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FACHLITERATUR INTERNATIONAL II
psychische Ausirkung der Kastration, Auswirkungen der Kastration auf das Gehör der Frau
[Surgical procedure connected complications in women with cervical cancer operated with ovarian transposition (transpositio ovariorum)]
[Article in Polish]
• Olejek A,
• Rzempoluch J,
• Adamczyk S,
• Binkiewicz P,
• Chimiczewski P.
I Katedry i Kliniki Poloznictwa i Ginekologii SIAM w Bytomiu.
OBJECTIVES: Approximately one-half of women with cervical cancer are premenopausal. Preservation of ovarian function in these women is highly desirable. The safety and efficacy of ovarian retention include risk of ovarian metastasis, risk of surgery, psychological impact of surgical castration, expense of hormone supplementation. DESIGN: This report compares intra- and postoperative surgical complications in 2 groups of women with cancer in stage Ib and IIa treated by radical hysterectomy (Wertheim-Meigs operation). MATERIALS AND METHODS: Two groups were compared: 72 patients with ovarian transposition and 55 women without transposition, but after brachy-HDR therapy. The surgery time was mean 30 minute longer in case of ovarian transposition. RESULTS: There was no difference in mean time of hospital stay after the surgery, the frequency of relaparotomy, deep vein thrombosis, urological complications and blood transfusion between the groups. There was confirmed the higher number of lymphatic pseudocysts (p < 0.0005) and fever (p < 0.001) in women without transposition, but after brachy-HDR therapy. We linked this with the previously applied radiotherapy. CONCLUSIONS: We conclude that ovarian transposition is the procedure which can safe the endogenous ovarian function in young women with cervical cancer without the higher risk of complications.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9813944&dopt=Abstract
Probleme mit den Ohren (grausames Dröhnen, laute Geräusche etc. berichten Frauen nach Kastrationen)
Hier die Erklärung, warum das so ist:
The effect of hormonal factors on the hearing organ in women, after surgical castration. Preliminary Report
by A. Reron, E. Reron, M. Modrzejewski, P. Strek &
M. Trojnar-Podlesny
Submitted: August 15, 200
2 Accepted: November 5, 2002
hearing organ, surgical castration
Abstract
Objectives. The content of C-Fos protein was tested in rat pinealocytes in the norm and stress and in case of intranasal administration of Epitalon (Ala-Glu-Asp-Gly), which regulated pineal secretion processes, presumably, via protooncogenes.
SETTING. Intact and osmotic-stress-exposed rats were used for the immunohistochemical detection of C-Fos protein. All animals were intranasally administered with Epitalon, the last infusion made in two hours before the biopsy. Simultaneously, light microscopy of the pineal parenchyma was performed in all groups of animals.
RESULTS. A slight but significant C-Fos increase was observed only in stress-exposed pinealocytes of rats after intranasal Epitalon infusions. C-Fos was irregularly distributed throughout pineal cells. In stress, the clusters of 5-10 cells containing C-Fos in their cytoplasm were detected. The dilation of capillaries and pericapillary space induced by an osmotic stress was partially reduced by the intranasal infusions of Epitalon.
CONCLUSIONS. Tetrapeptide Epitalon is synthesised on the basis of the amino acid composition of pineal peptide extract Epithalamin. Epitalon modulates pineal secretion only under a stress impact but never in the norm. It prevents osmotic-stress-induced pathologic changes in the pineal parenchyma structure. Besides, the physiological activity of Epitalon seems to be mediated by the activation of protooncogenes in pinealocytes.
NEL Vol.23 No.5/6, Oct-Dec 2002
ORIGINAL ARTICLE
The effect of hormonal factors on the hearing organ in women, after surgical castration. Preliminary Report.
2002; 23:455-458
pii: NEL235602A11
PMID: 12500172
http://www.nel.edu/23_56/NEL235602A11_Reron.htm
Satya B. Bellerose1 and Yitzchak M. Binik1
(1)
Department of Psychology, McGill University, Stewart Biology Building, 1205 Dr. Penfield Avenue, H3A 1B1 Montreal, Quebec, Canada
Abstract Five groups of women ages 35 to 55 years were studied, including a nonsurgical control group (CTL), a hysterectomy-only (HYS), and three oophorectomy groups: an untreated group (UNT), women on estrogen replacement therapy (EST), and women on androgen-estrogen replacement therapy (COM). The interview/questionnaire session assessed mood, body image, and sexual functioning. In a second session completed by 58 of 129 subjects (45%), a photoplethysmograph measured vaginal blood flow in response to an erotic stimulus while subjects concurrently monitored subjective arousal. Overall, the UNT and EST groups had significantly lower self-reported desire and arousal than the remaining three groups. Body image was significantly poorer in the UNT group. All surgical groups reported more sexual problems than the control group. Furthermore, about a third of the CTL group reported positive changes in body image and sexuality in the previous 5 years. This effect was attenuated in the HYS, COM, and EST groups and almost absent in the UNT group. No significant group differences were obtained, however, on mood or vaginal blood flow and subjective arousal to an erotic stimulus. The role of differential levels of testosterone on sexuality is discussed as well as its clinical implications.
Key words hysterectomy - oophorectomy - vaginal photoplethysmograph - female sexuality - body image
This research was conducted as part of the first author's Ph.D. thesis requirement under the direction of the second author at McGill University and was supported by grants from the Medical Research Council of Canada (Studentship), Fonds pour la Formation de Chercheurs et l'Aide à la Recherche, and McGill Faculty of Graduate Studies and Research-Social Science Research Grant. Dr. Bellerose is currently at the Douglas Hospital in Verdun, Quebec.
Does premenopausal oophorectomy adversely affect psychological or sexual outcome? A systematic review.
Teperi J, Clarke A, Sanderson C.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1998; 14: 56.
Health Services Research Unit, STAKES, Helsinki, Finland.
