Women who have their ovaries removed before menopause run a heightened risk of developing dementia or other mental problems later in life - unless they take estrogen until age 50, a new study suggests.
Friday, September 14, 2007
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Ovary removal, dementia linked
NEW YORK
Experts said the research needs to be confirmed by further study, but the findings suggest another issue for premenopausal women and their doctors to discuss as they consider ovary removal.
And if they decide to go ahead with surgery, they need to consider the risks and benefits of taking estrogen to age 50, said Dr. Walter Rocca, a Mayo Clinic neurologist and lead study author.
Hormone therapy has been linked to a greater risk of dementia and heart attacks when given to women after age 65. But recent research indicates that when given before menopause or just afterward, it doesn't raise heart attack risk and might protect against dementia.
The study did not include women who had ovaries removed as part of cancer treatment, and Rocca said the results do not apply to such women. The work was published yesterday in the online edition of the journal Neurology.
Ovaries produce estrogen. Rocca said the likeliest explanation of the study results is that removing ovaries causes a sudden deficiency of that hormone, which in turn affects the brain.
Hundreds of thousands of women have their ovaries removed each year in the United States. In women around age 45, approaching menopause, ovaries are often removed during hysterectomies as a precaution against developing ovarian cancer. In addition, some women at unusually high risk of developing ovarian cancer have ovaries removed without hysterectomies, as do others who have ovarian problems such as endometriosis.
Women younger than 45 often take estrogen after ovary removal because of such symptoms as hot flashes and concerns about developing osteoporosis, noted Dr. Nancy Chescheir of Vanderbilt University. But older women who have the surgery are less likely to start estrogen therapy, said Chescheir, who didn't participate in the new research.
The new study found the risk of later mental impairment was higher when the surgery was done at younger ages.
The research examined the fates of women who had one or both ovaries removed from 1950 to 1987 and compared them to other women. Interviewers spoke with either the women or somebody who knew them, asking about signs of memory impairment and any diagnosis of dementia or Alzheimer's disease.
Overall, the study found impairment or dementia in 150 of 1,489 women who'd had ovaries removed, versus 98 of 1,472 women who hadn't. That indicates nearly a 50 percent increase in risk.
A second study, which included about 2,300 women who'd had the surgery and about 2,400 who hadn't, found about a 70 percent increased risk for Parkinson's disease symptoms such as tremors.
Still, that outcome was far less common than mental impairment, and experts said the evidence behind it was weaker than for mental impairment.
