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Gynecologic Oncology Jun 2013Preclinical studies suggest that abrupt hormone deprivation caused by oophorectomy, leads to obesity and its metabolic sequelae. The purpose of the current study was to...
OBJECTIVE
Preclinical studies suggest that abrupt hormone deprivation caused by oophorectomy, leads to obesity and its metabolic sequelae. The purpose of the current study was to examine the association between oophorectomy and body fatness in a nationally representative sample of women.
METHODS
The association between prior oophorectomy and nine adiposity measures was examined using data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). The analytic population included cancer-free women age 40 or older (N=3549) who underwent standardized body measurements and reported on whether or not they had a bilateral oophorectomy. Multivariate linear and polytomous logistic regressions were used to evaluate the association of oophorectomy with multiple measures of adiposity.
RESULTS
Mean percent body fat, skinfold thickness, waist circumference and body mass index were significantly higher in women with oophorectomy before age 40 compared to those with intact ovaries, but no difference was observed in women with oophorectomy at an older age. Women who underwent an early oophorectomy were nearly three times more likely than women with intact ovaries to have percent body fat in the highest tertile compared to the lowest tertile (OR=2.82, 95% CI 1.39-5.75). Excluding hormone therapy (HT) users yielded stronger associations.
CONCLUSION
Bilateral oophorectomy in young women is strongly associated with an increase in percent body fat, a well-established risk factor for cancer and other chronic diseases. Measuring body fat in addition to BMI may provide a more comprehensive assessment of adiposity in these women.
Topics: Adipose Tissue; Adiposity; Adult; Body Composition; Body Mass Index; Female; Humans; Nutrition Surveys; Ovariectomy; Skinfold Thickness; United States; Waist Circumference
PubMed: 23428461
DOI: 10.1016/j.ygyno.2013.02.016 -
Current Oncology (Toronto, Ont.) Feb 2023Approximately 80% of breast cancers are estrogen receptor-positive (ER+), and 68-80% of those occur in premenopausal or perimenopausal women. Since the introduction of... (Review)
Review
Approximately 80% of breast cancers are estrogen receptor-positive (ER+), and 68-80% of those occur in premenopausal or perimenopausal women. Since the introduction of tamoxifen for adjuvant endocrine therapy in women with non-metastatic ER+ breast cancer, subsequent trials have demonstrated an oncologic benefit with the addition of ovarian function suppression (OFS) to adjuvant endocrine therapy. Subsequently, therapies to either suppress or ablate ovarian function may be included in the treatment plan for patients that remain premenopausal or perimenopausal after upfront or adjuvant chemotherapy and primary surgery. One strategy for OFS, bilateral salpingo-oophorectomy (BSO), has lasting implications, and the routine recommendation for this strategy warrants a critical analysis in this population. The following is a narrative review of the utility of ovarian suppression or ablation (through either bilateral oophorectomy or radiation) in the context of adjuvant endocrine therapy, including selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). The long-term sequelae of bilateral oophorectomy include cardiovascular and bone density morbidity along with sexual dysfunction, negatively impacting overall quality of life. As gynecologists are the providers consulted to perform bilateral oophorectomies in this population, careful consideration of each patient's oncologic prognosis, cardiovascular risk, and psychosocial factors should be included in the preoperative assessment to assist in shared decision-making and prevent the lifelong adverse effects that may result from overtreatment.
Topics: Humans; Female; Breast Neoplasms; Receptors, Estrogen; Antineoplastic Agents, Hormonal; Quality of Life; Ovariectomy
PubMed: 36826100
DOI: 10.3390/curroncol30020139 -
BJOG : An International Journal of... Aug 2022To examine the associations between adverse childhood experiences (ACE) and the risk of hysterectomy and bilateral oophorectomy in a national sample of women in England.
OBJECTIVE
To examine the associations between adverse childhood experiences (ACE) and the risk of hysterectomy and bilateral oophorectomy in a national sample of women in England.
DESIGN
Retrospective cohort study.
SETTING
A stratified random sample of households across England.
POPULATION
2648 women aged ≥55 years in 2007 from the English Longitudinal Study of Ageing (ELSA) were included in the bilateral oophorectomy analyses and 2622 in the hysterectomy analyses.