OBJECTIVE: To comprehensively review the evidence on psychological and sexual outcomes of premenopausal prophylactic bilateral oophorectomy (PPBO). METHODS: Original studies were searched by using sensitive strategies in 7 bibliographic databases. "Backsearches" and "author searches" were also used. Compliance with inclusion criteria relating to design, participants, interventions, and outcome measures were assessed for methodological quality. Assessments were undertaken independently by two experts blind to authorship, results, and conclusions. RESULTS: Included were 17 papers from 12 separate papers (6 papers from randomized trials and 7 from prospective cohort studies, 3 from retrospective cohort studies and one from a cross-sectional study). Most studies had small samples and short follow-up periods. Heterogeneity and inadequate reporting of outcomes prevented quantitative synthesis of the results. The evidence strongly suggested that PPBO causes depressive symptoms and deterioration of motivational aspects of sexual functioning. PPBO is also likely to induce negative mood changes, poor general psychological well-being and poor general quality of sex life. Estrogen replacement effectively prevents depression, but seems to only partially or minimally mitigate other psychological and sexual sequelae. Testosterone alone or combined with estrogen restores psychological well-being and sexual functioning more effectively, but the net benefit of this treatment is not known. CONCLUSIONS: Evidence on the negative effects of PPBO on psychological and sexual outcomes should be incorporated into clinical decision making in the context of each individual patient's values and life situation. The amount of research in this area is limited, and some of it is of poor quality. More research is needed to replicate key randomized trials, to evaluate effects of testosterone use and to assess long-term effects of PPBO.
http://gateway.nlm.nih.gov/MeetingAbstracts/102234678.html
Survival patterns after oophorectomy in premenopausal women: a population-based cohort study
Prof Walter A Rocca MDa, c, Corresponding Author Contact Information, E-mail The Corresponding Author, Brandon R Grossardt MSb, Mariza de Andrade PhDb, Prof George D Malkasian MDd and Prof L Joseph Melton III MDa
aDivision of Epidemiology, Mayo Clinic College of Medicine, Rochester, MN, USA
bDivision of Biostatistics, Mayo Clinic College of Medicine, Rochester, MN, USA
cDepartment of Health Sciences Research and Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
dDepartment of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
Available online 15 September 2006.
Summary
Background
A statistical model of death due to ovarian cancer, breast cancer, coronary heart disease, hip fracture, and stroke has suggested that women who undergo prophylactic bilateral oophorectomy are at increased risk of death for all causes. We aimed to investigate survival patterns in a population-based sample of women who had received an oophorectomy and compare these with women who had not received an oophorectomy.
Methods
From an existing cohort of all women who underwent unilateral or bilateral oophorectomy while residing in Olmsted County, MN, USA, in 1950-87, we analysed those who had received an oophorectomy for a non-cancer indication before the onset of menopause. Every member of the cohort was matched by age to a referent woman in the same population who had not undergone oophorectomy. 1293 women with unilateral oophorectomy, 1097 with bilateral oophorectomy, and 2390 referent women were eligible for the study. Women were followed up until death or the end of the study (staggered over 2001-06) by use of direct or proxy interviews, medical records in a records-linkage system, and death certificates.
Findings
Overall, mortality was not increased in women who underwent bilateral oophorectomy compared with referent women. However, mortality was significantly higher in women who had received prophylactic bilateral oophorectomy before the age of 45 years than in referent women (hazard ratio 1·67 [95% CI 1·16-2·40], p=0·006). This increased mortality was seen mainly in women who had not received oestrogen up to the age of 45 years. No increased mortality was recorded in women who underwent unilateral oophorectomy in either overall or stratified analyses.
Interpretation
Although prophylactic bilateral oophorectomy undertaken before age 45 years is associated with increased mortality, whether it is causal or merely a marker of underlying risk is uncertain.
Corresponding Author Contact InformationCorrespondence to: Prof Walter A Rocca, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
The Lancet Oncology
Volume 7, Issue 10, October 2006, Pages 821-828
PDF
Sexual Functioning and Quality of Life After Oophorectomy in Premenopausal Women
Teplin et al. Obstet Gynecol.2006; 107: 18S-19S
Early oophorectomy is linked with doubled risk of later Parkinson's
OB/GYN News, May 15, 2005 by Michele G. Sullivan
Find More Results for: "oophorectomy premenopausal "
Salpingo-oophorectomy
Oophorectomy
Salpingo-Oophorectomy
Higher-dose estrogen...
MIAMI BEACH -- Bilateral oophorectomy in premenopausal women is associated with an almost doubled risk of later developing both parkinsonism and Parkinson's disease.
The association may be due to prematurely reduced levels of endogenous estrogen. Walter Rocca, M.D., said at the annual meeting of the American Academy of Neurology. "The risk was maximum when the surgery occurred in women who were 35 and younger, and least when it occurred nearer to menopause," Dr. Rocca said in an interview. "This is supportive of the hypothesis that endogenous estrogen is important in brain protection."
Dr. Rocca, professor of epidemiology and neurology at the Mayo Clinic, Rochester, Minn., performed a historical cohort study on more than 4,000 women who were part of the Rochester Epidemiology Project. Established in 1935, the project encompasses the records of every resident of Olmstead County, Minn., who has received care in that county.
For this project, Dr. Rocca followed 2,511 women who had either bilateral or unilateral oophorectomy in the county from 1950 to 1987, affording up to 50 years of follow-up data. Among the group, 1,302 women had bilateral oophorectomy, and 1,209 had unilateral oophorectomy. These cases were matched with 2,511 women without oophorectomy. All women were followed through the onset of parkinsonism or Parkinson's disease, death, loss to follow-up, or the end of the study, whichever came first. In the nonexposed group, there were 29 cases of parkinsonism and 18 cases of Parkinson's disease. In the exposed group, there were 51 cases of parkinsonism and 31 cases of Parkinson's disease. Women with bilateral oophorectomy were 80% more likely than were controls to develop parkinsonism and twice as likely to develop Parkinson's disease. Women with unilateral oophorectomy were 60% more likely to develop parkinsonism and 40% more likely to develop Parkinson's disease.
"Although the association for unilateral surgery wasn't statistically significant, the risk was increased, which tells us that removing even one ovary may be important," Dr. Rocca said.
Many of the surgically menopausal women went for years without receiving any replacement estrogen, he added. "These surgeries took place 20-50 years ago, and there were concerns about giving estrogen for long periods of time even after a bilateral oophorectomy. Only half of the women with bilateral oophorectomy got any estrogen at all, because when they were operated on, half were at an age where the physician thought there was really no need for replacement. Even among the ones who were treated, the median therapy time was only 6 years."
Although the study suggests that premenopausal estrogen is neuroprotective, it does not support the same theory for postmenopausal estrogen therapy, he added. "We're talking about women who had their endogenous estrogen reduced during their normally productive years. That's a completely different thing than looking at postmenopausal women taking estrogen as a supplement."
BY MICHELE G. SULLIVAN
Mid-Atlantic Bureau
COPYRIGHT 2005 International Medical News Group
http://findarticles.com/p/articles/mi_m0CYD/is_10_40/ai_n13806918
Prophylactic oophorectomy: Removing your ovaries to reduce your risk of breast and ovarian cancer
From MayoClinic.com
Special to CNN.com
Risks of surgery
Any surgery carries with it the potential for complications. With laparoscopic oophorectomy, rare complications include infection, intestinal blockage and injury to internal organs.
