There are certain situations in which a woman may think about having her ovaries removed besides when they’re cancerous—for example, if odds are high that cancer will be found in the ovaries in the future (based on genetics) or if she is having a hysterectomy to remove her uterus, since removing the ovaries as well will greatly decrease her risk for ovarian cancer. In fact, approximately 300,000 women in the US have their ovaries removed each year when their ovaries are perfectly healthy. But, according to a new study, removing them has its own risks. The research suggests that it may raise the risk for both low bone mineral density (BMD), a risk factor for osteoporosis, and, surprisingly, either osteoarthritis or rheumatoid arthritis.
To find out more about how the procedure might raise a woman’s risk for these two serious health problems, I called Anne Marie McCarthy, ScM, a doctoral candidate in epidemiology at Johns Hopkins University Bloomberg School of Public Health in Baltimore and an author of the study. The research was presented at the San Antonio Breast Cancer Symposium in December 2011.
UNINTENDED CONSEQUENCES OF OVARY REMOVAL
McCarthy and her colleague Kala Visvanathan, MD, MHS, associate professor of epidemiology at the Bloomberg School of Public Health, examined BMD studies of 3,660 women and arthritis diagnosis reports of 4,039 women, comparing the results of those who had had both ovaries removed at some point in the past (on average, 17 years earlier) with those whose ovaries were intact. Here’s what the researchers found…
- Higher risk for low BMD. Women who had their ovaries removed before age 45 had a lower BMD, on average, compared with women with intact ovaries—and the difference was largest among women who had their ovaries removed before age 45 and were not on hormone replacement therapy (HRT). There was no significant difference in BMD among women who had their ovaries removed after age 45 compared with women with intact ovaries.
- Higher prevalence of arthritis. Among women who had their ovaries removed after age 45, about 42% had been diagnosed with either osteoarthritis or rheumatoid arthritis, compared with 32% of women with intact ovaries. Among women who had their ovaries removed before age 45, the prevalence of arthritis was even greater—47% had it. And the odds of being diagnosed with arthritis were greater yet among women who did not use HRT.
WHAT’S THE REASON?
Ovaries do lots more than simply churn out eggs—they also produce estrogens, hormones that we know greatly affect a woman’s health in a number of ways. Normally you start out with a lot of estrogens when you’re a young woman in your teens and then the amount gradually decreases as you get older until you hit menopause—at which time the ovaries stop producing estrogens. The liver, fatty tissue and adrenal glands then take over estrogen production, but the amount is not nearly as great. And McCarthy speculates that the estrogens may be a big factor when it comes to having low BMD and arthritis. “The findings suggest that both problems may be a result of estrogen deprivation since women who get their ovaries removed before the age of 45 and do not use HRT seem to be at an especially high risk, compared with women with intact ovaries, because the drop in estrogens is particularly steep and abrupt.”
You might say, well, why don’t more women just take HRT after getting their ovaries removed, since it seems to have a protective effect? Unfortunately, the decision to take HRT is complicated, said Dr. McCarthy, because taking it may raise your risk for other health problems, such as breast cancer. “Women should talk to their doctors about whether or not they should take HRT after having their ovaries removed.”
At any rate, I’ve said it before in Daily Health News and I am sure I will say it again—less is sometimes more when we make decisions about our health care. Cancer prevention is one thing. But if you’re a woman with no special risk for ovarian cancer and you need to have a hysterectomy (especially at a young age), based on this research, having your ovaries removed doesn’t seem to be the benign choice that some doctors may say it is. And if you’ve had your ovaries removed in the past, alert your doctor to this research by showing him or her this article—and ask about careful monitoring for BMD and osteoarthritis.