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Oophorectomy and Cardiovascular Risk

Long-term CVD mortality rates were significantly higher in women who had undergone premenopausal bilateral oophorectomy than in a nonsurgical comparator group.

Approximately 600,000 U.S. women undergo bilateral oophorectomy annually, with about half the surgeries aimed at preventing ovarian cancer. However, oophorectomy is associated with excess long-term risk for cardiovascular disease (CVD). To reveal the effects of oophorectomy on mortality, investigators analyzed death certificate data from more than 2300 women who underwent unilateral or bilateral oophorectomy before menopause in Olmsted County, Minnesota. Median follow-up was 25 years in the bilateral oophorectomy group, 30 years in the unilateral group, and 26 years for age-matched comparators (women who had not undergone oophorectomy).

Mortality from all causes was similar in women who underwent bilateral oophorectomy and in the comparator group; however, all-cause mortality was significantly higher among women who underwent prophylactic bilateral oophorectomy before age 45. Considering deaths in which CVD was one of the causes listed on the death certificate, mortality rates were significantly lower in women who underwent unilateral oophorectomy and higher in women who underwent bilateral oophorectomy than in the comparator group. However, in the bilateral oophorectomy group, those who were treated with estrogen from the time of surgery through at least age 45 had no excess CVD mortality.

Comment: These results support those of other studies showing that ovarian steroid production is associated with cardiovascular protection and that early menopause confers heightened risk for heart disease. Perhaps exogenous estrogen, if initiated early, also can reduce risk. Too often, clinicians extrapolate findings of the Women’s Health Initiative (WHI) to women with premature ovarian failure or early surgical menopause; I have even encountered teenage women with ovarian failure who were told not to take estrogen because of the WHI findings. In addition, this study validates the current American College of Obstetricians and Gynecologists recommendation that we should strongly consider retaining normal ovaries in premenopausal women who undergo hysterectomy and are not at specific genetic risk for ovarian cancer.

— Ann J. Davis, MD

Published in Journal Watch Women's Health February 19, 2009

Citation(s):

Rivera CM et al. Increased cardiovascular mortality after early bilateral oophorectomy. Menopause 2009 Jan/Feb; 16:15.

• Medline abstract (Free)

Parker WH and Manson JE. Oophorectomy and cardiovascular mortality: Is there a link? Menopause 2009 Jan/Feb; 16:1.

• Medline abstract (Free)