From the FDA Drug Label
Sometimes, both ovaries are removed during an operation before natural menopause takes place. The sudden drop in estrogen levels causes “surgical menopause. ” When the estrogen levels begin dropping, some women develop very uncomfortable symptoms, such as feelings of warmth in the face, neck, and chest, or sudden strong feelings of heat and sweating (“hot flashes” or “hot flushes”).
The effects of bilateral oophorectomy in a 67-year-old postmenopausal female are not directly addressed in the provided drug label, as the label discusses the effects of surgical menopause in women who have the procedure before natural menopause. However, based on the information provided, it can be inferred that bilateral oophorectomy would have already occurred before the age of 67 if the woman is postmenopausal, and the label does not provide information on the effects of the procedure at an advanced age. 1
From the Research
Removing ovaries (oophorectomy) in a 67-year-old postmenopausal woman typically has minimal hormonal effects since the ovaries have already significantly reduced hormone production after menopause. Most women at this age won't experience the severe hot flashes, mood changes, or other symptoms that younger women might face after ovary removal. The main hormonal change would be a small decrease in testosterone levels, which might slightly affect energy levels, muscle mass, or libido in some women.
Key Considerations
- Physical recovery from the surgery itself typically takes 4-6 weeks, with initial discomfort, fatigue, and limited activity during healing.
- Potential complications include infection, bleeding, damage to surrounding structures, and risks associated with anesthesia.
- The surgery may be recommended if there are concerns about ovarian cancer, especially with family history or genetic risk factors like BRCA mutations.
- No hormone replacement therapy is typically needed after oophorectomy at this age, unlike in younger women.
- However, each woman's experience varies, and some might notice subtle changes in energy or mood that should be discussed with their healthcare provider.
Evidence-Based Recommendations
Based on the most recent and highest quality study 2, opportunistic salpingectomy (removal of the fallopian tubes) is a recommended approach for preventing ovarian cancer in average-risk women, rather than removing the ovaries. However, for women with a high risk of ovarian cancer, such as those with BRCA mutations, bilateral salpingo-oophorectomy (removal of both the fallopian tubes and ovaries) is still the standard of care.
Quality of Life and Morbidity
It's essential to consider the potential impact of oophorectomy on a woman's quality of life, including the risk of decreased libido, energy levels, and muscle mass. However, as noted in the study 3, estrogen deficiency resulting from oophorectomy may be associated with higher risks of coronary artery disease, stroke, hip fracture, Parkinsonism, dementia, cognitive impairment, depression, and anxiety. Therefore, the decision to perform oophorectomy should be made on a case-by-case basis, taking into account the individual woman's risk factors and medical history.
Mortality
The study 2 highlights the importance of preventing ovarian cancer, which is the most fatal gynecologic malignancy. Removing the ovaries can reduce the risk of ovarian cancer, but it's crucial to weigh this benefit against the potential risks and complications associated with the surgery. As noted in the study 4, high-quality evidence regarding the harm or benefit of retaining ovaries after menopause is lacking, and dialogue between clinicians and patients on this topic is essential.