METHODS
Logistic and multinomial logistic regression analyses of the associations between categories of the ACE summary score (0, 1, 2, ≥3 ACE), eight individual ACE, and hysterectomy and bilateral oophorectomy.
RESULTS
615 women had undergone hysterectomy and 259 women bilateral oophorectomy. We found graded associations between the summary ACE score and risk of hysterectomy and bilateral oophorectomy. In the fully adjusted model, compared with women with no ACE, those with ≥3 ACE had double the odds of hysterectomy (odds ratio [OR] 2.01, 95% confidence interval [CI] 1.30-3.11) and more than double the odds of bilateral oophorectomy (OR 2.61, 95% CI 1.54-4.42). The exclusion of women with cancer history made the associations stronger, especially in women who underwent hysterectomy at age <40 years or bilateral oophorectomy at age ≤44 years. Several individual ACE were positively associated with both outcomes.
CONCLUSIONS
ACE are associated with increased risk of hysterectomy and bilateral oophorectomy. Individual-level covariates did not explain these associations. Our findings highlight the importance of a life course approach to understanding surgical menopause and add to our knowledge of the societal and public health impact of ACE.
TWEETABLE ABSTRACT
Adverse childhood experiences are associated with increased risk of hysterectomy and bilateral oophorectomy in a national sample of women in England.
Topics: Adult; Adverse Childhood Experiences; Female; Humans; Hysterectomy; Longitudinal Studies; Ovariectomy; Retrospective Studies; Risk Factors
PubMed: 34978369
DOI: 10.1111/1471-0528.17088 -
BMJ Open Jun 2017Bilateral oophorectomy has commonly been performed in conjunction with hysterectomy even in women without a clear ovarian indication; however, oophorectomy may have...
OBJECTIVES
Bilateral 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.
DESIGN
Population-based case-control study.
SETTING
Olmsted County, Minnesota (USA).
PARTICIPANTS
From 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).
METHODS
Information 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.
RESULTS
We 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.
CONCLUSIONS
Women 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.
Topics: Adolescent; Adult; Adult Survivors of Child Adverse Events; Age Factors; Case-Control Studies; Child; Cohort Studies; Female; Humans; Life Change Events; Logistic Models; Middle Aged; Minnesota; Multivariate Analysis; Ovariectomy; Premenopause; Risk Factors; Sex Offenses; Young Adult
PubMed: 28592582
DOI: 10.1136/bmjopen-2017-016045 -
Menopause (New York, N.Y.) Jan 2013Ovarian cancer remains the fifth deadliest cancer among women because of its early asymptomatic nature and lack of efficacious screening methods, leading to frequent... (Review)
Review
Ovarian cancer remains the fifth deadliest cancer among women because of its early asymptomatic nature and lack of efficacious screening methods, leading to frequent late-stage diagnosis. Elective oophorectomy is an option for women undergoing benign hysterectomy as a means of reducing their ovarian cancer risk. Benefits also include reduced risk of repeat surgical operation due to adnexal masses and reduced anxiety related to perceived risk of ovarian and breast cancer. The potential negative side effects of elective oophorectomy, such as decreased cognition and sexual function and increased risk of osteoporosis and cardiac mortality, offer support for ovarian conservation. The implications of this elective procedure and the possible consequences without it require physicians to review the pros and cons with patients in light of the patient's individual circumstances and ovarian cancer risk.
Topics: Anxiety; Cognition Disorders; Elective Surgical Procedures; Female; Heart Diseases; Humans; Hysterectomy; Osteoporosis; Ovarian Neoplasms; Ovariectomy; Risk Factors; Sexual Dysfunction, Physiological
PubMed: 22929033
DOI: 10.1097/gme.0b013e31825a27ab -
Journal of the American Veterinary... Jan 2019OBJECTIVE To describe a minimally invasive 3-portal laparoscopic approach for elective ovariohysterectomy and the outcome of that procedure in a population of goats....
