Early Surgical Menopause Linked To Cognitive Decline

By Jaimie Dalessio

A younger age at surgical menopause, or removal of the ovaries, than natural menopause was associated with long-term cognitive decline in an observational study of 1,839 women — 33 percent of whom had undergone surgical menopause.

The association was not observed in women who had natural menopause.

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While the average age for a woman to begin menopause in the United Sates is 51, some might have menopause earlier as a result of surgical removal of the ovaries.

Surgical menopause is not synonymous with hysterectomy, however. A hysterectomy is a surgery to remove the uterus. Women who have a hysterectomy may still keep both their ovaries and have natural menopause. In fact, a woman can still have natural menopause with only one ovary, or even just a piece of one ovary. Often done as part of a hysterectomy, surgical removal of the ovaries is performed for ovarian cancer, endometriosis, ovarian tumors, or cysts.

The findings, which were accepted for presentation at the annual meeting of the American Academy of Neurology in San Diego in March, suggest a link between the duration of hormone replacement therapy (HRT) following early surgical menopause and a slower decline in cognition. But the results are preliminary, says lead researcher Riley Bove, MD, an instructor at Harvard Medical School and an associate neurologist at the Brigham and Women's Hospital.

"Further research needs to be conducted to evaluate the potential neuroprotective effects of HRT after early surgical menopause," Dr. Bove says. "We are planning a more detailed analysis into the various types of HRT used, as well as of the timing of HRT start relative to age at menopause. Further studies in other cohorts are also warranted."

"It's interesting but not surprising," says Lauren Streicher, MD of the findings. Dr. Streicher is an assistant clinical professor of obstetrics and gynecology at Northwestern University's medical school in Chicago. "Estrogen is good for you, and there's a reason why, after women go through menopause, their risk for health problems like cognitive function and heart disease goes up."

Post-menopausal women face a higher risk of heart disease due to loss of estrogen, which affects heart health. They might also have problems related to bone health, sleep, bladder function, and cognition.

In this most recent study, cognition describes many types of thinking skills, Bove explains. She and colleagues measured five specific types, or domains: Episodic memory (relating to time and place); semantic memory (related to concepts and ideas); working memory (the ability to hold onto several pieces of information); perceptual speed (how quickly one can monitor and interpret incoming stimuli); and visuospatial ability (ability to copy a complex shape with many components).

The real question for women considering hysterectomy comes down to the ovaries, says Streicher. It's an important conversation to have with their doctors. Should women remove their ovaries, keep their ovaries, and if they do remove their ovaries, what are the consequences? Streicher recommends that women keep their ovaries unless there's a medical reason to remove them. And if a woman must lose her ovaries, Streicher finds estrogen therapy "absolutely appropriate and beneficial."

While HRT has been linked to health problems, making it a confusing and controversial topic for women, Streicher points out there is a big difference between the question of whether a woman who is 50 or 51 should take HRT and whether one who is 40 and just had surgical menopause should take it. "Yet they're all lumped together in same category," she says.

"We now have yet another study which shows there can be negative impact on women who lose estrogen early," she says, referring to the preliminary findings out today. Further research will hopefully shed more light on the usefulness of HRT for women who must lose both their ovaries.

"Early Surgical Menopause Linked to Cognitive Decline" originally appeared on Everyday Health.