However, the biggest risks of surgery aren't from the surgical procedure itself but from the loss of hormone function in premenopausal women. If you haven't already gone through menopause, prophylactic oophorectomy will cause you to go into early menopause. You then face these health risks:
* Osteoporosis. Although circulating estrogen may help some breast cancers grow, the estrogen your body makes has a protective effect on your bones. Removal of your ovaries if you're premenopausal means you lose the protective effect of estrogen and increase your risk of the bone-thinning disease osteoporosis. You may need to take a bone-building medication to prevent or treat osteoporosis.
* Discomforts of menopause. Hot flashes, vaginal dryness, sexual problems, sleep disturbance and sometimes cognitive changes are problems that some women experience during menopause. Removing your ovaries doesn't mean you'll experience such common menopausal signs and symptoms, but the risk is greater that some of these discomforts could impact your quality of life. Ask your doctor about non-hormonal alternatives, such as healthy lifestyle options, for managing bothersome menopausal signs and symptoms.
* Cancer. Although prophylactic oophorectomy can reduce your cancer risk a great deal, the surgery doesn't completely eliminate your risk of breast or ovarian cancer. Also, because it's possible that some ovarian cells or tissue may remain in your abdomen or pelvis (peritoneum) after an oophorectomy, you could still develop cancer in those cells. This risk is small but still present.
For the discomforts of menopause, taking low-dose hormone therapy to protect your health is an option, especially if you've had the surgery done at a young age. Although it seems contrary to reason to remove your ovaries because they release estrogen into your system and then receive hormone therapy to add estrogen to your system, the amount of hormone you receive through the medication is less than what your ovaries normally produce during the premenopausal years. If you decide to take low-dose estrogen, you'll need to discontinue this treatment after age 50.
It isn't entirely clear what effect estrogen or combined estrogen-progestin therapy might have on your cancer risk. Discuss this risk with your doctor so that you can gain insight with regard to your personal circumstances.
Alternatives to oophorectomy
As you consider prophylactic oophorectomy, be aware that there are alternatives. For instance, you can bypass surgery altogether and instead keep a close watch on your situation. This might entail having clinical breast exams every six months and mammograms every year to check for breast cancer, as well as other breast imaging, such as magnetic resonance imaging (MRI), upon your doctor's discretion. You might also need to have blood screening and pelvic ultrasounds to check for ovarian cancer.
It's also possible that you may qualify for medication that has a known preventive effect on cancer (chemoprevention), such as tamoxifen for breast cancer or birth control pills for ovarian cancer.
Another alternative is estrogen-suppressing medication to slow or stop the production of estrogen by your ovaries. Taking estrogen-suppressing medication offers the advantage that its effects are potentially reversible once you stop taking the medicine. These medications assist in reducing breast cancer risk, but since your ovaries remain in place, they have little to no effect on your ovarian cancer risk.
Yet another possibility to reduce your risk of ovarian cancer is tubal ligation — a surgical procedure that involves cutting or sealing each of your fallopian tubes. Researchers have found that tubal ligation reduces the risk of ovarian cancer in women with BRCA1 mutations, although they haven't found a benefit for women with BRCA2 mutations. Ovarian cancer risk may be reduced by about 60 percent for BRCA1 carriers. However, this is considerably less than the degree of protection offered by prophylactic oophorectomy. Still, if you're in your late 20s to mid-30s and you've finished having children, tubal ligation may provide a more acceptable option than surgically induced menopause.
Emotional effects of prophylactic oophorectomy
If you have a high risk of breast and ovarian cancer, prophylactic oophorectomy might make you feel better about your future because it can significantly reduce your risk. You might spend less time worrying about your health after the surgery.
However, this type of surgery also can take a toll emotionally. You might mourn the loss of your fertility — even if you didn't plan on having children in the future. You may have concerns over taking hormone therapy, especially in light of the associated health risks reported in recent years. Or you may, like some, have a strong sense of femininity tied to your ovaries and other reproductive organs. You might fear that you'll somehow be less of a woman.
The decision to have prophylactic oophorectomy is a difficult one. There's no clearly right or wrong answer. It comes down to a personal choice that merits advice from a genetic counselor along with discussions with a breast health specialist or gynecologic surgeon. Whether it's right for you — and when it might be right for you — depends on your individual risk of cancer and how aggressive you want to be in your cancer prevention efforts.
March 03, 2005
© 1998-2006 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.
http://www.cnn.com/HEALTH/library/WO/00095.html
GUIDELINE TITLE
Prophylactic oophorectomy.
BIBLIOGRAPHIC SOURCE(S)
American College of Obstetricians and Gynecologists (ACOG). Prophylactic oophorectomy. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 1999 Sep. 7 p. (ACOG practice bulletin; no. 7). [33 references]
GUIDELINE STATUS
This is the current release of the guideline.
According to the guideline developer, this guideline is still considered to be current as of December 2004, based on a review of literature published that is performed every 18-24 months following the original guideline publication.
MAJOR RECOMMENDATIONS
The grades of evidence (I-III) and levels of recommendations (A-C) are defined at the end of "Major Recommendations" field.
The following recommendations are based primarily on consensus and expert opinion (Level C):
The decision to perform prophylactic oophorectomy should not be based only on age; it should be a highly individualized decision that takes into account several patient factors and choices.
Removal of one ovary at the time of hysterectomy in premenopausal women may indicate the suspicion of clinical disease. The likelihood of future pathology in the retained ovary is therefore greater. The patient should be counseled before surgery that if ovarian pathology is found, bilateral oophorectomy may be indicated.
Hormone replacement therapy should be considered for women undergoing prophylactic oophorectomy, and patients should be counseled about the risks and benefits of hormone replacement therapy prior to undergoing surgery.
Compliance with hormone replacement therapy is important in women undergoing prophylactic oophorectomy to reduce the risk of future morbidity.
Prophylactic oophorectomy should be considered for select women at high risk of inherited ovarian cancer.
In addition to health risks and benefits, patient counseling should include consideration of how oophorectomy may relate to the individual patient's body image, perceptions concerning sexuality, and personal feelings.
http://www.guideline.gov/summary/summary.aspx?doc_id=3958&nbr=003095&string=oophorectomy
The National Guideline Clearinghouse™ (NGC) is a comprehensive database of evidence-based clinical practice guidelines and related documents. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. NGC was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans (now America's Health Insurance Plans [AHIP]).
Hysterectomy, oophorectomy, and heart disease risk factors in older women.
D Kritz-Silverstein, E Barrett-Connor, and D L Wingard
Department of Family and Preventive Medicine, University of California-San Diego 92093-0607, USA.
alt="Small right arrow pointing to:">This article has been cited by other articles in PMC.
Abstract
OBJECTIVES: This study examined the relation of hysterectomy and oophorectomy to heart disease risk factors. METHODS: Data were collected and analyzed for 1150 women aged 50 through 89. RESULTS: Of these women, 21.8% reported hysterectomy with bilateral oophorectomy; 22.1%, hysterectomy with ovarian conservation. Compared with women without hysterectomy, oophorectomized women, especially those 20 or more years postmenopause, had increased lipids, lipoproteins, glucose, and insulin; blood pressures were increased among current estrogen users. Women with hysterectomies with ovarian conservation had similar or more favorable risk factors than nonhysterectomized women.
