Study: Early removal of ovaries may be linked to small increase in risk of Parkinson’s disease in later life
Summary
The lifetime risk of developing Parkinson’s disease is low. However, having surgery to remove both ovaries before natural menopause can slightly increase the risk of Parkinson's disease later in life. Researchers studied over 20 years of medical records, which confirmed this small increase in risk, particularly for women who have their ovaries removed before age 43. (Posted 5/3/23)
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Printer Friendly Page Read the Original ArticleRELEVANCE
Most relevant for: Women considering risk-reducing removal of both ovaries.
It may also be relevant for:
- previvors
- healthy people with average cancer risk
- people with a genetic mutation linked to cancer risk
Relevance: Medium
Strength of Science: Medium-High
Research Timeline: Human Research
What is this study about?
This study looked at whether removing both ovaries increases the risk of Parkinson's disease later in life. It looks specifically at a woman’s age at the time of surgery to determine whether delaying surgery changes her level of risk. Note that when we use "women" we are referring to the sex assigned at birth.
What are Parkinson's disease and Parkinson-like disease?
Parkinson's disease and Parkinson-like diseases affect the brain and cause uncontrollable muscle movement. Experts think some forms of Parkinson's are caused by a change in how nerve cells work in the brain. The causes of other forms of Parkinson's are not known.
Parkinson's can affect balance and posture, the ability to talk, and facial expression. It can also lead to mental and behavioral changes, sleep problems, depression, memory difficulties and fatigue. Many Parkinson's symptoms affect quality of life. These symptoms get worse over time and are not easy to treat.
The lifetime risk of Parkinson's is about 3.3 percent. About 90,000 people in the US are diagnosed with this disease each year, at an average age of 70 years old. The risk of developing Parkinson's increases as you age. Rates for Parkinson's are higher in men than women.
There seems to be a genetic link to Parkinson's. You may be at higher risk of developing Parkinson’s if one or more of your family members has the disease. About 15 to 25 percent of people living with Parkinson’s have family members living with it too.
Why is this study important?
This study looked at how removing both ovaries before menopause affects a woman’s risk for Parkinson's later in life.
For women diagnosed with ovarian cancer, treatment includes removal of the ovaries and . For women at high risk for ovarian cancer removal of the ovaries and (called risk-reducing salpingo-oophorectomy or ) reduces cancer risk and increases overall survival. Experts recommend this surgery as the most effective way to lower the risk for people with inherited mutations that are linked to ovarian cancer.
The authors noted women’s ages at the time of ovary removal and whether they took after surgery. Data from this study may help premenopausal women who are considering removal of their ovaries to decide on the best time to have risk-reducing prophylactic surgery.
Study findings
5,499 women participated in the study. Approximately half had their ovaries removed between 1950 and 2007 and half did not. No person who had their ovaries removed had cancer. The reason for surgery or whether any of the women had an linked to ovarian cancer risk was unknown. The research team looked at data from medical records over a long period to see how many people in each group developed Parkinson's. On average, participants were followed for 24 years.
- 82 of 5,499 (1.5% percent) women were diagnosed with Parkinson's:
- 50 of 2,750 women (1.8%) had both ovaries removed.
- 32 of 2,749 women (1.1%) did not have their ovaries removed.
- Participants with Parkinson's were diagnosed, on average, 26 years after their ovaries were removed or 28 years after joining the study if they had intact ovaries:
- Women with ovaries removed were diagnosed with Parkinson's, on average, at age 72.
- Women with intact ovaries who developed Parkinson's were diagnosed, on average, at age 75.
- Women in this study who had their ovaries removed (regardless of their age at the time of the removal) had a 1.9% higher risk of Parkinson's compared to women who did not have their ovaries removed.
- This suggests that ovary removal slightly increases the lifetime risk of developing Parkinson's from 3.30% to 3.36%.
- The rate of Parkinson's among women who had their ovaries removed before age 43 was 3.7% higher than among women who did not have their ovaries removed.
- This suggests that ovary removal before age 43 increases the lifetime risk of developing Parkinson’s from 3.30% to 3.42%. This is also a very small increase in risk.
- Among women who had their ovaries removed at age 45 or younger, the risk of Parkinson's was lower in women who had their ovaries removed and then took through age 50 compared to women who did not. However, this result was not statistically significant.
What does this mean for me?
The amount of increased risk for Parkinson’s and Parkinson’s-like disease after ovary removal is small. The lifetime risk of Parkinson's disease is 3.3 percent in the general population. Ovarian removal may increase that risk to up to 3.4 percent. If you are premenopausal and your doctor has recommended that you remove your ovaries, you may want to weigh this possible outcome along with the other effects of surgical menopause against your risk for ovarian cancer. Although this study’s findings are not conclusive, may lower your risk of Parkinson's disease. If you decide to have your ovaries removed, talk with your doctor about the best timing for the procedure and the benefits and risks of hormone replacement after surgery.
