Oophorectomy linked to higher risk of heart failure in women

Women of childbearing age who had both ovaries removed, in a procedure called bilateral oophorectomy, were more likely to develop heart failure later in life, according to a study being presented at the American College of Cardiology's Annual Scientific Session (ACC.25).

Bilateral oophorectomy is often recommended to treat and, in some cases, prevent certain health issues, including endometriosis, pelvic inflammatory disease, heavy bleeding and ovarian cancer. The new study sheds light on the potential and unique role that this procedure might play in heightening cardiovascular risk given that it abruptly stops the production of estrogen and other hormones and, depending on timing, can induce early onset menopause, which researchers said may be distinct from other causes of early menopause.

We know that sex hormones, including estrogen and progesterone levels, play a crucial role in cardiovascular risk. Our study shows that there is an association between removing both ovaries and future development of heart failure, in particular. We believe this may be due to early menopause. However, in this case, early menopause results from the planned surgical removal of the ovaries, which differs from other causes such as occult infections, autoimmune diseases or unexpected genetic disorders. Understanding this allows us to anticipate and manage potential complications, particularly cardiovascular disease."

Narathorn Kulthamrongsri, MD, first-year internal medicine resident, University of Hawaii, Honolulu

The study uses data from 6,814 female patients who participated in the National Health and Nutrition Examination Survey (NHANES) between 2017 and 2023. The average age of women undergoing the procedure was 43.6 years and 57 years for heart failure diagnosis. The ages at oophorectomy and heart failure onset were self-reported.

Compared with women in the general population who have their ovaries, those who underwent a bilateral oophorectomy had a 1.5-fold increased risk of developing heart failure after adjusting for race, age, gender, diabetes, smoking status and high cholesterol. White women and those who had their ovaries removed at younger ages had an even higher, twofold increased risk of developing heart failure.

"The age at which a woman has her ovaries removed appears to [impact] her heart failure risk," Kulthamrongsri said. "We found that as the age at which a woman has her ovaries removed goes up by one year, the development of heart failure happens about 0.6 years later."

According to researchers, their findings also underscore the need to integrate cardiovascular risk discussions and closer heart monitoring for women contemplating oophorectomy before natural menopause (defined as not having a period for one full year), which usually occurs at 51 years of age, on average.

"Women must do what is medically necessary in terms of oophorectomy, but our findings suggest they should have an informed discussion with their health care team about how to monitor their cardiovascular health and manage potential risk factors for heart failure, including adopting a healthy lifestyle as much as possible and perhaps asking about any potential role of hormone replacement therapy," Kulthamrongsri said.

While some women may not have a choice in terms of when they undergo this procedure, for those who do, an informed discussion about the best timing based on their age and health is important to be able to discuss and weigh the potential added cardiovascular risks. This may be especially important for White women who appear to have a much higher risk of developing heart failure.

"This racial disparity is surprising, as previous research shows that Black individuals have a higher prevalence of worse outcomes in heart failure due to greater risks of hypertension, diabetes and obesity. In contrast, White individuals more often develop heart failure from ischemic heart disease and tend to have more lifestyle-related risk factors, such as smoking, poor diet and physical inactivity. This finding might be explained by the etiology of heart failure that develops in early surgical menopause, related to myocardial infarction or other etiologies in which sex hormones play a crucial role," Kulthamrongsri said.

The study is limited in that it relied on self-reported data and the researchers were only able to look at lifelong risk of heart failure rather than being able to determine if oophorectomy was more likely to lead to heart failure within a certain period after the procedure.

However, Kulthamrongsri said the findings add to a growing body of evidence that early surgical menopause may have long-term cardiovascular consequences, particularly an increased risk of heart failure. This concern is especially relevant given the number of women who undergo oophorectomy procedures.

Additional studies should be done to validate these findings using larger, global datasets. Future research should also explore possible preventive solutions, including cardiovascular screening recommendations and the use of prophylactic heart medications.