CONCLUSIONS: Bilateral oophorectomy, but not hysterectomy, may have long-term negative consequences for heart disease risk factors not totally ameliorated by estrogen use.
Full text
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1380855
Risk of Cardiovascular Disease by Hysterectomy Status, With and Without Oophorectomy. The Women’s Health Initiative Observational Study
Barbara V. Howard PhD*, Lewis Kuller MD, Robert Langer MD, JoAnn E. Manson MD, Catherine Allen PhD, Annlouise Assaf PhD, Barbara B. Cochrane PhD, RN, Joseph C. Larson MS, Norman Lasser MD, Monique Rainford MD, Linda Van Horn PhD, Marcia L. Stefanick PhD, and Maurizio Trevisan MD
From the MedStar Research Institute (B.V.H., M.R.), Washington, DC; University of Pittsburgh (L.K.), Pittsburgh, Pa; UCSD School of Medicine (R.L.), La Jolla, Calif; Brigham and Women’s Hospital (J.E.M.), Harvard Medical School, Boston, Mass; University of Wisconsin (C.A.), Madison, Wis; The Memorial Hospital of Rhode Island (A.A.), Pawtucket, RI; Fred Hutchinson Cancer Research Center (B.B.C.), Seattle, Wash; University of Medicine and Dentistry of New Jersey (N.L.), Newark, NJ; Northwestern University (L.V.H.), Chicago, Ill; Stanford School of Medicine (M.L.S.), Stanford, Calif; and Buffalo General Hospital (M.T.), Buffalo, NY.
* To whom correspondence should be addressed. E-mail: Barbara.V.Howard@MedStar.net.
Background--Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in women and may vary by hysterectomy (or oophorectomy) status. This study compared CVD risk factors and rates between postmenopausal women who had and had not undergone hysterectomy, with or without oophorectomy.
Methods and Results--This analysis was conducted on 89 914 women in the Women’s Health Initiative (WHI) Observational Study. Participants reported demographic characteristics, medical history, dietary habits, physical activity, medications, and previous hysterectomy (with or without oophorectomy). Baseline weight, height, waist circumference, and blood pressure were measured. CVD events were ascertained during 5.1 years of mean follow-up and adjudicated with standard criteria. Black, Hispanic, and American Indian women had higher rates of hysterectomy than white women (52.9%, 44.6%, and 49.2% versus 40.0%, respectively), and Asian/Pacific Islander women had lower rates (33.8%). Women with a hysterectomy (regardless of oophorectomy status) had an adverse risk profile at baseline compared with women with no hysterectomy, including a higher proportion of hypertension, diabetes, high cholesterol, obesity, and lower education, income, and physical activity (all P<0.01). Total mortality and fatal and nonfatal CVD were higher among women with a hysterectomy. Hysterectomy (regardless of oophorectomy status) was a significant predictor of CVD (HR: 1.26, P<0.001). After adjustment for demographic variables and CVD risk factors, the effect was reduced and nonsignificant.
Conclusions--Women with a hysterectomy had a worse risk profile and higher prevalence and incidence of CVD in this cohort. Multivariate models suggest that hysterectomy is not the major determinant of this outcome; rather, CVD risk may be due to the more adverse initial risk profile of women who had undergone hysterectomy.
http://circ.ahajournals.org/cgi/content/abstract/01.CIR.0000159344.21672.FDv1?ck=nck
PDF
Ovarian Conservation at the Time of Hysterectomy for Benign Disease
Smith Obstet Gynecol.2005; 106: 1413
http://www.greenjournal.org/cgi/reprint/106/6/1413
Originally published as JCO Early Release 10.1200/JCO.2004.01.926 on February 23 2004
Journal of Clinical Oncology, Vol 22, No 6 (March 15), 2004: pp. 978-980
© 2004 American Society of Clinical Oncology.
EDITORIAL
Prophylactic Oophorectomy and Hormone Replacement Therapy: Protection at What Price?
Judy Ellen Garber, Anne-Renee Hartman
Dana Farber Cancer Institute, Boston, MA
The publication of the Women's Health Initiative data within the last year has introduced more complexity into decisions faced by all women entering menopause who are trying to balance symptom management with increased risks of serious conditions, including breast cancer [1-4]. These decisions are perhaps more difficult for women with increased risk of breast and ovarian cancers based on mutations in the BRCA1 or BRCA2 breast and ovarian cancer susceptibility genes. Since prophylactic surgery reduces the risks of breast and ovarian cancers in these women, the question is no longer whether a carrier should undergo prophylactic bilateral salpingo-oophorectomy (BSO), but when to have surgery, whether or not to include the uterus, and whether to use hormone replacement therapy (HRT). The management of surgical menopause resulting from BSO requires strategies for mitigating frequently powerful menopausal symptoms, including hot flashes, loss of libido, potential cognitive effects, and changes in a woman's body image and self-image. One effective remedy, HRT, may further increase breast cancer risk above the excess risk conferred by the mutation. This situation, in which complete data on which to base recommendations are not yet available, is perfect for decision analysis.
In this issue of the Journal of Clinical Oncology, Armstrong et al [4a] take on the challenge of helping women and their physicians deal with this dilemma, by reporting the results of a Markov decision analysis estimating gains in life expectancy for a cohort of women who carry a germline mutation in BRCA1 or BRCA2 after BSO, with and without HRT. The model uses data from both single-institution and multicenter studies of mutation carriers, in which BSO resulted in approximately 90% and 50% reductions in the dominant risks of ovarian and breast cancers, respectively [5,6]. The potential impact of HRT on five major diseases, including breast and ovarian cancers, osteoporosis, coronary heart disease, and venous thromboembolism was culled from recent large randomized studies in post menopausal women [1-4]. Using these figures in their model, the authors derive estimates for very small reductions in life expectancy gains from BSO with HRT. They conclude that caregivers should recommend BSO at completion of childbearing for women who carry germline mutations in BRCA1 and BRCA2, and that neither the physician nor the patient should be dissuaded from considering HRT use for symptom management for fear of increased breast cancer risk.
