Long-Term Mortality Associated With Oophorectomy Compared With Ovarian Conservation in the Nurses' Health Study

Parker, William H.; Feskanich, Diane; Broder, Michael S.; Chang, Eunice; Shoupe, Donna; Farquhar, Cindy; Berek, Jonathan S.; Manson, JoAnn E.

doi:10.1097/aog.0b013e3182864350

Cited by 386 publications

(241 citation statements)

References 17 publications

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“…61–63 In the Nurse’s Health Study, women who underwent BSO before the age of 50 years had a significant increase in all-cause, total cancer, and cardiovascular mortality over 28 years of follow-up. 3 Similarly, Gierach et al found younger age at BSO to be associated with increased risk of all-cause mortality, and specifically with mortality related to CHD. This risk decreased progressively with increasing age at BSO, disappearing by the age of 50 years.…”

Section: Resultsmentioning

confidence: 95%

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Long-term health consequences of premature or early menopause and considerations for management

et al. 2015

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Aim To review the current evidence concerning the long-term harmful effects of premature or early menopause, and to discuss some of the clinical implications. Material and methods Narrative review of the literature. Results Women undergoing premature or early menopause, either following bilateral salpingo-oophorectomy or because of primary ovarian insufficiency, experience the early loss of estrogen and other ovarian hormones. The long-term consequences of premature or early menopause include adverse effects on cognition, mood, cardiovascular, bone, and sexual health, as well as an increased risk of early mortality. The use of hormone therapy has been shown to lessen some, although not all of these risks. Therefore, multiple medical societies recommend providing hormone therapy at least until the natural age of menopause. It is important to individualize hormone therapy for women with early estrogen deficiency, and higher dosages may be needed to approximate physiological concentrations found in premenopausal women. It is also important to address the psychological impact of early menopause and to review the options for fertility and the potential need for contraception, if the ovaries are intact. Conclusions Women who undergo premature or early menopause should receive individualized hormone therapy and counseling.

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Section: Resultsmentioning

confidence: 95%

“…1–3 Yet, a significant percentage of women still undergo elective BSO at the time of hysterectomy for benign disease (23% of women 40–44 years and 45% of women 45–49 years). 4–6 …”

Section: Introductionmentioning

confidence: 99%

Long-term health consequences of premature or early menopause and considerations for management

et al. 2015

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“…However, results are consistent that bilateral oophorectomy at age younger than 50 is associated with an increased risk of CVDs and CVD mortality (results have been inconclusive for bilateral oophorectomy at age older than 50). [42][43][44] Similarly, hysterectomy without oophorectomy has been shown to be associated with an increased risk of CVD in women aged <50 but not in women aged ≥50. 44 In addition, this finding was consistent with the previous endometriosis and CHD study which found that hysterectomy/oophorectomy and earlier age at these surgeries accounted for 40% of the overall association.…”

Section: Analysis 2: Hypercholesterolemia or Hypertension In Relationmentioning

confidence: 99%

Association Between Endometriosis and Hypercholesterolemia or Hypertension

et al. 2017

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Abstract-An altered hormonal or chronic systemic inflammatory milieu characterizing endometriosis may result in a higher risk of hypercholesterolemia and hypertension. Conversely, elevated low-density lipoprotein in hypercholesterolemia and chronic systemic inflammation resulting from hypertension may increase the risk of endometriosis. We assessed the association of laparoscopically confirmed endometriosis with hypercholesterolemia and hypertension in a large prospective cohort study. In 1989, 116 430 registered female nurses aged 25 to 42 completed the baseline questionnaire and were followed for 20 years. Multivariable Cox proportional hazards models were applied. In 1989, there were 4244 women with laparoscopically confirmed endometriosis and 91 554 women without. After adjusting for demographic, anthropometric, family history, reproductive, dietary, and lifestyle risk factors prospectively, comparing women with laparoscopically confirmed endometriosis to women without, the relative risks were 1.25 (95% confidence interval, 1.21-1.30) for development of hypercholesterolemia and 1.14 (95% confidence interval, 1.09-1.18) for hypertension. Conversely, the relative risks of developing laparoscopically confirmed endometriosis were 1.22 (95% confidence interval, 1.15-1.31) comparing women with hypercholesterolemia to women without and 1.29 (95% confidence interval, 1.18-1.41) comparing women with hypertension to women without. The strength of associations of laparoscopically confirmed endometriosis with hypercholesterolemia or hypertension was strongest among women aged ≤40 and weakened as age increased (P values for interaction <0.001). We observed that ≈45% of the associations between endometriosis and hypercholesterolemia and hypertension could be accounted for by treatment factors after endometriosis diagnosis, including greater frequency of hysterectomy/oophorectomy and earlier age for this surgery. In this large cohort study, laparoscopically confirmed endometriosis was prospectively associated with increased risk of hypercholesterolemia and hypertension. Conversely, hypercholesterolemia and hypertension were prospectively associated with higher risk of laparoscopically confirmed endometriosis. process, which may be contributing to blood pressure elevation. 23 Hence the chronic systemic inflammation in endometriosis may predispose women with endometriosis to a higher risk of hypertension.In sum, women with endometriosis may have higher risk of hypercholesterolemia or hypertension, and women with hypertension or hypercholesterolemia may have a higher risk of endometriosis. We examined these hypotheses in the NHSII (Nurses' Health Study II), an ongoing prospective cohort study. Methods Study PopulationThe NHSII is a prospective cohort study with 116 430 registered female nurses who were 25 to 42 and resided in 14 of the United States at enrollment in 1989. At baseline, participants completed a detailed questionnaire and every 2 years thereafter completed follow-up questionnaires on the incidence of disease out...

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“…The benefits of ovarian preservation for women at average risk have been described up to age 55 and may extend to women of even older age (74, 75). Careful individualization of counselling and treatment must take into account the patient's personal history of cancer, age, wishes regarding fertility and concomitant medical comorbidities, particularly if considering prophylactic surgery.…”

Section: Surgical Prevention For Women At High Risk Of Ovarian Cancermentioning

confidence: 99%

Ovarian Cancer Prevention in High-risk Women

Temkin

Bergstrom²,

Samimi

et al. 2017

Clinical Obstetrics &Amp; Gynecology

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Ovarian carcinoma is the most lethal malignancy of the female genital tract. Population-based trials in the general population have not demonstrated that screening improves early detection or survival. Therefore, application of prevention strategies is vital to improving outcomes from this disease. Surgical prevention reduces risk and prophylactic risk reducing salpingo-oophorectomy (RRSO) is the most effective means to prevent ovarian carcinoma in the high risk patient although the risks do not outweigh the benefits in average risk patients. Other surgical and medical options have unknown or limited efficacy in the high risk patient. In this review, we define the patient at high risk for ovarian cancer, discuss how to identify these women and weigh their available ovarian cancer prevention strategies.

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Long-Term Mortality Associated With Oophorectomy Compared With Ovarian Conservation in the Nurses' Health Study

Cited by 386 publications

References 17 publications

Long-term health consequences of premature or early menopause and considerations for management

Long-term health consequences of premature or early menopause and considerations for management

Association Between Endometriosis and Hypercholesterolemia or Hypertension

Ovarian Cancer Prevention in High-risk Women

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