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.

Keywords: Bilateral oophorectomy; cancer prevention; early ovarian insufficiency; estrogen replacement therapy; genetic variants; ovarian cancer; premature ovarian insufficiency.

Figure 1.

Flow chart of decision making for women considering bilateral oophorectomy for the prevention of ovarian cancer.

Figure 2.

Identification of four subgroups of women with different combinations of mental health conditions and gynecologic symptoms. Group 1: neither adverse childhood experiences nor psychiatric diagnoses. Group 2: both adverse childhood experiences and psychiatric diagnoses. Group 3: adverse childhood experiences but not psychiatric diagnoses. Group 4: no adverse childhood experiences but psychiatric diagnoses.