Early ovary removal tied to brain changes: Study highlights risks for women considering premenopausal bilateral oophorectomy

"Women who underwent bilateral oophorectomy before age 40 experienced decreased white matter integrity in various brain regions later in life. These findings are significant for women contemplating this procedure for noncancerous conditions," the researchers reported.

Premenopausal bilateral oophorectomy involves the surgical removal of both ovaries before natural menopause occurs. It is often performed to mitigate the risk of ovarian cancer or manage other noncancerous gynecological conditions. PBO is associated with later-life cognition, but there is no clarity on the underlying brain changes. Considering this, Michelle M. Mielke, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA, and colleagues sought to assess the impact of PBO and PBO age on white matter integrity.

The study included females with regional diffusion tensor imaging (DTI) metrics of fractional anisotropy (FA) and mean diffusivity (MD) (22 with PBO < 40 years; 39 with PBO 46-49 years; 43 with PBO 40-45 years; 907 referents without PBO < 50 years). Linear regression models were adjusted for age and apolipoprotein E (APOE) genotype.

The researchers reported the following findings:

• Females with PBO < 40 years, compared to referents, had lower FA and higher MD in the anterior corona radiata, genu of the corpus callosum, inferior frontal-occipital fasciculus, superior occipital, and superior temporal white matter.
• Adjusting for estrogen replacement therapy use did not attenuate results.
• Females who underwent PBO between 45 and 49 also had some changes in white matter integrity.

The researchers concluded, "Abrupt sex hormone changes due to PBO, especially < 40 years, are tied to lower white matter integrity in later life. A larger group of participants followed over an extended period is crucial to better understand the alterations in white matter and to establish how these changes relate to cognitive decline."

They noted that the women involved in this study utilized conjugated equine estrogens, and it remains unclear whether alternative forms of estrogen replacement therapy (ERT) could offer greater benefits in preserving white matter integrity in the brain later in life.

Reference:

Mielke MM, Frank RD, Christenson LR, Reid RI, Fields JA, Knyazhanskaya ZE, Kara F, Vemuri P, Rocca WA, Kantarci K. Premenopausal bilateral oophorectomy and brain white matter brain integrity in later-life. Alzheimers Dement. 2024 Jun 20. doi: 10.1002/alz.13852. Epub ahead of print. PMID: 38899634.