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Psychoneuroendocrinology. 2019 Aug;106:9-19. doi: 10.1016/j.psyneuen.2019.03.013. Epub 2019 Mar 19.

Surgical menopause in association with cognitive function and risk of dementia: A systematic review and meta-analysis.

Author information

1
Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; Graduate School of Systemic Neurosciences (GSN), LMU Munich, Munich, Germany. Electronic address: marios.georgakis@med.uni-muenchen.de.
2
Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
3
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.

Abstract

INTRODUCTION:

Experimental and epidemiological studies suggest female sex hormones to have long-lasting neuroprotective and anti-ageing properties. Surgically-induced menopause leads to a premature cessation of exposure to female sex hormones and could thus impact late-life cognitive function. Yet, evidence remains controversial.

METHODS:

We systematically reviewed literature for articles investigating the association of surgical menopause (defined as bilateral oophorectomy before the onset of menopause) with risk of dementia, cognitive performance, cognitive decline, and Alzheimer's disease neuropathological indices later in life. We evaluated study quality with the Newcastle-Ottawa scale and performed random-effects meta-analyses.

RESULTS:

We identified 11 eligible studies (N = 18,867). Although surgical menopause at any age was not associated with risk of dementia (4 studies; HR: 1.16, 95%CI: 0.96-1.43), early surgical menopause (≤45 years of age) was associated with a statistically significantly higher risk (2 studies; HR: 1.70, 95%CI: 1.07-2.69). Surgical menopause at any age was associated with faster decline in verbal memory, semantic memory, and processing speed, whereas early surgical menopause was further associated with faster global cognitive decline. No heterogeneity was noted. Among women undergoing surgical menopause, a younger age at surgery was associated with faster decline in global cognition, semantic and episodic memory, worse performance in verbal fluency and executive function, and accumulation of Alzheimer's neuropathology.

CONCLUSIONS:

Current evidence is limited, but suggests surgical menopause induced by bilateral oophorectomy at ≤45 years of age to be associated with higher risk of dementia and cognitive decline. Additional large-scale cohort studies are necessary to replicate these findings.

KEYWORDS:

Cognitive impairment; Dementia; Estrogen; Hysterectomy; Menopause; Oophorectomy

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