Early Surgical Menopause Linked to Early Cognitive Decline

Megan Brooks

January 15, 2013

Women who undergo surgical menopause at an earlier age are at increased risk of experiencing a decline in memory and thinking skills, a new study suggests.

"When both ovaries are surgically removed, there is an abrupt cessation of ovarian production of estrogen," first author Riley Bove, MD, associate neurologist, Brigham and Women's Hospital and instructor in neurology, Harvard Medical School, Boston, Massachusetts, told Medscape Medical News.

It's been suggested that this "abrupt loss of exposure to estrogen triggers changes in the brain that lead to cognitive decline," she explained. "More studies are required to confirm this finding," Dr. Bove emphasized, as well as investigate the potential protective role of hormone replacement therapy (HRT).

"While we found a link between surgical menopause and thinking and memory decline, women on longer HRT had slower declines," Dr. Bove noted in a statement. "Since HRT is widely available, our research raises questions as to whether these therapies have a protective effect against cognitive decline and whether women who experience early surgical menopause should be taking HRT afterward," she added.

Preliminary data from the study were released January 14 and will be presented at the American Academy of Neurology 65th Annual Meeting in March.

HRT to the Rescue?

The analysis included 1837 women at least 53 years of age participating in 2 longitudinal studies of cognitive decline. The researchers assessed 3 types of cognition-related outcomes.

For women with surgically induced menopause (33% of the cohort), earlier age at menopause was associated with faster decline in semantic memory (P = .002), episodic memory, and global cognition (P < .001), the researchers observed.

They also saw a significant association with earlier age at menopause and neuropathologic measures, primarily neuritic plaques (P = .01) and global pathology score (P = .04). No significant association was seen with incident Alzheimer's disease (P = .093).

"We did not separate women into early or late age at menopause, but rather examined the association between age, as a continuous variable, and cognitive decline," Dr. Bove noted.

The associations between earlier age at surgical menopause and cognitive decline were not seen in women who underwent natural menopause.

"The association in our study between age at surgical but not natural menopause, and cognitive decline, requires ongoing replication in other well defined cohorts," Dr. Bove told Medscape Medical News.

"These are only preliminary data," she said, "and do not warrant any new medical advice at this time. Further research needs to be conducted to evaluate the neuroprotective effects of HRT after early surgical menopause.

"We are planning a more detailed analysis into the various types of HRT used, as well as of the timing of HRT start relative to age at menopause," she added. "Further studies in other cohorts are also warranted."

More Research Warranted

Reached for comment, JoAnn E. Manson, MD, MPH, DrPH, professor of medicine and the Michael and Lee Bell Professor of Women's Health at Harvard Medical School and chief of the Division of Preventive Medicine at Brigham and Women's Hospital, pointed out risks associated with this procedure as well.

"There's mounting evidence that early surgical menopause is linked to an increased risk of many chronic disease outcomes, including coronary heart disease, stroke, and cognitive decline, as well as with an increased risk of all-cause mortality," she told Medscape Medical News.

Dr. Manson, who was not involved in the study, agreed that more research is needed to understand whether estrogen replacement can counteract these risks.

"In the interim, unless a woman is at increased risk of ovarian or breast cancer, ovarian conservation should be seriously considered for women below age 50 having hysterectomy for benign disease," Dr. Manson said.

The study was supported by the National Institutes of Health. The authors have disclosed no relevant financial relationships.

American Academy of Neurology 65th Annual Meeting. Abstract 2046. Released January 14, 2013.

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