Adverse childhood or adult experiences and risk of bilateral oophorectomy: a population-based case–control study

Abstract

ObjectivesBilateral oophorectomy has commonly been performed in conjunction with hysterectomy even in women without a clear ovarian indication; however, oophorectomy may have long-term deleterious consequences. To better understand this surgical practice from the woman’s perspective, we studied the possible association of adverse childhood or adult experiences with the subsequent occurrence of bilateral oophorectomy.DesignPopulation-based case–control study.SettingOlmsted County, Minnesota (USA).ParticipantsFrom an established population-based cohort study, we sampled 128 women who underwent bilateral oophorectomy before age 46 years for a non-cancerous condition in 1988–2007 (cases) and 128 age-matched controls (±1 year).MethodsInformation about adverse experiences was abstracted from the medical records dating back to age 15 years or earlier archived in the Rochester Epidemiology Project (REP) records-linkage system. Adverse childhood experiences were summarised using the Adverse Childhood Experience (ACE) score.ResultsWe observed an association of bilateral oophorectomy performed before age 46 years with verbal or emotional abuse, physical abuse, any abuse, substance abuse in the household, and with an ACE score ≥1 experienced before age 19 years (OR=3.23; 95% CI 1.73 to 6.02; p<0.001). In women who underwent the oophorectomy before age 40 years, we also observed a strong association with physical abuse experienced during adulthood (OR=4.33; 95% CI 1.23 to 15.21; p=0.02). Several of the associations were higher in women who underwent oophorectomy at a younger age (<40 years) and in women without an ovarian indication for the surgery. None of the psychosocial or medical variables explored as potential confounders or intervening variables changed the results noticeably.ConclusionsWomen who suffered adverse childhood experiences or adult abuse are at increased risk of undergoing bilateral oophorectomy before menopause. We suggest that the association may be explained by a series of biological, emotional, and psychodynamic mechanisms.

Cohort profile: the Mayo Clinic Cohort Study of Oophorectomy and Aging-2 (MOA-2) in Olmsted County, Minnesota (USA)

“…In women who underwent the oophorectomy before age 40 years, we also observed a strong association with prior physical abuse experienced during adulthood. 22 23 …”

“…Because of the recent findings from our case–control study linking bilateral oophorectomy to adverse childhood or adult experiences in a subsample of MOA-2, we plan to expand the medical record abstraction for these variables to all women in the cohort. 22 23 We plan to include adverse childhood or adult experiences as possible confounding or effect modifying variables in future analyses.…”

“…On the other hand, for some projects, we will be able to restrict the sample to a smaller segment of the overall study, as was done for the case–control study of adverse childhood or adult experiences. 22 …”

Understanding the impact of sex and gender in Alzheimer's disease: A call to action

“…However, several studies in the United States [6], and around the world [10], have not reported a significant sex difference. Different theories for the geographical difference in the prevalence and incidence of AD by sex between the United States and Europe have been suggested [6, 13]. For example, in the early part of the 20 th century, gender differences in educational and occupational opportunities varied between the United States and Europe.…”

Reproductive Health of Women Veterans: A Systematic Review of the Literature from 2008 to 2017

“…8,9 Such experiences are associated with infertility, low birth weight, and early bilateral oophorectomy for noncancerous conditions. [10][11][12] Additionally, women Veterans may have experiences and exposures unique to military service that could adversely impact their reproductive health, including environmental and occupational exposures, military sexual assault, and combat-associated injuries. Possibly related to these exposures, women Veterans have a higher prevalence of posttraumatic stress disorder (PTSD) than their non-Veteran peers.…”