Removing both of a woman's ovaries before natural menopause may reduce the integrity of white matter in their brains, scientists have found.
For most women this operation, known as surgical menopause, can be lifesaving or at least life-changing. In many cases, it is performed as a preventative measure in those who are at an increased risk of ovarian or breast cancer. For others, it is used to reduce the pain caused by endometriosis, a condition where womb tissues grow outside of the uterus.
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By improving our understanding of the potential brain risks of surgical menopause, experts hope that patients and physicians will be able to make more informed decisions over surgical options when it comes to women's health.
"It has been estimated that historically one in eight women had their ovaries removed—some before and some after natural menopause," Michelle Mielke, a professor and chair of epidemiology and prevention at Wake Forest University School of Medicine, told Newsweek.
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"For women who are at high risk of ovarian and breast cancer due to carrying a BRCA [breast cancer gene] mutation or who have a strong family history, the potential benefits of premenopausal bilateral oophorectomy (i.e. removing both ovaries before menopause) may outweigh the risks of subsequent conditions. However, for women who are at normal risk of ovarian cancer, the risks of other subsequent diseases may outweigh the benefits."
Previous research has shown that removal of both ovaries before natural menopause may increase patients' risk of cardiovascular disease and dementia. But what do our ovaries have to do with our brain?
"In addition to their reproductive function, the ovaries are important endocrine organs that secrete hormones both before and after menopause," Mielke said. "Thus, ovaries have many important nonreproductive actions mediated via receptors spread throughout most tissues and organs of the body, including the brain, muscle, bone, blood vessels, heart, and the gastrointestinal tract.
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"Having both ovaries removed results in an abrupt decrease in both estrogen and testosterone in women.... As a result, removal of the ovaries, especially before natural menopause, can contribute to significant endocrine disruption, affecting multiple organs and systems throughout the body."
Despite the roughly 600,000 women who undergo this surgery every year, there has been very little research into the long-term effects of this hormonal disruption. However, thanks to new research, this is beginning to change.
In 2010, researchers from the Mayo Clinic published a paper in the journal Women's Health highlighting a link between ovary removal and dementia, cognitive impairment, and mental health problems. Now, Mielke and colleagues have used MRI data to explore the underlying mechanisms behind this association.
In their study, published in the journal Alzheimer's and Dementia, the Wake Forest team examined MRI data from roughly 100 women who had had their ovaries removed before the onset of menopause. Specifically, they were looking for changes in the integrity of white matter, the tissue that lies in the deep tissues of the brain and consists of nerve fibers and their fatty insulation.
White matter makes up half of the human brain and plays an important role in connecting different brain regions. Loss in white matter integrity can affect our brain's ability to send coordinated signals between these different brain regions, which may ultimately impact our ability to learn, process memories, balance, and solve problems. And it appears this integrity might be affected by surgical menopause.
"Females who had premenopausal bilateral oophorectomy before the age of 40 had significantly reduced white matter integrity in multiple regions of the brain," Mielke said. "There were also trends in some brain regions such that women who had premenopausal bilateral oophorectomy between the ages of 40 to 44 or 45 to 49 years also had reduced white matter integrity, but many of these results were not statistically significant."
More research is needed to understand how these changes in white matter affect cognitive function, as well as whether hormone replacement therapy can mitigate against these effects.
"Additional information regarding the long-term effects of early menopause for all women, including whether the use of menopausal hormone therapy mitigates the risk of early menopause and what makes some women more resilient, is critical to improving women's health," Mielke said.
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Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
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