07 (95% CI, 0.01-0.51; P = .009) for women with estrogen receptor–negative breast cancer. Conclusions and Relevance Oophorectomy is associated with a decrease in mortality in women with breast cancer and a BRCA1 mutation. Women with estrogen receptor–negative breast cancer and a BRCA1 mutation should undergo Oophorectomy shortly after diagnosis.
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the impact of prophylactic salpingo Oophorectomy on quality of life and psychological distress in women with a brca mutation
Psycho-oncology, 2013Co-Authors: Amy Finch, Kelly A. Metcalfe, Rochelle Demsky, Laurie Elit, C Springate, Jaclyn Chiang, John Mclaughlin, Mary Jane Esplen, Joan MurphyAbstract:OBJECTIVES The objective of this study was to measure the impact of prophylactic salpingo-Oophorectomy on health-related quality of life and psychological distress in women. METHODS Women who underwent prophylactic salpingo-Oophorectomy between August 20, 2003 and June 26, 2008 because of a BRCA1 or BRCA2 mutation were invited to participate. Participants completed three questionnaires (SF-12(®) Health Survey, Brief Symptom Inventory and the Impact of Events Scale) before prophylactic surgery and again 1 year after surgery. Measures of health-related quality of life, of general psychological distress and of ovarian cancer worry before and after surgery were compared. RESULTS Few women who underwent salpingo-Oophorectomy experienced a worsening in physical or mental health functioning after salpingo-Oophorectomy. On average, women experienced less ovarian cancer-specific worry after surgery; 34.3% experienced moderate to severe ovarian cancer-specific distress before surgery, compared with 18.6% after surgery. CONCLUSIONS For most women, physical and mental health-related quality of life did not deteriorate after prophylactic salpingo-Oophorectomy, and they were less worried about ovarian cancer. A subset of women continued to experience moderate to severe cancer-specific distress. Identification of these women is important in order to provide continued counseling and support.
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the impact of prophylactic salpingo Oophorectomy on menopausal symptoms and sexual function in women who carry a brca mutation
Gynecologic Oncology, 2011Co-Authors: Amy Finch, Kelly A. Metcalfe, Rochelle Demsky, Joan Murphy, J K Chiang, Laurie Elit, John R Mclaughlin, C Springate, Bruce R RosenAbstract:Abstract Objective Prophylactic salpingo-Oophorectomy is recommended to women who carry a BRCA1 or BRCA2 mutation to reduce the risks of breast, ovarian and fallopian tube cancer. We measured the impact of prophylactic salpingo-Oophorectomy on menopausal symptoms and sexual functioning in women with a BRCA mutation. Methods Women who underwent prophylactic salpingo-Oophorectomy between October 1, 2002 and June 26, 2008 for a known BRCA1 or BRCA2 mutation were invited to participate. Participants completed questionnaires before prophylactic surgery and again one year after surgery. Measures of sexual functioning and menopausal symptoms before and after surgery were compared. Satisfaction with the decision to undergo prophylactic salpingo-Oophorectomy was evaluated. Results 114 women who underwent prophylactic surgery completed questionnaires before and one year after surgery. Subjects who were premenopausal at the time of surgery ( n =75) experienced a significant worsening of vasomotor symptoms (hot flashes, night sweats and sweating) and a decline in sexual functioning (desire, pleasure, discomfort and habit). The increase in vasomotor symptoms and the decline in sexual functioning were mitigated by HRT, but symptoms did not return to pre-surgical levels. HRT decreased vaginal dryness and dyspareunia; however, the decrease in sexual pleasure was not alleviated by HRT. Satisfaction with the decision to undergo prophylactic salpingo-Oophorectomy remained high regardless of increased vasomotor symptoms and decreased sexual function. Conclusions Women who undergo prophylactic salpingo-Oophorectomy prior to menopause experience an increase in vasomotor symptoms and a decrease in sexual functioning. These symptoms are improved by HRT, but not to pre-surgical levels.
William H Parker - One of the best experts on this subject based on the ideXlab platform.
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Indications for Oophorectomy and Adnexectomy
Hysterectomy, 2017Co-Authors: William H ParkerAbstract:Oophorectomy is associated with decreased long-term health outcomes and ovarian conservation should be considered in many woman having pelvic surgery. Oophorectomy is indicated for women with an adnexal mass that is suspicious for malignancy or for a mass that increases in size or complexity when monitored with serial sonography. Adnexal torsion can usually be treated with de-torsion rather than adnexectomy. Oophorectomy decreases the likelihood of repeat surgery in women with severe, symptomatic endometriosis.