The model is well constructed and is based on current data. However, the fundamental question that must be asked before the conclusion of the analysis can be applied in general practice is whether the data on postmenopausal hormone use from a cohort of women at average population risk of breast cancer apply to the women in the model, who have a markedly increased breast cancer risk based on their mutations. Armstrong et al [4a] use sensitivity analysis (shown in Table 2 of their article) to address this question and simulate a maximum 2.5-fold relative risk of breast cancer in this population of women taking HRT. However, recent studies of oral contraceptives and breast cancer risk in women with a family history of the disease in first-degree relatives or founder mutations in BRCA1 and BRCA2, though not always consistent, have demonstrated estimated relative risks of 3.3 and 7.8, respectively [7,8]. Breast cancer risk from exogenous hormone use among women with BRCA1 and BRCA2 mutations, therefore, may exceed those estimated in the current model. Furthermore, this model was not constructed to address potential scenarios in which hormone use alters the penetrance function to shift more breast cancer risk to earlier ages, or, perhaps more plausibly, to negate or substantively diminish the risk-reducing benefit of the BSO, at least for the duration of the hormone use.
In addition, there are reasons to believe that the effects of estrogen or progesterone on breast tissue may differ between carriers of BRCA1 versus BRCA2 mutations, something that could not be examined in the Armstrong et al [4a] model. BRCA1 carriers are more likely to develop estrogen receptor-negative cancers [9]. These tumors have distinct genetic profiles and may have a specific cell of origin [10]. Conversely, women who carry a germline BRCA2 mutation are more likely to develop estrogen receptor-positive breast cancer and, therefore, may be more susceptible to the effects of HRT [9]. Yet, prophylactic BSO has been shown to substantially reduce the breast cancer risk in both BRCA1 and BRCA2 mutation carriers. The most likely mechanism of the risk reduction is the removal of the vast majority of endogenous hormonal influence, though loss of other ovarian products (eg, inhibin, Mullerian inhibitory factor) could contribute to the effect. This suggests that estrogen or progesterone may play a role in the development of BRCA1-associated tumors that is different from their action on sporadic, estrogen receptor-negative disease. These issues do not constitute direct evidence against the treatment of hormone replacement in the Armstrong et al model, but they do provide some reasons for caution in considering the model as a basis for recommendation of hormone use in mutation carriers.
Another reason to consider BRCA1 and BRCA2 mutation carriers separately in future models is the emerging difference in the ovarian cancer penetrance curves between the two genes. There are much higher age-specific and lifetime risks of ovarian cancer for BRCA1 carriers (in which the ovarian cancer risk is 40%) than for BRCA2 carriers, who have a 10% lifetime risk [11]. Although the authors suggest that the lower risk of an individual for breast and ovarian cancer results in a smaller benefit of BSO in life expectancy gain, separate analyses for BRCA1 and BRCA2 carriers may ultimately prove useful in considering other complexities in estimating life-expectancy gains for these two groups. Strong, growing data support the ability of high-quality magnetic resonance imaging (MRI) to detect very early stage breast cancers, and this may also translate to a survival benefit [12-14]. Interventions, including tamoxifen and breast MRI screening, may significantly reduce the risk of both developing breast cancer and dying from it, perhaps permitting at least BRCA2 carriers to defer the difficult quality-of-life decisions for early BSO and HRT until they are older.
The authors also indicate that the current data on the adverse effects of hormones on the risk of breast cancer and other potentially life-threatening conditions (coronary artery disease, thromboembolism) are confined to estrogen-progesterone combinations and raise the question as to whether estrogen alone may be a preferable option for women considering short-term hormone use for symptom management. For young BRCA1 and BRCA2 mutation carriers, this strategy currently requires the addition of hysterectomy to BSO, more extensive surgery with longer recovery and higher complication rates.
In the absence of definitive data or a model specifically addressing these issues, medical oncologists must carefully weigh the results of the Armstrong et al [4a] model and other emerging data in their recommendations to the increasingly identified population of young BRCA1 and BRCA2 mutation carriers. Many experts consider the data for another hormonal manipulation, tamoxifen, to be at best preliminary in BRCA1 and BRCA2 mutation carriers. Yet a recent survey of medical oncologists interested in breast cancer found that many were more likely to prescribe tamoxifen to BRCA2 carriers than BRCA1 carriers [15]. We have not always served our patients well by relying on clinical judgment and speculation instead of data, as the recent experience with HRT and cardiovascular disease illustrates. The Armstrong et al model is a huge step forward in this process and should help ease some of our concerns over recommending short-term HRT for menopausal symptoms. However, many aspects of the effects of HRT on breast cancer risk in mutation carriers remain unclear. Therefore, advising caution in the widespread prescription of HRT after BSO in these women seems prudent. Better early detection tools and risk-reduction strategies should obviate the need for prophylactic surgeries and the associated decisions that compromise our patients' quality of life.
Authors' Disclosures of Potential Conflicts of Interest
The authors indicated no potential conflicts of interest.
http://jco.ascopubs.org/cgi/content/full/22/6/978
REFERENCES
1. Shumaker SA, Legault C, Rapp SR, et al: Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: The Women's Health Initiative Memory Study—A randomized controlled trial. JAMA 289:2651-2662, 2003[Abstract/Free Full Text]
2. Rapp SR, Espeland MA, Shumaker SA, et al: Effect of estrogen plus progestin on global cognitive function in postmenopausal women: The Women's Health Initiative Memory Study—A randomized controlled trial. JAMA 289:2663-2672, 2003[Abstract/Free Full Text]
3. Chlebowski RT, Hendrix SL, Langer RD, et al: Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: The Women's Health Initiative Randomized Trial. JAMA 289:3243-3253, 2003[Abstract/Free Full Text]
4. Wassertheil-Smoller S, Hendrix SL, Limacher M, et al: Effect of estrogen plus progestin on stroke in postmenopausal women: The Women's Health Initiative—A randomized trial. JAMA 289:2673-2684, 2003[Abstract/Free Full Text]
4. Armstrong K, Sanford Schwartz J, Randall T, et al: Hormone replacement therapy and life expectancy after prophylactic oophorectomy in women with BRCA1/2 mutations: A decision analysis. J Clin Oncol 22:1045-1054, 2004[Abstract/Free Full Text]
5. Kauff ND, Satagopan JM, Robson ME, et al: Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med 346:1609-1615, 2002[Abstract/Free Full Text]
6. Rebbeck TR, Lynch HT, Neuhausen SL, et al: Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med 346:1616-1622, 2002[Abstract/Free Full Text]
7. Sellers TA, Grabrick DM, Hartmann LC: Oral contraceptives and risk of breast cancer in women with a family history of breast cancer. JAMA 285:39-40, 2001[Free Full Text]
8. Ursin G, Henderson BE, Haile RW, et al: Does oral contraceptive use increase the risk of breast cancer in women with BRCA1/BRCA2 mutations more than in other women?. Cancer Res 57:3678-3681, 1997[Abstract/Free Full Text]
