Surgical menopause in association with cognitive function and risk of dementia: A systematic review and meta-analysis.
Level 2 - randomized trial
Systematic review and meta-analysis of observational studies
PubMed 30928686 · doi:10.1016/j.psyneuen.2019.03.013
What was done
The authors conducted a systematic review and random-effects meta-analysis of studies investigating bilateral oophorectomy before menopause onset in relation to dementia risk, cognitive performance, cognitive decline, and Alzheimer's disease neuropathology. Study quality was evaluated using the Newcastle-Ottawa scale.
What was found
Eleven studies were included (N = 18,867). Surgical menopause at any age was not significantly associated with dementia risk (4 studies; HR: 1.16, 95% CI: 0.96-1.43), but early surgical menopause (≤45 years) was significantly associated with increased dementia 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, without heterogeneity. Early surgical menopause was also associated with faster global cognitive decline. Across surgical menopause patients, younger age at surgery was associated with faster decline in global cognition and episodic memory, worse verbal fluency and executive function, and increased Alzheimer's neuropathology.
Why it matters
This synthesis suggests that early loss of ovarian hormones (≤45 years) through bilateral oophorectomy may increase vulnerability to late-life cognitive decline and dementia, emphasizing the clinical relevance of surgical timing.
Limits
The included studies were observational. Key meta-analytic outcomes were based on very few studies (only 2 studies for early surgical menopause dementia risk and 4 for overall dementia risk). The abstract does not report data on hormone replacement therapy use, indication for surgery, or detailed confounding control.
Cited by
- contradicts Loss of estrogen during menopause is not a cause of cognitive problems or Alzheimer's disease.