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Salpingo-Oophorectomy at the Time of Benign Hysterectomy: A Systematic Review.
Obstetrics and gynecology, 2017Co-Authors: William H Parker, Michael S Broder, Jonathan S Berek, Joann E MansonAbstract:The authors of the systematic review of benefits and risks of salpingo-Oophorectomy did an excellent job of identifying and reviewing the literature on this important topic.1 We are perplexed, however, by the approach used for grading the evidence. Suggesting that bilateral salpingo-Oophorectomy to
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long term mortality associated with Oophorectomy compared with ovarian conservation in the nurses health study
Obstetrics & Gynecology, 2013Co-Authors: William H Parker, Diane Feskanich, Michael S Broder, Eunice Chang, Donna Shoupe, Cindy Farquhar, Jonathan S Berek, Joann E MansonAbstract:OBJECTIVE: To report long-term mortality after Oophorectomy or ovarian conservation at the time of hysterectomy in subgroups of women based on age at the time of surgery, use of estrogen therapy, presence of risk factors for coronary heart disease, and length of follow-up. METHODS: This was a prospective cohort study of 30,117 Nurses’ Health Study participants undergoing hysterectomy for benign disease. Multivariable adjusted hazard ratios for death from coronary heart disease, stroke, breast cancer, epithelial ovarian cancer, lung cancer, colorectal cancer, total cancer, and all causes were determined comparing bilateral Oophorectomy (n516,914) with ovarian conservation (n513,203). RESULTS: Over 28 years of follow-up, 16.8% of women with hysterectomy and bilateral Oophorectomy died from all causes compared with 13.3% of women who had ovarian conservation (hazard ratio 1.13, 95% confidence interval 1.06–1.21). Oophorectomy was associated with a lower risk of death from ovarian cancer (four women with Oophorectomy compared with 44 women with ovarian conservation) and, before age 47.5 years, a lower risk of death from breast cancer. However, at no age was Oophorectomy associated with a lower risk of other cause-specific or all-cause mortality. For women younger than 50 years at the time of hysterectomy, bilateral Oophorectomy was associated with significantly increased mortality in women who had never used estrogen therapy but not in past and current users: assuming a 35-year lifespan after Oophorectomy: number needed to harm for all-cause death58, coronary heart disease death533, and lung cancer death550. CONCLUSIONS: Bilateral Oophorectomy is associated with increased mortality in women aged younger than 50 years who never used estrogen therapy and at no age is Oophorectomy associated with increased survival.
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Effect of bilateral Oophorectomy on women's long-term health
Women's health (London England), 2009Co-Authors: William H Parker, Donna Shoupe, Vanessa L. Jacoby, Walter A. RoccaAbstract:Bilateral Oophorectomy at the time of hysterectomy for benign disease is commonly practiced in order to prevent the subsequent development of ovarian cancer or other ovarian pathology that might require additional surgery. At present, bilateral Oophorectomy is performed in 78% of women aged between 45 and 64 years having a hysterectomy, and a total of approximately 300,000 prophylactic oophorectomies are performed in the USA every year. Estrogen deficiency resulting from pre- and post-menopausal oophorectomies has been associated with higher risks of coronary heart disease, stroke, hip fracture, Parkinsonism, dementia, cognitive impairment, depression and anxiety in many studies. While ovarian cancer accounts for 14,800 deaths per year in the USA, coronary heart disease accounts for 350,000 deaths per year. In addition, 100,000 cases of dementia may be attributable annually to prior bilateral Oophorectomy. At present, observational studies suggest that bilateral Oophorectomy may do more harm than good. In...
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Elective Oophorectomy for benign gynecological disorders.
