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Observational Study
. 2025 Jun:197:108265.
doi: 10.1016/j.maturitas.2025.108265. Epub 2025 Apr 11.

No increased arterial stiffness after premenopausal risk-reducing salpingo-oophorectomy (RRSO)

Maarten J Beekman  1 , Lara Terra  2 , Jeanine E Roeters van Lennep  3 , Bernadette A M Heemskerk-Gerritsen  4 , Marc van Beurden  5 , Helena C van Doorn  6 , Joanne A de Hullu  7 , Eleonora B L van Dorst  8 , Constantijne H Mom  9 , Brigitte F M Slangen  10 , Marian J E Mourits  11 , Katja N Gaarenstroom  12 , Klaartje van Engelen  13 , Lizet E van der Kolk  14 , J Margriet Collée  15 , Marijke R Wevers  16 , Margreet G E M Ausems  17 , Lieke P V Berger  18 , Encarna B Gomez Garcia  19 , Christi J van Asperen  20 , Maartje J Hooning  4 , Flora E van Leeuwen  2 , Angela H E M Maas  21
Affiliations
Observational Study

No increased arterial stiffness after premenopausal risk-reducing salpingo-oophorectomy (RRSO)

Maarten J Beekman et al. Maturitas. 2025 Jun.

Abstract

Objective: Women at high familial risk of ovarian cancer are recommended to undergo premenopausal risk-reducing salpingo-oophorectomy (RRSO). The procedure leads to immediate surgical menopause, and while early natural menopause is associated with an increase in the risk of cardiovascular disease (CVD), evidence on CVD risk after surgical menopause is inconsistent.

Main outcome measures: To investigate the long-term CVD risk after surgical menopause we conducted a cross-sectional study comparing a group of women who underwent a premenopausal RRSO (≤45 years) with a group who underwent postmenopausal RRSO (≥54 years). We assessed arterial stiffness, measured by pulse wave velocity (PWV). Increased PWV has been shown to be an independent predictor for CVD. Age differences between the pre- and postmenopausal RRSO groups were accounted for by restricting analyses to women aged 60-70 at study visit (n = 307). Within the premenopausal RRSO group (n = 461), we also examined the effect of timing of premenopausal RRSO on PWV (RRSO<41 vs RRSO 41-45 years). In addition, we assessed the association between PWV and coronary artery calcium (CAC) in women who underwent premenopausal RRSO.

Results: In women aged 60-70 at study visit, PWV levels were significantly lower in the premenopausal RRSO group compared with the postmenopausal RRSO group (β: -0.87, 95 % CI, -1.45, -0.28 for PWV level; RR: 0.47, 95 % CI, 0.24, 0.93 for being in the upper PWV quintile). The timing of premenopausal RRSO did not influence PWV. Among all women who underwent premenopausal RRSO, having a PWV in the upper quintile was an independent predictor of the presence of CAC (RR 1.32, 95 % CI, 1.04-1.68 for CAC > 0).

Conclusion: Our study does not support a long-term adverse effect of premenopausal RRSO on arterial stiffness, but increased arterial stiffness is associated with the presence of CAC in women who have undergone a premenopausal RRSO.

Clinical trial registration: The pre-registered clinical trial number is <NCT03835793>.

Keywords: Estrogen deficiency; Ovarian cancer - surgical menopause; Pulse wave velocity - cardiovascular disease.

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Conflict of interest statement

Declaration of competing interest MA reports institutional payments by AstraZeneca. AM reports speaker fees by Novartis, Organon and Omron. All other authors have no potential competing interest to disclose.

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