Bilateral oophorectomy increases risk for severe carpal tunnel syndrome
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Premenopausal women who underwent bilateral oophorectomy had a higher risk for severe carpal tunnel syndrome compared with women who did not have the procedure, according to a study published in Menopause.
Walter A. Rocca, MD, MPH, the Ralph S. and Beverley E. Caulkins Professor of Neurodegenerative Diseases Research and a professor of epidemiology and neurology at the Mayo Clinic in Rochester, Minnesota, said the findings add to previously published research on the long-term risks of bilateral oophorectomy performed for the prevention of ovarian cancer.
“Starting around the early 2000s, our research team and other groups of clinical investigators started to report data suggesting that the prevention of ovarian cancer was coming at a very high cost,” Rocca told Healio. “In the long term, women who underwent bilateral oophorectomy are experiencing increased morbidity and mortality. The most important long-term outcomes are cardiovascular disease, dementia, psychiatric conditions, osteoporosis and bone fractures. The current study adds severe carpal tunnel syndrome to the growing list of the long-term harmful sequelae. Carpal tunnel syndrome is not a life-threatening condition, but it is common, may cause severe pain, and may determine functional impairment.”
Rocca and colleagues reviewed data from premenopausal women who underwent a bilateral oophorectomy for a nonmalignant indication in Olmsted County, Minnesota, from 1988 to 2007. Each woman was randomly age-matched to a woman in the same county who had not undergone a bilateral oophorectomy. Researchers excluded 254 women who underwent a bilateral oophorectomy and 175 in the age-matched cohort who had carpal tunnel syndrome at baseline. Demographics, clinical characteristic data and surgical indication were obtained through manual abstraction of medical records. Diagnoses of carpal tunnel syndrome were obtained through Dec. 31, 2014. Women who were treated for carpal tunnel syndrome with a steroid injection, had carpal tunnel release surgery or had electrodiagnostic studies with moderate or more severe results were defined as having severe carpal tunnel syndrome.
Oophorectomy increases risk
There were 1,399 women who underwent bilateral oophorectomy and 1,478 controls included in the analysis. The median age of severe carpal tunnel syndrome onset was age 52 years in the oophorectomy group and age 51 years in the reference cohort.
Women who underwent bilateral oophorectomy had an increased risk for severe carpal tunnel syndrome compared with the reference group (adjusted HR = 1.65; 95% CI, 1.2-2.2). There was a significant increased risk for severe carpal tunnel syndrome in the oophorectomy group for women with lower BMI, women who never gave birth and those who had at least one child, and women who had an oophorectomy for a benign indication. However, interactions by BMI, parity and indication were not significant. No protective effect was observed for women who were on estrogen therapy.
“A possible role of estrogen, with or without concurrent progestin, in reducing the risk of carpal tunnel syndrome has been shown quite convincingly by the Women’s Health Initiative clinical trials,” Rocca said. “Our findings are consistent with a protective role of estrogen or of other hormones produced by the ovaries. However, in our study, women who underwent bilateral oophorectomy and later received estrogen therapy did not experience a reduced risk.”
Increased risk for idiopathic carpal tunnel syndrome
In a first set of secondary analyses, women who underwent bilateral oophorectomy had an increased risk for any type of carpal tunnel syndrome, but only the interaction by indication was significant. In a second set of sensitivity analyses, women who underwent bilateral oophorectomy had a higher risk for idiopathic carpal tunnel syndrome compared with the reference group (aHR = 1.35; 95% CI, 1.07-1.7).
“Our study adds important new evidence to be considered in the decision to offer to women bilateral oophorectomy for the prevention of ovarian cancer,” Rocca said. “It is our recommendation that for the vast majority of women who are at average risk of ovarian cancer, bilateral oophorectomy should not be performed. The only indication would be for women who have a primary or metastatic ovarian cancer or who carry a high-risk genetic variant.”
Rocca said a cost-to-benefit ratio for bilateral oophorectomy should be created to give women correct advice about whether to perform the procedure.
For more information:
Walter A. Rocca, MD, MPH, can be reached at rocca@mayo.edu.
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