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Oophorectomy before menopause linked to cognitive impairment, dementia

In reassessment of prophylactic oophorectomy in premenopausal women, use of estrogen treatment may be necessary.

Issue: October 2007

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An increased risk for cognitive impairment and dementia was associated with unilateral and bilateral oophorectomy preceding the onset of menopause.

Investigators analyzed the risk for cognitive impairment or dementia in women with and without oophorectomy surgery in a recent study appearing in Neurology.

“Women who had their ovaries removed before menopause were at an increased risk for developing memory problems or dementia and movement disorders such as Parkinson’s disease,” Walter A. Rocca, MD, MPH, told Endocrine Today. Rocca is a professor of epidemiology and neurology with the Mayo Clinic College of Medicine in Rochester, Minn.

“Women who were younger at the time of ovariectomy were at particularly high risk; however, there was some evidence that treatment with estrogen until approximately age 50 eliminated the increased risk,” he said.

Investigators performed telephone interviews for women who underwent unilateral (n=813) or bilateral (n=676) oophorectomy before the onset of menopause for a noncancer indication from 1950 to 1987. They also interviewed referent women who had not undergone oophorectomy (n=1,472). Proxy informants were interviewed using a brief dementia questionnaire for participants who died before the conclusion of the study or who were incapacitated.

Risk analyzed

Seventy-six women who underwent unilateral oophorectomy developed cognitive impairment or dementia, and 74 women who underwent bilateral oophorectomy developed cognitive impairment or dementia. Ninety-eight of the referent women developed cognitive impairment or dementia.

Data suggested there was an increased risk for cognitive impairment or dementia in women who underwent oophorectomy compared with referent women (HR=1.46). Results were adjusted for education, type of interview and history of depression. In addition, the association between both unilateral and bilateral oophorectomy was age dependent, and risk increased for younger age at surgery (P<.0001).

“A woman considering ovary removal should discuss these findings with her physician prior to the surgery to consider the long-term implications and the possible strategies for estrogen treatment following the surgery,” Rocca said. “In view of this new information, careful individualized counseling is necessary to help women make informed decisions.” – by Christen Haigh

For more information:

• Rocca WA, Bower JH, Maraganore DM, et al. Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause. Neurology. 2007;69:1074-1083.