Premenopausal removal of the ovaries accelerates bone loss and carotid artery thickening in postmenopausal women, putting women at higher risk for both osteoporosis and cardiovascular disease.
Women who are more than 10 years postmenopause and who have had their ovaries removed lose bone mineral density (BMD) at twice the rate of those who have kept their ovaries and show greater progression in the thickening of the carotid artery. These findings, which will be published in Fertility and Sterility, indicate that oophorectomy appears to put women at higher risk for developing both osteoporosis and cardiovascular disease (CVD).
Osteoporosis and cardiovascular disease are common health problems in women as they age, particularly after menopause. The severity of both conditions is affected by decreasing levels of hormones. This ebbing of hormones occurs naturally as a woman goes through menopause, but it can occur abruptly if she has her ovaries surgically removed.
Researchers at the University of Southern California’s Keck School of Medicine investigated the effect of premenopausal oophorectomy on the rate of loss of BMD and the rate of thickening of the carotid artery, a measure of cardiovascular health, in healthy postmenopausal women. They hypothesized that women who retained their ovaries would have some protection against bone loss and vascular thickening compared with women who had had their ovaries removed.
They used data from 222 healthy postmenopausal women living in the greater Los Angeles area, enrolled in the WISH (Women’s Isoflavone Soy Health) trial, conducted from April 2004 to March 2009. The participants underwent BMD scans at the start of the trial and annually thereafter, and they had ultrasound assessments of carotid artery intima-media thickness (CIMT) every 6 months. Since the WISH trial found no treatment group differences in BMD or CIMT between women who had taken soy protein supplementation and women who received a placebo, data from both the treatment and control groups were used in this study. Data were evaluated from women who kept their ovaries and those who had oophorectomies, who were 5 to 10 years postmenopause and more than 10 years postmenopause. Data were excluded for estrogen and bisphosphonate use.
The researchers found that the rate of subclinical atherosclerosis progressed faster in those having undergone oophorectomy when compared with their ovary-retaining counterparts. CIMT progression and BMD loss were worse in those women greater than 10 years postmenopause who had undergone oophorectomy.
Rebecca Sokol, MD, MPH, acting president of American Society for Reproductive Medicine, commented, “Most women in the United States having a hysterectomy have their ovaries removed as well as their uterus, even those who do not have increased risk of breast or ovarian cancer. As we learn more about the protective effects the ovaries may exert on bone and cardiovascular health after menopause, this practice could be reconsidered. While the incidence of ovarian cancer increases with age and it is notoriously difficult to detect, a physician’s careful analysis of a woman’s individual risks-for cancer, as well as for bone loss or cardiovascular disease-could help her decide whether oophorectomy is the best course.”
Note: This article is the basis of a continuing education module through ASRM eLearn®, which will be available beginning February 14. For more information on this and other American Society for Reproductive Medicine CME/CE activities, go to https://www.asrm.org/eLearn/.