OBJECTIVE To describe a minimally invasive 3-portal laparoscopic approach for elective ovariohysterectomy and the outcome of that procedure in a population of goats. DESIGN Descriptive clinical study. ANIMALS 16 healthy client-owned goats. PROCEDURES Food but not water was withheld from all goats for 24 hours before the procedure. Goats were anesthetized and positioned in dorsal recumbency. Three laparoscopic portals were created in the caudoventral portion of the abdomen, and the abdomen was insufflated to a maximum pressure of 10 mm Hg. A blunt-tip vessel sealer and divider device was used to transect the left and right mesovarium and mesometrium and uterus, and the resected tissue was removed from the abdomen. After hemostasis was verified, the portals were closed in a routine manner and anesthesia was discontinued. Goats were discharged from the hospital 24 hours after the procedure, and owners were contacted by telephone or email to obtain short- and long-term follow-up information by use of standardized questions. RESULTS All procedures were performed by a surgeon and assistant surgeon. The procedure was not complex and was easily learned. No intraoperative complications were reported, and only 1 goat required rescue analgesia post-operatively. No other postoperative complications were recorded. Median surgery time was 43 minutes (range, 20 to 65 minutes). All owners were satisfied with the outcome of the procedure, and several perceived that the procedure improved goat behavior. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that laparoscopic ovariohysterectomy was a viable alternative for elective sterilization of female goats.
Topics: Animals; Female; Aggression; Behavior, Animal; Goats; Hysterectomy; Lactation; Laparoscopy; Neoplasms; Ovariectomy
PubMed: 30605389
DOI: 10.2460/javma.254.2.275 -
Maturitas Nov 2018We investigated the association of personal, reproductive, and familial characteristics with bilateral oophorectomy performed for nonmalignant indications in a US...
OBJECTIVES
We investigated the association of personal, reproductive, and familial characteristics with bilateral oophorectomy performed for nonmalignant indications in a US population.
STUDY DESIGN
In an established cohort study, we used the records-linkage system of the Rochester Epidemiology Project (REP http://www.rochesterproject.org) to identify 1653 premenopausal women who underwent bilateral oophorectomy in Olmsted County, Minnesota between 1988 and 2007 for a nonmalignant indication. Each woman was matched by age (±1 year) to a population-based referent woman who had not undergone bilateral oophorectomy as of the index date. We used case-control analyses to investigate several characteristics associated with bilateral oophorectomy. Odds ratios and their 95% confidence intervals were adjusted for race, education, and income.
RESULTS
In the overall analyses, infertility was more common in women who underwent bilateral oophorectomy than in the controls, whereas use of oral contraceptives, a history of breast feeding, and fibrocystic breast disease were less common. The women who underwent bilateral oophorectomy weighed more than controls, had a higher body mass index and were younger at menarche. The associations were more pronounced for women who underwent the bilateral oophorectomy before age 46 years, and some associations were different for women with or without a benign ovarian indication. Reported family histories of uterine and other cancers were more common in women without a benign ovarian indication.
CONCLUSIONS
We identified a number of personal, reproductive, and familial characteristics that were associated with bilateral oophorectomy over a 20-year period. Our historical findings may help inform decision-making about oophorectomy in the future.
Topics: Adult; Body Mass Index; Breast Feeding; Case-Control Studies; Family Characteristics; Female; Fibrocystic Breast Disease; Humans; Medical History Taking; Menarche; Middle Aged; Minnesota; Odds Ratio; Ovariectomy; Premenopause; Reproduction
PubMed: 30314564
DOI: 10.1016/j.maturitas.2018.09.002 -
Fertility and Sterility Dec 2016Bilateral oophorectomy performed in women before they are menopausal induces surgical primary ovarian insufficiency, an acute and chronic deficiency of the hormones... (Review)
Review
Bilateral oophorectomy performed in women before they are menopausal induces surgical primary ovarian insufficiency, an acute and chronic deficiency of the hormones normally produced by the ovaries. Without hormone replacement therapy (HRT) most of these women develop severe symptoms of estrogen (E) deficiency and are at increased risk for osteoporosis, cardiovascular disease, cognitive decline, dementia, and the associated increases in morbidity and mortality. In cases in which a hysterectomy has been performed at the time of bilateral oophorectomy transdermal or transvaginal E replacement therapy without cyclic progestin replacement is the optimum hormonal management for these women. There is substantial evidence this approach even reduces the risk for breast cancer. Unfortunately, unwarranted fear of all menopausal HRTs has become widespread following the reports of the Women's Health Initiative studies. This fear has led to a steep decline in use of E therapy, even in women in whom HRT is clearly indicated. Discussion of possible ovarian conservation in women who are premenopausal is an integral part of the preoperative planning for any women undergoing hysterectomy. Timely and effective HRT for women who will experience surgical primary ovarian insufficiency is clearly indicated.
