Women are often advised to have their ovaries removed if they have a mutated BRCA gene – famously carried by Angelina Jolie – which dramatically increases the risk of ovarian cancer
Women who have their ovaries removed to reduce the risk of cancer have a greater risk of dementia, research suggests.
The operation, which triggers early menopause, results in a reduction in memory and thinking skills, scientists have found.
Experts fear this may eventually lead to early-onset dementia for many women, and may even lead to Alzheimer’s.
But taking hormone replacement therapy (HRT) pills may halt this cognitive decline, according to findings presented at the Alzheimer’s Association International Conference in Toronto.
Nearly 4,000 women undergo surgery to extract their ovaries in Britain each year, many of them to lower their chance of developing ovarian cancer later in life.
Women are often advised to have their ovaries removed if they have a mutated BRCA gene – famously carried by Angelina Jolie – which dramatically increases the risk of ovarian and breast cancer.
But ovarian removal triggers immediately brings on the menopause, as the body’s method for producing the oestrogen hormone is removed.
Dr Gillian Einstein of Toronto University, an expert in the way dementia hits women, said oestrogen has a protective impact on the connections in the brain – and when natural hormone production stops this protection disappears.
Her research team tracked 133 women aged between 35 and 50, measuring their brain power with a series of tests for at least three years.
A third of the group underwent surgery to remove both ovaries, another third carried the BRCA-gene mutation but did not undergo the operation, and another third were healthy volunteers used as a comparison.
Dr Einstein’s team found women who had lost their ovaries displayed declining scores in the tests.
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They did worse in word-recall tests and logical memory tests, some of them showing protracted decline for eight years after operation, a drop that was not seen among the other two groups.
But if the women had been given HRT pills – which artificially replace oestrogen – less decline was seen.
Dr Einstein said the results suggested oestrogen, whether natural or artificial, is vital for brain health.
And when it is removed, it may send women down a path of decline that ends in Alzheimer’s disease.
‘This may give us an insight of oestrogen for healthy brain ageing along the trajectory for Alzheimer’s disease,’ Dr Einstein said.
Nearly 4,000 women undergo surgery to extract their ovaries in Britain each year, many of them to lower their chance of developing ovarian cancer later in life
‘It may give us a clearer understanding of the role of withdrawal of 17-beta-estradiol [the main form of oestrogen involved in the menstrual cycle] for exacerbating Alzheimer’s disease risk.’
Cancer experts want even more women to have their ovaries removed in their 30s and 40s, as they come up with new genetic tests to calculate someone’s cancer risk many years before a tumour appears.
For women at risk, removing the ovaries almost entirely eradicates the chance they will develop cancer.
Interest in the procedure soared after Miss Jolie, 41, famously chose to have her breasts, ovaries and fallopian tubes removed after her mother died of ovarian cancer aged just 56.
DEMENTIA MAY BE A SILVER LINING
Being diagnosed with dementia may have a ‘silver lining’, doctors claim.
People who are told their fate tend to gain a new appreciation of life– and finally receive an explanation as to why they have been suffering memory problems or confusion, in some cases for years.
A study of patients with dementia or mild cognitive impairment – often a precursor to the disease – found more than half said their diagnosis had made them view life more positively.
Many also said receiving a diagnosis had strengthened their relationships.
Scientists from Kentucky University in the US asked 48 men and women with early dementia or mild cognitive impairment a series of questions about their quality of life and personal outlook.
Presenting their results at the Alzheimer’s Association International Conference, in Toronto, the researchers said patients reported higher levels of tolerance of others and courage to face problems in life.
Professor Gregory Jicha said: ‘The overall assumption is this diagnosis would have a uniformly negative impact on a patient’s outlook on life.
‘But we were surprised to find almost half of respondents reported positive scores.
‘The common stereotype for this type of diagnosis is depression, denial and despair.
‘However this study – while small – suggests positive changes in attitude are as common as negative ones.’
Dr Einstein said HRT might also help reduce the risk of dementia for those who go through the menopause naturally, usually in the late 40s and early 50s.
Scientists have long been divided about the benefits and risks of taking HRT to ease the symptoms of the menopause, with well-publicised studies in the early 2000s increasing fears the pills come with risks of cancer and might even reduce brain power.
The balance, however, is beginning to swing back in favour of HRT, with emerging data suggesting the treatment is not as bad as feared.
NICE – the NHS health guidance watchdog – last autumn issued new advice which said far more women should be offered HRT.
Dr Einstein said: ‘The age at which women go through the menopause is really important.
‘If HRT is going to be beneficial to women in natural menopause it needs to be given at the time of transition, when the neurons are still healthy.’
Dr David Reynolds, chief scientific officer of Alzheimer’s Research UK, said: ‘Now we understand the risk BRCA-mutation carriers have for developing cancer, increasing numbers of women are opting to have their ovaries removed to reduce their risk of cancer.
‘Currently it is unknown if surgery predisposes them to other risks, one of which could be cognitive decline to lower levels of female hormones like oestrogen.
‘Gillian Einstein’s study is important in it is investigating these effects and will establish whether or not HRT is beneficial. It is still early days but her data perhaps suggests that it is of some benefit but clearly further research is needed.’
Katherine Taylor, chief executive at Ovarian Cancer Action, said: ‘We welcome research that builds on our knowledge of BRCA and cancer prevention but urge women with BRCA gene mutations not to panic in light of this new research, which is in early stages.
‘If you’re offered ovarian removal surgery and face a premature menopause you will usually also be offered HRT.’