9. Lakhani SR, Van De Vijver MJ, Jacquemier J, et al: The pathology of familial breast cancer: Predictive value of immunohistochemical markers estrogen receptor, progesterone receptor, HER-2, and p53 in patients with mutations in BRCA1 and BRCA2. J Clin Oncol 20:2310-2318, 2002[Abstract/Free Full Text]
10. Sorlie T, Perou CM, Tibshirani R, et al: Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A 98:10869-10874, 2001[Abstract/Free Full Text]
11. Antoniou A, Pharoah PD, Narod S, et al: Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case Series unselected for family history: A combined analysis of 22 studies. Am J Hum Genet 72:1117-1130, 2003[CrossRef][Medline]
12. Warner E, Plewes DB, Shumak RS, et al: Comparison of breast magnetic resonance imaging, mammography, and ultrasound for surveillance of women at high risk for hereditary breast cancer. J Clin Oncol 19:3524-3531, 2001[Abstract/Free Full Text]
13. Tilanus-Linthorst MM, Obdeijn IM, Bartels KC, et al: First experiences in screening women at high risk for breast cancer with MR imaging. Breast Cancer Res Treat 63:53-60, 2000[CrossRef][Medline]
14. Kuhl CK, Schmutzler RK, Leutner CC, et al: Breast MR imaging screening in 192 women proved or suspected to be carriers of a breast cancer susceptibility gene: Preliminary results. Radiology 215:267-279, 2000[Abstract/Free Full Text]
15. Peshkin BN, Isaacs C, Finch C, et al: Tamoxifen as chemoprevention in BRCA1 and BRCA2 mutation carriers with breast cancer: A pilot survey of physicians. J Clin Oncol 21:4322-4328, 2003[Abstract/Free Full Text]
Increased risk of cognitive impairment
or dementia in women who underwent
oophorectomy before menopause
W.A. Rocca, MD, MPH
J.H. Bower, MD
D.M. Maraganore, MD
J.E. Ahlskog, PhD, MD
B.R. Grossardt, MS
M. de Andrade, PhD
L.J. Melton III, MD, MPH
ABSTRACT
Objective: There is increasing laboratory evidence for a neuroprotective effect of estrogen; however,
the clinical and epidemiologic evidence remains limited and conflicting. We studied the association
of oophorectomy performed before the onset of menopause with the risk of subsequent cognitive impairment or dementia.
Methods: We included all women who underwent unilateral or bilateral oophorectomy before the
onset of menopause for a non-cancer indication while residing in Olmsted County, MN, from 1950
through 1987. Each member of the oophorectomy cohort was matched by age to a referent woman from the same population who had not undergone oophorectomy. In total, we studied 813 women with unilateral oophorectomy, 676 women with bilateral oophorectomy, and 1,472 referent
women. Women were followed through death or end of study using either direct or proxy
interviews.
Results: Women who underwent either unilateral or bilateral oophorectomy before the onset of
menopause had an increased risk of cognitive impairment or dementia compared to referent
women (hazard ratio [HR] 1.46;95%CI 1.13 to 1.90; adjusted for education, type of interview, and history of depression). The risk increased with younger age at oophorectomy (test for linear
trend; adjusted p 0.0001). These associations were similar regardless of the indication for the
oophorectomy, and for women who underwent unilateral or bilateral oophorectomy considered
separately.
Conclusions: Both unilateral and bilateral oophorectomy preceding the onset of menopause are associated with an increased risk of cognitive impairment or dementia. The effect is age-dependent and suggests a critical age window for neuroprotection. Neurology® 2007;69:1074-1083
Psychological Aspects of Pelvic Surgery. As the article notes:
The most important aspect of gynecologic surgery, total care of the patient, is often overlooked today. With the pressure to keep abreast of the daily technological advances, to practice our specialty in a "cost-effective" manner, and to practice "defensive medicine" in an effort to avoid litigation, we, as gynecologists, are dealing with our patients on an increasingly impersonal level. Concern for the patient as a whole person, which engages the "art of medicine," has suffered. When women face surgery, they face more than the successful removal or alteration of those organs that make them unique and complex; their whole identity may be at stake. It is imperative that gynecologic surgeons understand and address the psychological as well as the technological aspects of pelvic surgery.
The exciting technological advances in gynecologic surgery, including virtual and robotic surgery, seem to have overshadowed the advances made in neuroscientific research. Studies at the National Institutes of Health (NIH) and other leading institutions have shown the importance of treating the patient's psyche and her soma as inseparable. In The Balance Within: The Science Connecting Health and Emotions, Dr. Esther Sternberg, Director of the Integrative Neural Immune Program at NIH,[1] presents evidence reinforcing the importance of addressing the patient's psychological as well as somatic needs at the time of surgery. When gynecologic surgeons perform surgery, they are not simply altering the soma but may be temporarily, and in some cases permanently, altering the psyche of the patient; thus, they must take time to listen to the patient. Doing so can greatly improve the outcome of her surgery.
This article briefly considers the gynecologic surgeon's preoperative responsibilities, special needs of various patient populations, and care during and after hospitalization. The aim is to encourage gynecologists to recognize that although a gynecologic operation may be an ordinary procedure for the surgeon, it is a unique experience for the patient. Her sense of well-being and health may be threatened; she may lose control of her body for some period of time; and she may perceive the planned procedure as temporarily or permanently affecting her sexual identity. As once complicated procedures become routine, the gynecologic surgeon risks losing perspective about the impact of surgery on the life of the individual woman.
http://www.medscape.com/viewarticle/534156
Testosterone substitution in women
ALESSANDRA GRAZIOTTIN MD
Director, Center of Gynecology and Medical Sexology
H. San Raffele Resnati, Milan, Italy
The prevalence of sexual desire disorders is also higher among women following surgical menopause. A recent
European survey of 2467 women (in France, UK, Germany and Italy) showed that in the age cohort from 20 to 49 the
percentage of women with low sexual desire is 19%, but is 32% in women who have undergone surgical menopause.
This difference disappears when comparing naturally post-menopausal women (ages 50 to 70) and age-matched
surgically menopausal women (46% and 48%, respectively). The percentage of women distressed by their HSDD was
27% in fertile women and 28% after surgical menopause in the age cohort 20 to 49, compared to 11% in women with
natural menopause and 14% in those with surgical menopause in the age cohort 50 to 70. Thus although the probability
of HSDD increases with age, the distress associated with the loss of desire is inversely correlated with age (Dennerstein
et Al, 2006). Physiology of androgens, their actions on the brain and genital function, consequences of the Androgen
Insufficiency Syndrome (AIS) and treatment outcomes of testosterone substitution in women will be presented with a
clinical perspective (Alexander et Al, 2006, Davis et Al, 2006, Shifren et Al, 2006). Current evidence indicate its direct,
positive role in significantly improving sexual desire, arousal, orgasm, satisfaction and self-image, while reducing
concerns and sexual distress. Other positive effects involve improved mood, well being and vital energy and reduced
anxiety: sexual hormones modulate as well the neurobiological substrate of psychological feelings, which indirectly
may impact women’s sexuality.
