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    Women’s Wellness: Reduce health risks from early removal of ovaries

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DEAR MAYO CLINIC: I recently read about a study that showed women should not have their ovaries removed before menopause because of the increased risk of developing chronic conditions such as heart disease, lung disease and depression. I had my ovaries removed at age 44 when I had a hysterectomy and am now 55. Are there things I can do to prevent the other conditions mentioned in the study?

ANSWER: For women who have their ovaries removed before 45 and before they reach menopause naturally (usually around 51 in the U.S.), menopausal hormone therapy, or MHT, often is recommended to prevent the negative effects of early estrogen loss.

At 55, though, MHT likely would not be useful for you to prevent chronic disease. There are, however, a variety of lifestyle changes that could lower your risk of chronic disease. Depending on your medical history, other steps may be helpful, too. It would be worthwhile to make an appointment with your primary health care provider to review your health risks and discuss how you might reduce them.

The study you mention, led by a Mayo Clinic research team and published this fall, found that women who had both ovaries removed before age 46 experienced a significantly elevated risk of multiple chronic health conditions, including depression, high cholesterol, heart disease, arthritis, asthma, chronic obstructive pulmonary disease and osteoporosis.

Removing both ovaries — a procedure called bilateral oophorectomy — triggers menopause in women who have not already gone through it. Along with menopause comes a significant drop in the amount of estrogen in a woman’s body.

The study results showed that, in younger women, the premature loss of estrogen caused by an oophorectomy may affect a series of aging mechanisms at the cellular and tissue level across the whole body that can lead to diseases in multiple systems and organs. That means the effects of oophorectomy in premenopausal women are much broader and more severe than previously documented. With these findings in mind, the researchers involved in the study recommend the practice of removing the ovaries to prevent ovarian cancer be discontinued in premenopausal women who are not at high risk of cancer.

For women who go through menopause before 45, several options are available to help lower the risk of chronic disease. Multiple medical societies, including the North American Menopause Society and the International Menopause Society, recommend that women who go through menopause before 45, either naturally or as the result of medical treatment, take MHT at least until 51 — unless there is a clear reason not to do so. MHT can help prevent the potential adverse, long-term health consequences of losing estrogen too soon.

Because you are past 51, there is no evidence that MHT will help prevent chronic disease in your situation, although it can be useful in managing menopause symptoms such as hot flashes, night sweats and sleep problems.

If you want to reduce your risk of chronic disease in midlife and beyond, though, there are many things that you can do. Heart disease is still the No. 1 killer of women, so lowering your risk factors for heart disease is key. Lifestyle factors, such as maintaining a healthy weight, eating a healthy diet, exercising regularly and stopping smoking, are all crucial for long-term health.

Having a discussion with your primary health care provider is a good idea, too. He or she can review your situation, including your personal and family health history, so any treatment you may need can be personalized for you, and you can understand and modify your risks for future disease. — Dr. Stephanie Faubion, Women’s Health Clinic, Mayo Clinic, Rochester, MinnesotaWomen's Wellness logo