Long-Term Mortality Associated With Oophorectomy Compared With Ovarian Conservation in the Nurses' Health Study
Open accessAbstract
OBJECTIVE: To report long-term mortality after oophorectomy or ovarian conservation at the time of hysterectomy in subgroups of women based on age at the time of surgery, use of estrogen therapy, presence of risk factors for coronary heart disease, and length of follow-up. METHODS: This was a prospective cohort study of 30,117 Nurses' Health Study participants undergoing hysterectomy for benign disease. Multivariable adjusted hazard ratios for death from coronary heart disease, stroke, breast cancer, epithelial ovarian cancer, lung cancer, colorectal cancer, total cancer, and all causes were determined comparing bilateral oophorectomy (n=16,914) with ovarian conservation (n=13,203). RESULTS: Over 28 years of follow-up, 16.8% of women with hysterectomy and bilateral oophorectomy died from all causes compared with 13.3% of women who had ovarian conservation (hazard ratio 1.13, 95% confidence interval 1.06-1.21). Oophorectomy was associated with a lower risk of death from ovarian cancer (four women with oophorectomy compared with 44 women with ovarian conservation) and, before age 47.5 years, a lower risk of death from breast cancer. However, at no age was oophorectomy associated with a lower risk of other cause-specific or all-cause mortality. For women younger than 50 years at the time of hysterectomy, bilateral oophorectomy was associated with significantly increased mortality in women who had never used estrogen therapy but not in past and current users: assuming a 35-year lifespan after oophorectomy: number needed to harm for all-cause death=8, coronary heart disease death=33, and lung cancer death=50. CONCLUSIONS: Bilateral oophorectomy is associated with increased mortality in women aged younger than 50 years who never used estrogen therapy and at no age is oophorectomy associated with increased survival. LEVEL OF EVIDENCE: I.
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Treatments for endometriosis, including hysterectomy or oophorectomy and analgesics, may increase the risk of coronary heart disease in women with endometriosis.
“In addition, the treatments of endometriosis, such as hysterectomy or oophorectomy (20-24) and analgesics (25) may confer increased risk of CHD to women with endometriosis.”
From Endometriosis and Risk of Coronary Heart Disease (2016) · cites this paper as [22]
The Results (page not available) associate bilateral oophorectomy at hysterectomy with higher CHD mortality, and the Introduction reports an earlier finding of higher incident CHD. The paper does not establish this association specifically in women with endometriosis or for hysterectomy without oophorectomy. The sentence cites a different source for analgesics, so that part is not assessed here. (LLM, conf=0.86)
Experimental — accuracy not yet measuredBilateral oophorectomy at ages younger than 50 has been associated with increased incidence and mortality of cardiovascular diseases, although results have been inconclusive for bilateral oophorectomy at ages older than 50.
“bilateral oophorectomy at ages younger than 50 has been associated with an increased incidence and mortality of cardiovascular diseases, although results have been inconclusive for bilateral oophorectomy at ages older than 50.(20-22)”
From Endometriosis and Risk of Coronary Heart Disease (2016) · cites this paper as [22]
The Results report increased coronary heart disease mortality among women who had oophorectomy before age 50. They do not establish increased cardiovascular disease incidence, and the paper focuses on mortality after hysterectomy rather than incidence. For older women, the Results say CVD mortality estimates remained elevated at age 60 and above, although mortality outcomes did not differ statistically when stratified by age; this supports uncertainty about an age-specific effect, not a clear older-than-50 contrast. (LLM, conf=0.87)
Experimental — accuracy not yet measuredSurgically induced menopause before natural menopause may increase coronary heart disease risk, and this elevated risk may be most evident at younger ages.
“The surgically-induced menopause prior to a natural menopause may increase risk of CHD among women, and this elevated risk may be most evident at a younger age (i.e., before all women reach natural menopause). (20-24)”
From Endometriosis and Risk of Coronary Heart Disease (2016) · cites this paper as [22]
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- Authors
- Parker, W. H., Feskanich, D., Broder, M. S., Chang, E., Shoupe, D., Farquhar, C. M., Berek, J. S., & Manson, J. E.
- Affiliations
- University of Southern California (US)
- ORCID
- Venue
- Obstetrics & Gynecology
- Published
- 2013-04
- Volume
- 121
- Issue
- 4
- Pages
- 709-716
- ISSN
- 0029-7844 (ISSN-L)
- PMC
- PMC4254662
- OpenAlex
- W2111012335
- Semantic Scholar
- 58ae0724b846a8dc341d70f48902c2aae4c4c897
- Cited by
- 454
- References
- 18
- Citations by year
- 2026: 24 · 2025: 21 · 2024: 25 · 2023: 30 · 2022: 37 · 2021: 41 · 2020: 49 · 2019: 33 · 2018: 38 · 2017: 46 · 2016: 38 · 2015: 29 · 2014: 24 · 2013: 18
- FWCI
- 28.64
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL34594, R01HL034594)
- National Cancer Institute (CA-87969, P01CA087969)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Keywords
- bilateral oophorectomy, ovarian preservation, hysterectomy, long-term mortality, estrogen therapy, coronary artery disease, breast cancer, ovarian cancer, lung cancer, colorectal cancer, number needed to harm, age at surgery, Nurses' Health Study
- MeSH terms
- Aged, Cardiovascular Diseases, Cause of Death, Female, Humans, Hysterectomy, Middle Aged, Ovariectomy, Prospective Studies, Risk Factors, Time Factors, Cohort Studies
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