Menopause (New York N.Y.), 2007Co-Authors: Donna Shoupe, William H Parker, Michael S Broder, Cindy Farquhar, Zhimei Liu, Jonathan S BerekAbstract:To review the risks and benefits of elective Oophorectomy and to make a clinical recommendation for an appropriate age when benefits of this procedure outweigh the risks. The risks and benefits of Oophorectomy as detailed in published articles are reviewed with regard to quality-of-life issues and mortality outcomes in oophorectomized versus non-oophorectomized women from five diseases linked to ovarian hormones (coronary heart disease, ovarian cancer, breast cancer, stroke, and hip fracture). Numerous reports link Oophorectomy to higher rates of cardiovascular disease, osteoporosis, hip fractures, dementia, short-term memory impairment, decline in sexual function, decreased positive psychological well-being, adverse skin and body composition changes, and adverse ocular changes, as well as more severe hot flushes and urogenital atrophy. The potential benefits associated with Oophorectomy include prevention of ovarian cancer, a decline in breast cancer risk, and a reduced risk of pelvic pain and subsequent ovarian surgery. In our study of long-term mortality after Oophorectomy using Markov modeling, preservation of ovaries until women are at least aged 65 years was associated with higher survival rates. For women between ages 50 and 54 with hysterectomy and ovarian preservation, the probability of surviving to age 80 was 62% versus 54% if Oophorectomy was performed. This 8% difference in survival is primarily due to fewer women dying from cardiovascular heart disease and/or hip fracture. This survival advantage far outweighs the 0.47% increased mortality rate from ovarian cancer prevented by Oophorectomy. If surgery occurred between ages 55 and 59, the survival advantage was 4%. After age 64 there were no significant differences in survival rates. Prior literature supports our conclusion of a benefit over risk for ovarian conservation. Elective Oophorectomy is associated with short-and long-term health consequences that merit serious consideration. For women with an average risk of ovarian cancer, ovarian conservation until at least age 65 seems to benefit long-term survival.
Brandon R Grossardt - One of the best experts on this subject based on the ideXlab platform.
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CKD in Patients with Bilateral Oophorectomy.
Clinical journal of the American Society of Nephrology : CJASN, 2018Co-Authors: Andrea G. Kattah, Brandon R Grossardt, Liliana Gazzuola Rocca, Carin Y. Smith, Vesna D. Garovic, Walter A. RoccaAbstract:Background and objectives Premenopausal women who undergo bilateral Oophorectomy are at a higher risk of morbidity and mortality. Given the potential benefits of estrogen on kidney function, we hypothesized that women who undergo bilateral Oophorectomy are at higher risk of CKD. Design, setting, participants, & measurements We performed a population-based cohort study of 1653 women residing in Olmsted County, Minnesota who underwent bilateral Oophorectomy before age 50 years old and before the onset of menopause from 1988 to 2007. These women were matched by age (±1 year) to 1653 referent women who did not undergo Oophorectomy. Women were followed over a median of 14 years to assess the incidence of CKD. CKD was primarily defined using eGFR (eGFR 90 days apart). Hazard ratios were derived using Cox proportional hazards models, and absolute risk increases were derived using Kaplan–Meier curves at 20 years. All analyses were adjusted for 17 chronic conditions present at index date, race, education, body mass index, smoking, age, and calendar year. Results Women who underwent bilateral Oophorectomy had a higher risk of eGFR-based CKD (211 events for Oophorectomy and 131 for referent women; adjusted hazard ratio, 1.42; 95% confidence interval, 1.14 to 1.77; absolute risk increase, 6.6%). The risk was higher in women who underwent Oophorectomy at age ≤45 years old (110 events for Oophorectomy and 60 for referent women; adjusted hazard ratio, 1.59; 95% confidence interval, 1.15 to 2.19; absolute risk increase, 7.5%). Conclusions Premenopausal women who undergo bilateral Oophorectomy, particularly those ≤45 years old, are at higher risk of developing CKD, even after adjusting for multiple chronic conditions and other possible confounders present at index date. Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_10_11_CJASNPodcast_18_1
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Bilateral Oophorectomy and Accelerated Aging: Cause or Effect?
The journals of gerontology. Series A Biological sciences and medical sciences, 2017Co-Authors: Walter A. Rocca, Brandon R Grossardt, Lynne T. Shuster, Liliana Gazzuola Rocca, Carin Y. Smith, Stephanie S. Faubion, James L. Kirkland, Elizabeth A. Stewart, Virginia M. MillerAbstract:Background The cause-effect relationship between bilateral Oophorectomy and accelerated aging remains controversial. We conducted new analyses to further address this controversy. Methods The Rochester Epidemiology Project records-linkage system was used to identify all premenopausal women who underwent bilateral Oophorectomy for a noncancerous condition before age 50 years between 1988 and 2007 in Olmsted County, MN. Each woman was randomly matched to a referent woman born in the same year (±1 year) who had not undergone bilateral Oophorectomy. We studied the rate of accumulation of 18 common chronic conditions over a median of approximately 14 years of follow-up (historical cohort study). Analyses were restricted to women free of any of the 18 chronic conditions at the time of Oophorectomy (or index date). Results After adjustments for race/ethnicity, education, body mass index, smoking, and age and calendar year at the index date, women who underwent Oophorectomy before age 46 years experienced an accelerated rate of accumulation of the 18 chronic conditions considered together (hazard ratio = 1.24; 95% confidence interval: 1.12, 1.37; p < .001). The single-year incidence rate of new conditions was most different in the first 6 years after Oophorectomy but the difference attenuated thereafter. Findings did not vary by surgical indication for the Oophorectomy. Conclusions Bilateral Oophorectomy is associated with a higher risk of multimorbidity among women who did not have any of the 18 selected conditions at baseline. The association did not vary by surgical indication for Oophorectomy. Our findings suggest that bilateral Oophorectomy is causally linked to accelerated aging.
