Long-term risk of depressive and anxiety symptoms after early bilateral oophorectomy
ABSTRACT Objective: We studied the long-term risk of depressive and anxiety symptoms in women who underwent bilateral oophorectomy before menopause.
Design: We conducted a cohort study among all women residing in Olmsted County, MN, who underwent bilateral oophorectomy before the onset of menopause for a noncancer indication from 1950 through 1987. Each member of the bilateral oophorectomy cohort was matched by age with a referent woman from the same population who had not undergone an oophorectomy. In total, we studied 666 women with bilateral oophorectomy and 673 referent women. Women were followed for a median of 24 years, and depressive and anxiety symptoms were assessed using a structured questionnaire via a direct or proxy telephone interview performed from 2001 through 2006.
Results: Women who underwent bilateral oophorectomy before the onset of menopause had an increased risk of depressive symptoms diagnosed by a physician (hazard ratio = 1.54, 95% CI: 1.04-2.26, adjusted for age, education, and type of interview) and of anxiety symptoms (adjusted hazard ratio = 2.29, 95% CI: 1.33-3.95) compared with referent women. The findings remained consistent after excluding depressive or anxiety symptoms that first occurred within 10 years after oophorectomy. The associations were greater with younger age at oophorectomy but did not vary across indications for the oophorectomy. In addition, treatment with estrogen to age 50 years in women who underwent bilateral oophorectomy at younger ages did not modify the risk.
Conclusions: Bilateral oophorectomy performed before the onset of menopause is associated with an increased long-term risk of depressive and anxiety symptoms.
- SourceAvailable from: Elyse Singer
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- "Rocca et al.   1,252 women with unilateral and 1,075 women with bilateral ophorectomy, and 2,368 referent women. "
ABSTRACT: Over the past two decades, there has been a significant amount of research investigating the risks and benefits of hormone replacement therapy (HRT) with regards to neurodegenerative disease. Here, we review basic science studies, randomized clinical trials, and epidemiological studies, and discuss the putative neuroprotective effects of HRT in the context of Alzheimer's disease, Parkinson's disease, frontotemporal dementia, and HIV-associated neurocognitive disorder. Findings to date suggest a reduced risk of Alzheimer's disease and improved cognitive functioning of postmenopausal women who use 17β-estradiol. With regards to Parkinson's disease, there is consistent evidence from basic science studies for a neuroprotective effect of 17β-estradiol; however, results of clinical and epidemiological studies are inconclusive at this time, and there is a paucity of research examining the association between HRT and Parkinson's-related neurocognitive impairment. Even less understood are the effects of HRT on risk for frontotemporal dementia and HIV-associated neurocognitive disorder. Limits to the existing research are discussed, along with proposed future directions for the investigation of HRT and neurodegenerative diseases.04/2012; 2012:258454. DOI:10.1155/2012/258454
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- "The risk of colorectal cancer also is decreased (van Wayenburg et al. 2000), and despite an increase in death from uterine and ovarian cancer with increasing age at menopause, the net effect of later menopause is an increased lifespan (Ossewaarde et al. 2005). As might be expected, early reproductive endocrine dyscrasia, occurring naturally or induced by unilateral or bilateral oophorectomy in premenopausal women, is associated with increased risk of developing dementia, cognitive decline, stroke, fatal and nonfatal coronary heart disease, Parkinsonism, osteoporosis , hip fracture, lung cancer, depression, and anxiety (Parker and Manson 2009; Parker et al. 2009; Rivera et al. 2009a, b; Rocca et al. 2006; Nappi et al. 1999; Rocca et al. 2007; Shuster et al. 2010; Gleason et al. 2005; Rocca et al. 2008a, b, c, 2009; Lisabeth et al. 2009; Baba et al. 2010; Koushik et al. 2009). Indeed, the increased prevalence of cognitive disease in women correlates with the abrupt earlier loss of gonadal function (Jorm et al. 1987; McGonigal et al. 1993; Brookmeyer et al. 1998; Gao et al. 1998; Andersen et al. 1999; Hy and Keller 2000). "
ABSTRACT: The reproductive-cell cycle theory of aging posits that reproductive hormone changes associated with menopause and andropause drive senescence via altered cell cycle signaling. Using data from the Wisconsin Longitudinal Study (n = 5,034), we analyzed the relationship between longevity and menopause, including other factors that impact "ovarian lifespan" such as births, oophorectomy, and hormone replacement therapy. We found that later onset of menopause was associated with lower mortality, with and without adjusting for additional factors (years of education, smoking status, body mass index, and marital status). Each year of delayed menopause resulted in a 2.9% reduction in mortality; after including a number of additional controls, the effect was attenuated modestly but remained statistically significant (2.6% reduction in mortality). We also found that no other reproductive parameters assessed added to the prediction of longevity, suggesting that reproductive factors shown to affect longevity elsewhere may be mediated by age of menopause. Thus, surgical and natural menopause at age 40, for example, resulted in identical survival probabilities. These results support the maintenance of the hypothalamic-pituitary-gonadal axis in homeostasis in prolonging human longevity, which provides a coherent framework for understanding the relationship between reproduction and longevity.Age 12/2011; 35(1). DOI:10.1007/s11357-011-9342-1 · 3.45 Impact Factor
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- "Earlier age at menopause in women with lower educational levels increased their risk of depression, but long-term oral contraceptive use (>10 years) was protective against depression.43 Earlier bilateral oophorectomy before the onset of menopause is associated with an increased risk of depressive symptoms.44 "
ABSTRACT: Only recently has the perimenopause become recognized as a time when women are at risk for new onset and recurrence of major depression. Untreated depression at this time not only exacerbates the course of a depressive illness, but also puts women at increased risk for sleep disorders, cardiovascular disease, diabetes, and osteoporosis. Although antidepressant medication is the mainstay of treatment, adjunctive therapy, especially with estrogen replacement, may be indicated in refractory cases, and may speed the onset of antidepressant action. Many, but not all, studies, report that progesterone antagonizes the beneficial effects of estrogen. Although some antidepressants improve vasomotor symptoms, in general they are not as effective as estrogen alone for relieving these symptoms. Estrogen alone, however, does not generally result in remission of major depression in most (but not all) studies, but may provide benefit to some women with less severe symptoms if administered in therapeutic ranges. The selective serotonin reuptake inhibitors (SSRIs) in addition to estrogen are usually more beneficial in improving mood than SSRIs or estrogen treatment alone for major depression, whereas the selective norepinephrine and serotonin reuptake inhibitors do not require the addition of estrogen to exert their antidepressant effects in menopausal depression. In addition to attention to general health, hormonal status, and antidepressant treatment, the optimal management of perimenopausal depression also requires attention to the individual woman's psychosocial and spiritual well being.International Journal of Women's Health 08/2010; 2(1):143-51. DOI:10.2147/IJWH.S7155