Study finds increased risk for severe carpal tunnel syndrome after oophorectomy
Women who had a bilateral oophorectomy had an increased risk for de novo severe carpal tunnel syndrome vs. women who did not undergo the procedure, according to researchers.
“Although [carpal tunnel] syndrome is predominantly of idiopathic nature, an association with sex hormones has been suggested given the higher incidence in women compared with men at all ages, and the peak incidence around the age of menopause in women (ages 50-59 y) but at later age in men (70-79 y),” Julia Starlinger, MD, PhD, a research fellow at the Mayo Clinic, and colleagues wrote in Menopause. “The impact of bilateral oophorectomy on hormone homeostasis is striking, and bilateral oophorectomy has been linked to increased morbidity and mortality, in particular to several neurological disorders.”
Starlinger and colleagues conducted a population-based cohort study using data on 1,653 premenopausal women who had a bilateral oophorectomy and participated in the Mayo Clinic Cohort Study of Oophorectomy and Aging-2. The researchers randomly matched participants to 1,653 referents by age and assessed diagnoses of carpal tunnel syndrome in each cohort.
Women who had a bilateral oophorectomy had an increased risk for severe carpal tunnel syndrome (adjusted HR [aHR] = 1.65; 95% CI, 1.2-2.25). Women with a BMI less than 30 kg/m2 (aHR = 2.07; 95% CI, 1.37-3.17), nulliparity (aHR = 3.05; 95% CI, 1.31-7.11) and benign ovarian indication for oophorectomy (aHR = 2.28; 95% CI, 1.36-3.82) had a “suggestively greater” risk, according to the researchers.
The data did not show that estrogen therapy after oophorectomy conferred a protective effect, Starlinger and colleagues wrote.
“These findings, in conjunction with the results of other studies addressing more severe disease outcomes such as cardiovascular disease or dementia, have important clinical implications and should prompt a reassessment of bilateral oophorectomy in premenopausal women who are not at high genetic risk of ovarian cancer,” the researchers wrote.
Perspective
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This study highlights the increase in morbidity and mortality that women who undergo bilateral oophorectomy before the natural age of menopause are experiencing. There are important long-term adverse health outcomes associated with removal of the ovaries before natural menopause, including CVD, dementia, mood disorders, osteoporosis, fractures and early mortality. This study adds severe carpal tunnel syndrome to the growing list of harmful outcomes over the long-term. While not life-threatening, carpal tunnel syndrome can impair function and result in decreased quality of life.
Providers should be aware of the importance of avoiding removal of the ovaries before the natural age of menopause for conditions other than ovarian cancer or a high-risk mutation that significantly increases the risk of ovarian cancer.
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