Reference
Rocca WA, Smith CY, Rocca LG, et al., Association of premenopausal oophorectomy with parkinsonism and Parkinson disease. Journal of the American Medical Association Network Open; 2022; 5:10. Published online October 26, 2022
Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.
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posted 5/3/23
What does this mean for me?
The amount of increased risk for Parkinson’s and Parkinson’s-like disease after ovary removal is small. The lifetime risk of Parkinson's disease is 3.3 percent in the general population. Ovarian removal may increase that risk to up to 3.4 percent. If you are premenopausal and your doctor has recommended that you remove your ovaries, you may want to weigh this possible outcome along with the other effects of surgical menopause against your risk for ovarian cancer. Although this study’s findings are not conclusive, may lower your risk of Parkinson's disease. If you decide to have your ovaries removed, talk with your doctor about the best timing for the procedure and the benefits and risks of hormone replacement after surgery.
Reference
Rocca WA, Smith CY, Rocca LG, et al., Association of premenopausal oophorectomy with parkinsonism and Parkinson disease. Journal of the American Medical Association Network Open; 2022; 5:10. Published online October 26, 2022
Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.
Share your thoughts on this XRAY review by taking our brief survey.
posted 5/3/23
- What is my risk of developing ovarian cancer?
- Do you recommend that I get my ovaries removed before menopause; if so, at what age?
- What is my risk of developing Parkinson's disease now? How will my risk change if I have this surgery?
- If I have surgery, can I have replacement therapy? What are the benefits and risks?
- Are there other things I can do to reduce my risk of ovarian cancer?
Context
Three prior studies showed a possible link between (removal of the ovaries) and Parkinson's disease while two other studies did not. This study is significantly larger than the earlier studies. The lifetime risk of Parkinson's disease is 3.3 percent in the general population. The lifetime risk of ovarian cancer for some people with inherited mutations in genes can be as high as 60 percent. For those with an in a gene, the relatively rare chance of Parkinson's and small increase in risk of Parkinson's with ovary removal needs to be weighed against the lifetime risk of ovarian cancer.
Strengths and limitations
Strengths
- This study looked at the records of a large sample of women for nearly 24 years.
- The study compared similar people from one geographic area.
- Medical records, rather than participants’ memory or self-reporting, were used to determine surgical history. This improves the accuracy and reliability of the findings.
- The sample size was large enough to produce significant evidence for a link between the age at the time of surgery and the risk of Parkinson’s disease.
Limitations
- This study used data from the Mayo Clinic. Participants were all from the Northern Midwest. These results may not apply to people from other geographical regions.
- Medical records may be inaccurate. Parkinson's disease can be difficult to diagnose. Currently, no blood or laboratory tests are available to diagnose non-genetic cases of Parkinson’s disease, and several other conditions have a similar set of symptoms, which may lead to . Some people may have been missed or misdiagnosed.
- The study population was mostly white (97 percent). These findings may not reflect the risk of Parkinson’s-like disease in other racial groups.
- The sample was not large enough to conclude whether the use of could reduce the risk of Parkinson’s.
- The medical reason for ovary removal was unknown for most of the people included in the study.
- Whether participants had an that increased ovarian cancer risk was not known. It is not clear whether this would apply similarly to those with inherited mutations increasing risk.
The National Comprehensive Cancer Network (NCCN) provides guidelines for management of gynecologic cancer risk in people with and mutations.
Prevention
- Risk-reducing removal of ovaries and , (known as salpingo-oophorectomy) is recommended between ages 35-40 for and 40-45 for and upon completion of childbearing.
- Research studies show that removing the ovaries can increase survival for women with mutations.
- Women should talk with their doctors about the effects of early menopause and options for managing them.
- Women should talk with their doctors about the risks and benefits of keeping or removing their uterus (hysterectomy), including:
- Women with a mutation have an increased risk for a rare form of aggressive uterine cancer; hysterectomy removes this risk.
- For women considering hormone replacement after surgery, the presence or absence of a uterus can affect the choice of hormones used.
- Estrogen-only hormone replacement is less likely to increase the risk for breast cancer, although it increases the risk for uterine cancer. Women who still have their uterus are typically given hormone replacement with both and progesterone.
- Adding progesterone to hormone replacement can protect against uterine cancer. However, the combination of these hormones may increase the risk for breast cancer more than alone.
- A medical history of fibroids or other uterine or cervical issues may justify a hysterectomy.
