Surgical menopause may lead to short-term cognitive impairment in premenopausal women
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Premenopausal women at high risk for ovarian cancer who experienced surgical menopause reported impaired cognition 6 months after surgery, but the decline was not sustained long term, according to study data.
“There is still a lot we don’t know about the impact of menopause on cognition,” Heidi Chang, MD, a gynecologic oncology provider at East Bay Gynecologic Oncology, Bay Area Surgical Specialists in Walnut Creek, California, told Healio. “What we found is that subjective [cognitive] complaints appear to increase 6 months after surgical menopause in our population, but with prolonged follow-up it seems that these changes become less noticeable over time. Hormone therapy does not appear to mitigate this finding, and in the short run these patients may actually experience more cognitive complaints.”
Chang and colleagues published the findings in Menopause.
Researchers conducted a prospective study assessing cognitive changes in 58 premenopausal women (mean age, 43 years; 88% white) at a high risk for ovarian cancer who underwent a risk-reducing bilateral salpingo-oophorectomy between 2015 and 2018. All participants had a documented germline pathogenic variant or a strong family history of ovarian cancer and planned to have surgery within 6 months of study enrollment. Participants completed a questionnaire before surgery to establish baseline subjective cognitive function scores. Cognitive function was measured in four domains: perceived cognitive impairment, perceived cognitive abilities, noticeability and quality of life. Self-reported data on sleep disruption, daily alcohol use, prior depression diagnoses and current medication use for depression were also collected.
Follow-up surveys were sent to participants 6, 12 and 18 months after surgery. Participants completed the cognition questionnaire and provided responses about the use of HT, new diagnoses, depression and sleep disruption. All participants were permitted to choose whether to use HT after surgery.
Of the 58 women in the study population, 43 completed the 6-month follow-up and 38 completed the 12- and 18-month follow-up surveys. Of the study cohort, 63% used HT at 6 months, 78% at 12 months and 68% at 18 months.
Six months after surgery, the study group had a mean decline of 5.5 points in perceived cognitive impairment compared with baseline. The decline was sustained at 12 months, but no longer significant at 18 months. Women who used HT had a mean decline of six points 6 months after surgery. No changes were seen in perceived cognitive abilities, noticeability or quality of life after surgery.
The proportion of the study population reporting sleep disruptions increased from 19% at baseline to 41% at the 6-month follow-up and 35% at 12 months (P = .02). Self-reported depression declined from 31% at baseline to 8% at 18 months (P = .004). Among women reporting depressive symptoms, surgery had no impact on antidepressant medication use. There were no changes in alcohol consumption.
“Clinically, this study can be helpful in counseling patients at high risk of ovarian cancer about what to expect postoperatively; that they can expect some changes in domains of well-being, such as sleep disruption and potentially less depression,” Chang said. “They may also experience a decline in subjective cognition short term, but over time there does not appear to be a detrimental effect of the surgery on cognition.”
Chang said larger studies looking at more objective measures for cognition should be conducted in the future, adding that future research should also examine specific data about hormone replacement formulations.
“As we learn more about specific genes that give rise to these hereditary cancers, more women will be faced with decisions about risk-reducing surgeries, and we need to be able to adequately counsel these women about the risks and benefits of these surgeries prior to natural menopause so that they can make informed decisions about their own health,” Chang said.
For more information:
Heidi Chang, MD, can be reached at hchang28@gmail.com.
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