References
Alexander J.L Dennerstein L. Burger H. Graziottin A. Testosterone and libido in surgically and naturally menopausal women Womens' Health 2006; 2 (3), 459-477
Davis SR,, Davison SL, Donath S, Bell RJ Circulating androgen levels and self-reported sexual function in women. JAMA. 2005 Jul 6; 294(1):91-6.
Davis SR, Goldstat R Papalia MD et Al Effects of aromatase inhibition on sexual function and well-being in postmenopausal women treated with testosterone: a
randomized, placebo-controlled trial.Menopause. 2006 Jan-Feb;13(1):37-45
Davis SR, van der Mooren MJ, van Lunsen RH et Al. Efficacy and safety of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically
menopausal women: a randomized, placebo-controlled trial. Menopause. 2006 May-Jun;13(3):387-96
Dennerstein L. Koochaki P.E. Barton I. Graziottin A. Hypoactive sexual desire disorder in menopausal women: a survey of western european women J Sex Med 2006; 3: 212-222
Graziottin A. Hormonal therapy after menopause: what clinicians want to know in: Porst H & Buvat J. (Eds), ISSM (International Society of Sexual medicine)
Standard Committee Book - Standard practice in Sexual medicine, Blackwell, Oxford, UK, 2006
Shifren JL, Davis SR, Moreau M et Al. Testosterone patch for the treatment of hypoactive sexual desire disorder in naturally menopausal women: results from the
Intimate NM1 Study.Menopause. 2006 September/October;13(5):770-779.
Prophylactic Oophorectomy
ACOG Prctice Bulletin
For purchasing or reprint information, click here.
Background
Prophylactic oophorectomy is the removal of the ovaries for the potential benefit of preventing long-term morbidity and mortality. The term prophylactic implies that the ovaries are normal at the time of removal. Oophorectomy can be performed either alone as a planned surgical procedure or in conjunction with other planned surgical procedures such as hysterectomy or colectomy. Incidental oophorectomy is a term commonly used when the ovaries are removed at the time of another indicated surgery, and this term should not be used interchangeably with prophylactic oophorectomy. The term incidental implies that the surgery occurs by chance or without consequence. There are obvious consequences associated with oophorectomy; therefore, when oophorectomy is performed for future benefit, the surgery should be termed prophylactic.
Ovarian Physiology
The ovary is a complex metabolic organ consisting of follicular and stromal compartments. Follicles produce both androgens and estrogen, and stromal tissue synthesizes androgens. With the loss of all follicles around menopause, both androgen and estrogen levels decrease, but the ovary remains a source of androgens that are peripherally converted to estrogen. The role of endogenous androgens and the consequences of their removal may be significant but have not yet been clarified.
The positive effects of estrogen production on lipid metabolism and bone remodeling remain the primary argument for retention of the ovaries in premenopausal women. The benefits of estrogen are well documented (2-4), but any benefits of ovarian androgen production remain to be documented.
Cancer Prevention
In the United States, one in 70 women will develop ovarian cancer in her lifetime. Between 4% and 14% of these women will have had antecedent hysterectomies in which the ovaries were retained (5). Current screening techniques for ovarian cancer, including the use of ultrasonography and tumor markers, are neither sensitive nor specific enough to detect early cancer as part of a screening program for the general population. A high proportion of ovarian cancer is detected when it is in advanced stages. Prevention of ovarian cancer is the primary reason for prophylactic oophorectomy. Although oophorectomy does not eliminate the risk of cancer (patients still can develop peritoneal carcinoma, which acts like ovarian cancer), reported cases are rare (6).
The literature has recorded elective oophorectomy rates of between 50% and 66% in women 40-64 years of age undergoing hysterectomy (7, 8). Data from the Centers for Disease Control and Prevention collected between 1988 and 1993 concur that ovarian retention occurs in approximately 40-50% of patients undergoing hysterectomy at 40 years of age or older (1). It has been suggested that, in the United States, approximately 1,000 cases of ovarian cancer can be prevented if prophylactic oophorectomy is practiced in all women older than 40 years of age who undergo hysterectomy. This assumes an annual incidence of 24,000 new ovarian cancer cases and does not take into account the incidence of peritoneal carcinoma. The dilemma for the patient and the clinician is whether the estimated number of cancer cases prevented (1,000) is worth the number of oophorectomies performed (approximately 300,000) (9). The benefit of prophylactic oophorectomy may be offset by the consequence of estrogen loss early in life.
Factors to Consider for Prophylactic Oophorectomy
The potential risks and benefits of this procedure need to be considered within the context of the potential risks and benefits of extended hormone production or prescribed hormone replacement. The potential for alleviation of symptoms related to ovarian function should be considered, especially in patients with documented premenstrual syndrome. New developments in genetic testing, early diagnosis, refinements in diagnostic imaging, knowledge of hormone interactions with the cardiovascular and central nervous systems, and refined surgical techniques must all be considered with the individual patient.
Risk Factors for Ovarian Cancer
There is no consensus regarding the benefits of oophorectomy performed at the time of hysterectomy. Patients at greater risk for developing ovarian cancer are those with low parity, decreased fertility, and delayed childbearing if they did not use oral contraceptives (6, 10-12).
Women who have used oral contraceptives have a lower risk for invasive epithelial ovarian cancer than non-users do. Both hospital and population studies revealed that, among those who have used oral contraceptives, the risk continues to decrease as years of use increase, although there is little additional protection conferred by oral contraceptives beyond 6 years of use. The protective benefits of higher parity, as well as longer duration of breastfeeding, also have been reported. Use of fertility drugs may be associated with a higher risk of ovarian cancer, as is a history of longer premenopausal sexual activity without contraception. There are no consistent data linking age at menarche, age at menopause, or duration of estrogen replacement therapy with development of epithelial ovarian cancer (10).
Operative Risk at the Time of Hysterectomy
There are no studies evaluating increased operative risk or morbidity at the time of abdominal hysterectomy when prophylactic oophorectomy is included. Retrospective studies looking at prophylactic oophorectomy at the time of vaginal hysterectomy have shown that the ovaries can be removed successfully in 65-97% of patients (13, 14). One study found no significant increase in operating time, estimated blood loss, length of hospital stay, or postoperative morbidity between patients who had their ovaries removed and those who did not (13). Another study found that oophorectomy added 23.4 minutes to the total operating time compared with vaginal hysterectomy alone (14).
