A new study shows that ovary removal before menopause is linked
to decreased white matter in the brain later in life.
-A new study examined the brains of females who underwent full
ovary removal before going through menopause.
-Sometimes, females must undergo this type of procedure to treat
conditions such as ovarian cancer or endometriosis.
-The study’s findings show that females who undergo ovary removal
before menopause have a decrease in white matter in their brains later in life.
-A decrease in white matter is linked to cognitive impairment.
A new study examined the cognitive effects of ovary removal in
females.
A researcher with Wake Forest University utilized data from the
Mayo Clinic Study of Aging to study females who had their ovaries surgically
removed before menopause — a procedure called a premenopausal bilateral
oophorectomy (PBO).
When a woman undergoes a PBO, this impacts the body’s hormones,
which can lead to cognitive impairment such as dementia. The researcher,
Professor Michelle Mielke, wanted to see if there was a physiological reason
this occurs.
By studying magnetic resonance imaging (MRI) results from more
than 1,000 females, Michelle Marie Mielke, PhD, a professor of epidemiology and
prevention at WFU, learned that females who underwent PBOs experienced reduced
white matter in multiple parts of their brains.
The findings appear in Alzheimer’s & Dementia: The Journal of
the Alzheimer’s Association.
What’s
the link between ovary removal and cognitive decline?
Human brains consist of two types of brain tissue: gray and white
matter. According to the National Library of Medicine, gray matter controls
movement, memory, and emotions.
White matter plays a different role in the brain. White matter
consists of nerve fibers or axons which allow the brain to process information
and send signals to other parts of the brain and the central nervous system.
Both forms of brain matter decrease with age, which can contribute
to cognitive dysfunction.
In the current study, Mielke examined white matter in the brains
of females because PBOs can be associated with cognitive impairment.
Sometimes, having a PBO is medically indicated when a woman has
ovarian cancer, a history of ovarian cysts, endometriosis, or ovarian torsion.
Females may also opt to have their ovaries removed if genetic testing indicates
a mutation in their BRCA gene, which puts them at a higher risk for both breast
and ovarian cancer.
According to the study, having both ovaries removed before
menopause can cause “abrupt endocrine dysfunction. as a result of removing the
ovaries. The endocrine system is responsible for producing and releasing
hormones, and the ovaries play a direct role in the production of estrogen,
progesterone, and testosterone hormones.
With this in mind, Mielke wanted to see if the endocrine
dysfunction caused by PBOs contributes to any physiological changes within the
brain that could explain cognitive dysfunction.
The study included 1,011 female participants who had MRIs and
diffusion tensor imaging (DTI) on file. DTI measures white matter in the brain.
Mielke divided the participants who had a PBO into the following
groups:
PBO before age 40 (22 participants)
PBO between ages 40 to 45 (43 participants)
PBO between ages 46 to 49 (39 participants)
The reference group was substantially larger, with 907
participants who did not have a history of having a PBO before turning 50.
After sorting out the participants into groups, Mielke compared the white
matter integrity of each group.
Oophorectomy
before menopause led to decreased white matter
The study found that females who underwent a PBO procedure before
turning 40 had lower white matter integrity in their brains later in life
compared to the reference group.
“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 in a news release.
Some regions of the brain that females who had PBOs before 40 saw
changes in include:
·
Anterior corona radiata
·
Genu of the corpus callosum
·
Inferior fronto-occipital fasciculus
·
Superior occipital
While the study maintains that these brain regions are not
typically connected to cognitive decline or Alzheimer’s disease, it does
mention there was a change in the superior temporal white matter, which is
associated with Alzheimer’s pathology.
Females in the age 40–44 group did not show any differences in
white matter integrity compared to the reference group, but females in the age
45–49 group did experience reductions in white matter volume.
Mielke took estrogen replacement therapy into consideration and
noted that 80% of females in all age groups that had PBOs took hormones, so she
was unsure if it had any effect on the white matter findings.
More research is necessary, but the study findings do show that
females who have a PBO procedure before going through menopause may be at a
higher risk for white matter decrease later in life. These initial findings may
factor into someone’s decision to consider PBO for a non-life-threatening
condition.
How hormones may impact cognitive
impairment
Verna Porter, MD, a board certified
neurologist and director of the Dementia, Alzheimer’s Disease and
Neurocognitive Disorders at Pacific Neuroscience Institute in Santa Monica, CA,
spoke with Medical News Today about the study findings.
“The findings are very interesting since they highlight a
potential long-term consequence of premenopausal bilateral oophorectomy (PBO),”
Porter said.
“Women
who had their ovaries removed before age 40 showed reduced white matter
integrity, which suggests an increased risk for cognitive impairment and
dementia. This emphasizes the critical role of ovarian hormone regulation in
maintaining brain structure/ function, particularly in preserving white matter
integrity.”— Verna Porter, MD, neurologist
Porter explained why ovary removal could potentially contribute to
cognitive impairment.
When the ovaries are removed, the body’s source of the hormones
estrogen and testosterone are also removed. Both hormones have “neuroprotective
properties” that contribute to brain health.
“Both hormones contribute to overall brain health, influencing
mood, cognition, and neuroprotection,”
Porter said.
While the study findings are concerning for females who have PBO
procedures before menopause, Porter noted that hormone replacement therapy (HRT) could
help reduce the risk of cognitive issues.
“Estrogen therapy, particularly when started
soon after oophorectomy and within certain therapeutic windows, may help
preserve white matter integrity and cognitive function,” Porter said.
However, not all females who undergo PBO are candidates for
estrogen therapy afterward.
“Other strategies include lifestyle
interventions such as regular physical exercise, cognitive training, a
balanced diet rich in antioxidants and omega-3 fatty acids, and
managing cardiovascular risk factors,” Ported added.
Jonathan Rasouli, MD, a neurosurgeon with
the Department of Neurological Surgery at Staten Island University Hospital in
New York, also spoke with MNT about the study.
“The study’s findings are important because they show that females
who had their ovaries removed before age 40 have reduced white matter integrity
later in life,” Rasouli said.
“This suggests a potential long-term impact on cognitive health
and highlights the importance of hormonal balance in brain maintenance.
While this area needs more research, Rasouli noted it’s possible
these findings could influence future guidelines.
“These
results may influence future guidelines by highlighting the importance of
preserving hormonal balance in women considering oophorectomy at an earlier
age. They could lead to recommendations for monitoring cognitive health and
considering HRT to mitigate risks. The findings advocate for a more nuanced
approach to women’s health, particularly regarding surgical decisions and
hormonal therapies.”— Jonathan Rasouli, MD, neurosurgeon.
https://www.medicalnewstoday.com/articles/ovary-removal-before-menopause-cognitive-decline-dementia-risk