Premature or early bilateral oophorectomy: a 2021 update

Abstract

In this invited review, we discuss some unresolved and controversial issues concerning premature (<40 years) or early (40–45 years) bilateral oophorectomy. First, we clarify the terminology. Second, we summarize the long-term harmful consequences of bilateral oophorectomy. Third, we discuss the restrictive indications for bilateral oophorectomy in premenopausal women to prevent ovarian cancer that are justified by the current scientific evidence. Fourth, we explain the importance of estrogen replacement therapy when bilateral oophorectomy is performed. Hormone replacement therapy is indicated after bilateral oophorectomy until the age of expected natural menopause like in premature or early primary ovarian insufficiency. Fifth, we discuss the relationship between adverse childhood experiences, adverse adult experiences, mental health, gynecologic symptoms and bilateral oophorectomy. The acceptance and popularity of bilateral oophorectomy over several decades, and its persistence even in the absence of supporting scientific evidence, suggest that non-medical factors related to sex, gender, reproduction, cultural beliefs and socioeconomic structure are involved. We discuss some of these non-medical factors and the need for more research in this area.

过早或早期双侧卵巢切除术：2021年更新 摘要

本篇约稿中, 我们讨论了一些未解决的和有争议的问题：过早（<40岁）或早期（40-45岁）双侧卵巢切除术。 首先, 我们阐明了相关术语。其次, 总结了双侧卵巢切除术的长期的不良后果。第三, 讨论了以当前证据论证的绝经前双侧卵巢切除术预防卵巢癌的限制性适应证。第四, 解释双侧卵巢切除术后雌激素替代治疗的重要性。在双侧卵巢切除术后激素替代治疗应直到预期自然绝经年龄, 就像早发性卵巢功能不全或原发性卵巢功能不全。第五, 我们讨论了不良儿童经历、不良成人经历、心理健康、妇科症状和双侧卵巢切除术之间的关系。几十年来双侧卵巢切除术有一定的接受度和普及度, 即使在缺乏支持性科学证据的情况下也持续存在, 表明与性别、生殖、文化信仰和社会经济结构相关的非医学因素也参与其中。我们讨论了其中的一些非医疗因素以及在这一领域应进行更多研究的必要性。

Keywords:

• Bilateral oophorectomy
• premature ovarian insufficiency
• early ovarian insufficiency
• estrogen replacement therapy
• genetic variants
• ovarian cancer
• cancer prevention

Potential conflict of interest

E. A. Stewart has no conflicts of interest directly related to the subject of this article. However, over the past 36 months she has the following conflicts of interest related to uterine fibroids: she has been a consultant for AbbVie, Bayer, ObsEva and Myovant; she has received research support from the National Institutes of Health related to uterine fibroids (P50HS023418) and holds a patent for Methods and Compounds for Treatment of Abnormal Uterine Bleeding (US 6440445), which has no commercial activity; and she has received royalties from UpToDate and payments for the development of educational content from the Med Learning Group, PER, Massachusetts Medical Society and Peer View. M. M. Mielke has no conflicts of interest directly related to the subject of this article. However, she has consulted for Biogen and Brain Protection Company related to blood-based biomarkers of Alzheimer’s disease.

Additional information

Funding

W. A. Rocca and M. M. Mielke are funded by the National Institutes of Health [U54 AG044170], [RF1 AG055151]; L. Gazzuola Rocca and E. A. Stewart do not receive external funding.