Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012;10(1-4):175-8.
doi: 10.1159/000334764. Epub 2012 Jan 21.

Hysterectomy, Oophorectomy, Estrogen, and the Risk of Dementia

Affiliations
Free PMC article

Hysterectomy, Oophorectomy, Estrogen, and the Risk of Dementia

Walter A Rocca et al. Neurodegener Dis. .
Free PMC article

Abstract

Background: The long-term cognitive effects of hysterectomy and oophorectomy remain controversial.

Objective: To explore the association of hysterectomy and oophorectomy with the subsequent risk of cognitive impairment or dementia.

Methods: We combined the results from two cohort studies graphically and conducted additional analyses.

Results: Combined results from the Mayo Clinic Cohort Study of Oophorectomy and Aging and from a Danish nationwide cohort study suggest that the extent of gynecologic surgery may correlate with a stepwise increase in the risk of cognitive impairment or dementia. Compared with women with no gynecologic surgeries, the risk of cognitive impairment or dementia was increased in women who had hysterectomy alone, further increased in women who had hysterectomy with unilateral oophorectomy, and further increased in women who had hysterectomy with bilateral oophorectomy. The risk increased with younger age at the time of the surgery.

Conclusion: We hypothesize that both hysterectomy and oophorectomy may have harmful brain effects via direct endocrinological mechanisms or other more complex mechanisms. Estrogen deficiency appears to play a key role in these associations, and estrogen therapy may partly offset the negative effects of the surgeries.

Figures

Fig. 1
Fig. 1
Relative risks or hazard ratios for cognitive impairment or dementia associated with hysterectomy, unilateral oophorectomy, and bilateral oophorectomy in the Danish nationwide study (squares and solid lines), and in the MCSO (circles and dotted lines) [1, 2]. The estimates for the MCSO were recomputed considering only oophorectomy before age 40 years for consistency with the Danish study. The asterisk indicates that the estimate was based on only 4 women, and the upper confidence limit of 33.8 is not shown.
Fig. 2
Fig. 2
Relative risks or hazard ratios for cognitive impairment or dementia associated with hysterectomy, unilateral oophorectomy, and bilateral oophorectomy stratified by age at the time of surgery in the Danish nationwide study (top block; squares and solid lines) and in the MCSO (middle and lower blocks; circles and dotted lines) [1, 2].

Similar articles

See all similar articles

Cited by 22 articles

See all "Cited by" articles

References

    1. Rocca WA, Bower JH, Maraganore DM, Ahlskog JE, Grossardt BR, de Andrade M, Melton LJ., 3rd Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause. Neurology. 2007;69:1074–1083. - PubMed
    1. Phung TK, Waltoft BL, Laursen TM, Settnes A, Kessing LV, Mortensen PB, Waldemar G. Hysterectomy, oophorectomy and risk of dementia: a nationwide historical cohort study. Dement Geriatr Cogn Disord. 2010;30:43–50. - PubMed
    1. Vearncombe KJ, Pachana NA. Is cognitive functioning detrimentally affected after early, induced menopause? Menopause. 2009;16:188–198. - PubMed
    1. Rocca WA, Grossardt BR, Shuster LT. Oophorectomy, menopause, estrogen treatment, and cognitive aging: clinical evidence for a window of opportunity. Brain Res. 2011;1379:188–198. - PMC - PubMed
    1. Craig MC, Murphy DGM. Estrogen therapy and Alzheimer's dementia. Ann NY Acad Sci. 2010;1205:245–253. - PubMed

Publication types

Feedback