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MEDTECH Premenopausal Ovary Removal: Potential Cognitive Risks and White Matter Integrity
Recent research published in Alzheimer’s & Dementia reveals a potential link between premenopausal bilateral oophorectomy (PBO) and reduced white matter integrity in the brain. The study, led by Michelle Mielke from Wake Forest University School of Medicine, analyzed data from the Mayo Clinic Study of Aging to investigate the neurological impacts of ovary removal before natural menopause. The findings suggest that early ovary removal may increase the risk of cognitive decline, particularly in women who undergo the procedure before age 40.
Key Points:
- The study analyzed data from 1,011 women who underwent diffusion tensor imaging to assess brain white matter integrity.
- Participants were categorized into four groups based on age at PBO: before 40, 40-45, 46-49, and those who did not undergo PBO before 50.
- Women who had PBO before age 40 showed reduced white matter integrity in multiple brain regions.
- Similar trends were observed in women who underwent PBO between ages 46 and 49.
- No significant differences were found in brain pathways for women who had PBO between ages 40 and 44 compared to those who didn’t have the procedure.
- Approximately 80% of participants who had ovary removal also used estrogen replacement therapy (ERT).
- Despite ERT use, white matter integrity remained diminished in women who underwent PBO.
- Researchers suggest that testosterone loss, rather than estrogen, may play a critical role in brain health.
- The study highlights the need for further research on the relationship between white matter changes and cognitive impairment.
- About 500,000 hysterectomies are performed annually in the United States, with most occurring between ages 40 and 50.
- An estimated 23% of women ages 40-44 and 45% of women ages 45-49 undergo bilateral oophorectomy for ovarian cancer prevention.
- Women at high risk for ovarian cancer, such as those with BRCA1 mutations, face a 35-45% lifetime risk compared to the general population’s 1% risk.
- The decision to remove ovaries premenopausally requires careful consideration of both benefits and risks.
Surgical removal of both ovaries is associated with an increased risk of Parkinson’s disease and parkinsonism in women younger than 43. (JAMA Network Open)
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