- Oral contraceptives (birth control pills) have been shown to lower the risk for ovarian cancer in women with mutations. Research on the effect of oral contraceptives on breast cancer risk has been mixed. Women should discuss the benefits and risks of oral contraceptives for lowering ovarian cancer risk with their doctors.
- Removal of the only () is being studied as an option for lowering risk in high-risk women who are not ready to remove their ovaries. Studies on the effects of are ongoing. At this time whether lowers the risk for ovarian cancer in high-risk women remains unknown.
- Consider enrolling in a research study looking at this procedure to lower cancer risk.
Screening
- There are no proven benefits to routine ovarian cancer screening using transvaginal and a blood test. However, some doctors still recommend this screening, starting at ages 30-35.
- Women should be aware of the symptoms of gynecologic cancer and report abnormalities to their doctors.
Updated: 05/08/2024
The following are studies looking at ovarian cancer screening or prevention.
- NCT04251052: A Study to Compare Two Surgical Procedures in Women with Mutations to Assess Reduced Risk of Ovarian Cancer (SOROCk). This study is looking at whether women with mutations who remove just the can reduce the risk of ovarian cancer nearly as much as women who remove their ovaries and .
- NCT05287451: Risk Reducing With Delayed as an Alternative to Risk- Reducing Salpingo-oophorectomy in High Risk-Women to Assess the Safety of Prevention. This study will look at outcomes in women with , , , and who remove their , followed by removal of their ovaries compared to women who undergo standard-of-care removal of their ovaries and at the same time.
- Validating a Blood Test for Early Ovarian Cancer Detection in High-risk Women and Families: MicroRNA Detection Study (MiDE). The goal of MiDe is to develop a test to detect early-onset ovarian cancer. Currently, no reliable screening or early detection tests are available. Participants can be expected to provide up to 4 tubes of blood every 6 months for up to 5 years. These samples can be collected by mobile phlebotomy all around the US.
- NCT04794322: Developing a Test for the Detection of Ovarian Cancer. This study aims to develop an ovarian cancer early detection test that looks at found in a uterine (womb) washing and proteins found in the blood. Participants will not receive the results of their tests.
Additional clinical trials for ovarian cancer screening and prevention may be found here.
Updated: 09/11/2022
FORCE offers many peer support programs for people with inherited mutations.
- Our Message Boards allow people to connect with others who share their situation. Once registered, you can post on the Diagnosed With Cancer board to connect with other people who have been diagnosed.
- Our Peer Navigation Program will match you with a volunteer who shares your mutation and situation.
- Our moderated, private Facebook group allows you to connect with other community members 24/7.
- Check out our virtual and in-person support meeting calendar.
- Join one of our Zoom community group meetings.
Updated: 08/06/2022
The following resources can help you locate an expert near you.
Finding gynecologists with expertise in cancer risk and treatment
- The Foundation for Women's Cancer has a search tool to help you find a gynecologic oncologist.
Related experts
Some symptoms and conditions related to female reproduction may be managed by other experts.
Fertility experts
- The Oncofertility Consortium maintains a national database of healthcare providers with expertise in fertility preservation and treatment of people who are diagnosed with cancer or have a high risk for cancer due to an .
- Livestrong has a listing of 450 sites that offer fertility preservation options for people diagnosed with cancer.
Financial assistance may be available to make the cost of fertility preservation affordable for more patients. Patients are referred to those programs as needed.
Menopause experts
- The North American Menopause Society has a tool to help you find a qualified menopause expert in your area.
Sexual health experts
- The Sexual Medicine Society of North America (SMSNA) has a search tool to find experts in your area who provide sexual health care services.
- The American Association of Sexuality Educators, Counselors and Therapists (AASECT) maintains a tool to help people find a sexual health expert near them.
Other ways to find experts
- The National Cancer Institute (NCI)-designated comprehensive cancer centers deliver cutting-edge cancer care to patients in communities across the United States. Most centers have specialized screening and prevention centers for high-risk people. Find a center near you and learn about its specific research capabilities, programs, and initiatives.
- Register for the FORCE Message Boards to get referrals from other members. Once you register, you can post on the Find a Specialist board to connect with other people who share your situation.
Updated: 04/09/2023
Who covered this study?
Healthing
Parkinson’s disease risk goes up with the removal of ovaries This article rates 2.5 out of 5 stars
Parkinson's News Today
Ovary removal surgery before age 43 may increase the risk of Parkinson’s This article rates 2.5 out of 5 stars
U.S. and World Report
Ovary removal before menopause could raise a woman's odds for Parkinson's This article rates 4.0 out of 5 stars