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Hysterectomy, Oophorectomy, Estrogen, and the Risk of Dementia
Neuro-degenerative diseases, 2012Co-Authors: Walter A. Rocca, Brandon R Grossardt, Lynne T. Shuster, Elizabeth A. StewartAbstract:Background: The long-term cognitive effects of hysterectomy and Oophorectomy remain controversial. Objective: To explore the association of hysterectomy and Oophorectomy with the subsequent risk of cognitive impairment or dementia. Methods: We combined the results from two cohort studies graphically and conducted additional analyses. Results: Combined results from the Mayo Clinic Cohort Study of Oophorectomy and Aging and from a Danish nationwide cohort study suggest that the extent of gynecologic surgery may correlate with a stepwise increase in the risk of cognitive impairment or dementia. Compared with women with no gynecologic surgeries, the risk of cognitive impairment or dementia was increased in women who had hysterectomy alone, further increased in women who had hysterectomy with unilateral Oophorectomy, and further increased in women who had hysterectomy with bilateral Oophorectomy. The risk increased with younger age at the time of the surgery. Conclusion: We hypothesize that both hysterectomy and Oophorectomy may have harmful brain effects via direct endocrinological mechanisms or other more complex mechanisms. Estrogen deficiency appears to play a key role in these associations, and estrogen therapy may partly offset the negative effects of the surgeries.
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Prophylactic bilateral Oophorectomy jeopardizes long-term health
Sexuality Reproduction and Menopause, 2010Co-Authors: Lynne T. Shuster, Brandon R Grossardt, Bobbie S. Gostout, Walter A. RoccaAbstract:Disclosures The authors report no commercial or financial relationships relevant to this article. Approximately 4.5 million women in the United States have undergone bilateral Oophorectomy before reaching natural menopause, yet accumulating evidence indicates that surgical removal of the ovaries increases the risk of long-term deleterious outcomes. Bilateral Oophorectomy refers to the simultaneous or sequential removal of both ovaries. The surgery may be performed for a malignancy, benign disease of the ovaries (eg, endometriosis or a cyst), or prophylaxis against cancer. Oophorectomy is most commonly performed along with hysterectomy. Although age-adjusted rates of prophylactic Oophorectomy have decreased over time, the proportion of hysterectomies accompanied by prophylactic Oophorectomy in the United States has actually increased, from 29% in 1979 to 45% in 2004. Women who experience the premature loss of ovarian function as a result of bilateral Oophorectomy performed before the onset of natural menopause are at increased risk for death, cardiovascular disease, stroke, lung cancer, cognitive impairment or dementia, parkinsonism, osteoporosis, depressive or anxiety symptoms, and sexual dysfunction. The risks appear to be greater for women who are younger at the time of Oophorectomy. Some studies, however, show that even women who underwent Oophorectomy after the onset of natural menopause had an increased risk of deleterious outcomes. Health care practitioners who advise women about bilateral Oophorectomy need to be aware of the riskbenefit balance and counsel patients accordingly. For premenopausal women who are not at markedly increased risk for ovarian or breast cancer, prophylactic Oophorectomy should be discouraged (FIGURE).
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increased mortality for neurological and mental diseases following early bilateral Oophorectomy
Neuroepidemiology, 2009Co-Authors: Cathleen M Rivera, Brandon R Grossardt, Deborah J. Rhodes, Walter A. RoccaAbstract:Background: The effects of Oophorectomy on brain aging remain uncertain. Methods: We conducted a cohort study with long-term follow-up of women in Olmsted County, Minn., USA, who underwent either unilateral or bilateral Oophorectomy before the onset of menopause from 1950 through 1987. Each member of the Oophorectomy cohort was matched by age to a referent woman from the same population who had not undergone any Oophorectomy. We studied underlying and contributory causes of death in 1,274 women with unilateral Oophorectomy, 1,091 women with bilateral Oophorectomy, and 2,383 referent women. Results: Mortality for neurological or mental diseases was increased in women who underwent bilateral Oophorectomy before age 45 years compared with referent women (hazard ratio = 5.24; 95% confidence interval = 2.02–13.6; p Conclusions: Bilateral Oophorectomy performed before age 45 years is associated with increased mortality for neurological or mental diseases.