Genetic Factors
The emergence of data suggesting the close link of ovarian cancer with familial breast-ovarian cancer syndromes has contributed to arguments favoring oophorectomy in subsets of patients identified with genetic risk factors. The role of BRCA1 mutations in ovarian cancer indicates that these tumors have unique biologic clinical and pathologic features (15). Recent evidence identifies the significant contribution of BRCA1 mutations to the development of ovarian cancer, revealing that this mutation occurs in approximately 5% of women in whom cancer is diagnosed before 70 years of age (16). Although screening for BRCA1 mutations has been suggested, it is difficult to define those women at risk based only on the number of family members affected. Because of the relatively small number (5%) of all ovarian cancers related to inherited mutations in the BRCA1 gene, the optimal strategy for decreasing cancer mortality in these patients has yet to be determined.
BRCA2 mutations increase the risk of ovarian cancer but to a lesser degree than BRCA1 mutations (17). The risk of ovarian cancer in families with Lynch syndrome II is reported to be 3.5 times higher than expected, with the estimated cumulative risk by 70 years of age still less than 10% (18). The mean age at diagnosis for ovarian cancer in women with Lynch syndrome II is approximately 45 years of age, roughly 20 years earlier than in the general population (19).
References
1. Lepine LA, Hillis SD, Marchbanks PA, Koonin LM, Morrow B, Kieke BA, et al. Hysterectomy surveillance--United States 1980-1993. MMWR Morb Mortal Wkly Rep 1997;46:1-15
2. Bush TL, Barrett-Connor E, Cowan LD, Criqui MH, Wallace RB, Suchindran CM, et al. Cardiovascular mortality and noncontraceptive use of estrogen in women: results from the Lipid Research Clinics Program Follow-up Study. Circulation 1987;75;1102-1109
3. Ettinger B, Genant HK, Cann CE. Postmenopausal bone loss is prevented by treatment with low-dosage estrogen with calcium. Ann Intern Med 1987;106:40-45
4. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. The Writing Group of the PEPI Trial. JAMA 1995;273:199-208
5. Sightler SE, Boike GM, Estape RE, Averette HE. Ovarian cancer in women with prior hysterectomy: a 14-year experience at the University of Miami. Obstet Gynecol 1991;78:681-684
6. Piver MS, Jishi MF, Tsukada Y, Nava G. Primary peritoneal carcinoma after prophylactic oophorectomy in women with a family history of ovarian cancer. Cancer 1993;71:2751-2755
7. Dicker RC, Scally MJ, Greenspan JR, Layde PM, Ory HW, Maze JM, et al. Hysterectomy among women of reproductive age. JAMA 1982;248:323-327
8. Pokras R, Hufnagel VG. Hysterectomy in the United States, 1965-84. Am J Public Health 1988;78:852-853
9. Averette HE, Nguyen HN. The role of prophylactic oophorectomy in cancer prevention. Gynecol Oncol 1994;55:S38-S41
10. Whittemore AS, Harris R, Itnyre J. Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. II. Invasive epithelial ovarian cancers in white women. Collaborative Ovarian Cancer Group. Am J Epidemiol 1992;136:1184-1203
11. NIH consensus conference. Ovarian cancer: screening, treatment, and follow-up. NIH Consensus Development Panel on Ovarian Cancer. JAMA 1995;273:491-497
12. Narod SA, Risch H, Moslehi R, Dorum A, Neuhausen S, Olsson H, et al. Oral contraceptives and the risk of hereditary ovarian cancer. Hereditary Ovarian Cancer Clinical Study Group. N Engl J Med 1998;339:424-428
13. Ballard LA, Walters MD. Transvaginal mobilization and removal of ovaries and fallopian tubes after vaginal hysterectomy. Obstet Gynecol 1996;87:35-39
14. Davies A, O'Connor H, Magos AL. A prospective study to evaluate oophorectomy at the time of vaginal hysterectomy. Br J Obstet Gynaecol 1996;103:915-920
15. Rubin SC, Benjamin I, Behbakht K, Takahashi H, Morgan MA, LiVolsi VA, et al. Clinical and pathological features of ovarian cancer in women with germ-line mutations of BRCA1. N Engl J Med 1996;335:1413-1416
16. Stratton JF, Gayther SA, Russell P, Dearden J, Gore M, Blake P, et al. Contribution of BRCA1 mutations to ovarian cancer. N Engl J Med 1997;336:1125-1130
17. Ford D, Easton DF. The genetics of breast and ovarian cancer. Br J Cancer 1995;72:805-812
18. Burke W, Petersen G, Lynch P, Botkin J, Daly M, Garber J, et al. Recommendations for follow-up care of individuals with an inherited predisposition to cancer. I. Hereditary nonpolyposis colon cancer. JAMA 1997;277:915-919
19. Watson P, Lynch HT. Extracolonic cancer in hereditary nonpolyposis colorectal cancer. Cancer 1993;71:677-685
Excerpted from: ACOG Practice Bulletin, No. 7, September 1999. Prophylactic Oophorectomy.
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Copyright © 1999 American College of Obstetricians and Gynecologists
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Bilateral oophorectomy and premature menopause
Susan L. Hendrix DOCorresponding Author Contact Information, E-mail The Corresponding Author
Department of Obstetrics and Gynecology, Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, Michigan, USA
Available online 17 January 2006.
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The ovary is a complex metabolic organ. The follicles produce both androgens and estrogens, whereas the stromal tissue synthesizes androgens only. When menopause occurs, both androgen and estrogen levels decrease. The postmenopausal ovary remains a source of endogenous androgens that are converted to estrogen. The consequences of premature removal of the ovaries are not well known. The risks and benefits of menopausal hormone therapy (HT) in women with premature menopause have not been studied. Women who have had surgical menopause experience more severe symptoms and will need to stop estrogen therapy at some point in their lives. Intense symptoms such as hot flashes, night sweats, and insomnia will redevelop, so women should be given informed consent about the need for long-term use of HT and the greater difficulty in discontinuing therapy.
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Quality of Life After Prophylactic Oophorectomy
Authors: Mary B. Daly; FOX CHASE CANCER CENTER PHILADELPHIA PA
Abstract: While an increasing number of women at risk for ovarian cancer are being identified through awareness efforts and risk assessment programs, a gap still exists in the known psychological and physical sequelae of preventive surgery options offered to these women. To meet the needs of women seeking information about the effects of prophylactic oophorectomy, this pilot study will provide significant information on the broader quality of life issues and physical changes following surgery. In order to make informed decisions about their choices, women considering prophylactic oophorectomy need scientific data on the hormonal and other physical consequences of surgery, and on the potential alterations in their emotional and social well being. They also need the opportunity to choose from an array of coping strategies to manage their health decisions. Studying multidimensional quality of life issues will contribute to the knowledge base about the short and long-term effects on physical, emotional, cognitive, sexual and social functioning following oophorectomy and will contribute to the development of Optimum medical and alternative therapy strategies to deal with post-surgical changes. As important, it will also identify issues and needs faced by women who make the choice not to undergo surgery.
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