Topics: Age Factors; Estrogen Replacement Therapy; Female; Humans; Ovariectomy; Primary Ovarian Insufficiency; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 27793381
DOI: 10.1016/j.fertnstert.2016.09.018 -
LGBT Health Oct 2023The purpose of this study is to estimate population-based rates of inpatient hysterectomy and accompanying bilateral salpingo-oophorectomy by indication and evaluate...
The purpose of this study is to estimate population-based rates of inpatient hysterectomy and accompanying bilateral salpingo-oophorectomy by indication and evaluate surgical patient characteristics by indication, year, patient age, and hospital location. We used 2016 and 2017 cross-sectional data from the Nationwide Inpatient Sample to estimate the hysterectomy rate for individuals aged 18-54 years with a primary indication for gender-affirming care (GAC) compared to other indications. Outcome measures were population-based rates for inpatient hysterectomy and bilateral salpingo-oophorectomy by indication. The population-based rate of inpatient hysterectomy for GAC per 100,000 was 0.05 (95% confidence interval [CI] = 0.02-0.09) in 2016 and 0.09 (95% CI = 0.03-0.15) in 2017. For comparison, the rates per 100,000 for fibroids were 85.76 in 2016 and 73.25 in 2017. Rates of bilateral salpingo-oophorectomy in the setting of hysterectomy were higher in the GAC group (86.4%) than in comparison groups (22.7%-44.1% for all other benign indications, 77.4% for cancer) across all age ranges. A higher rate of hysterectomies performed for GAC was done laparoscopically or robotically (63.6%) than other indications, and none was done vaginally, as opposed to comparison groups (0.7%-9.8%). The population-based rate for GAC was higher in 2017 compared to 2016 and low compared to other hysterectomy indications. Rates of concomitant bilateral salpingo-oophorectomy were more prevalent for GAC than for other indications at similar ages. The patients in the GAC group tended to be younger, insured, and most procedures occurred in the Northeast (45.5%) and West (36.4%).
Topics: Female; Humans; Inpatients; Transgender Persons; Cross-Sectional Studies; Hysterectomy; Salpingo-oophorectomy
PubMed: 37252769
DOI: 10.1089/lgbt.2022.0388 -
Cancer Prevention Research... Jun 2012Bilateral oophorectomy is used as a risk reduction strategy in BRCA1/2 mutation carriers, although data on long-term side effects are not yet available. In the general...
Bilateral oophorectomy is used as a risk reduction strategy in BRCA1/2 mutation carriers, although data on long-term side effects are not yet available. In the general population, oophorectomy, particularly at a young age, has been associated with increased overall and cardiovascular disease (CVD) mortality. The mechanisms for this association are not well understood. We examined the association between prior bilateral oophorectomy, obesity, and all-cause, cancer, and CVD mortality. Our study population included women ages 40 and above from the Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative survey with enrollment from 1988 to 1994 and prospective mortality follow-up through December 31, 2006. We excluded women with a history of reproductive cancer or missing oophorectomy status, yielding a study population of 4,040. Cox proportional hazards modeling was used to estimate HR for all-cause and cause-specific mortality. In multivariate analyses, body mass index (BMI) significantly modified the association between oophorectomy and mortality (P(interaction) = 0.04). Women who were obese at the time of interview and who had an oophorectomy at less than 40 years were more than twice as likely to die [HR, 2.23; 95% confidence interval (CI), 1.25-3.98], particularly of CVD (HR, 2.77; 95% CI, 0.91-8.41), than nonobese women with intact ovaries. These associations persisted after excluding women who used estrogen therapy and women who had oophorectomy before 35 years of age. The joint effect of obesity and early oophorectomy on mortality was significantly greater than expected, given the independent effects of both exposures. Our results suggest that minimizing weight gain after oophorectomy and addressing cardiovascular risk factors could beneficially impact mortality.
Topics: Adult; Aged; Body Mass Index; Cardiovascular Diseases; Cause of Death; Cross-Sectional Studies; Female; Follow-Up Studies; Humans; Middle Aged; Neoplasms; Nutrition Surveys; Obesity; Ovariectomy; Prognosis; Risk Factors; Survival Rate
PubMed: 22556202
DOI: 10.1158/1940-6207.CAPR-11-0430