Boston—Age appears to matter when determining the benefit of estrogen therapy on women who had their ovaries removed, as well as those who didn’t, according to a new study.

The report in Annals of Internal Medicine points out that women who started estrogen older than age 60 years did not derive a mortality benefit and experienced more adverse effects whether or not their ovaries had been removed. That was especially the case among those aged 70 years and older, according to Brigham and Women’s Hospital–led researchers.

On the other hand, even though no statistically significant benefit was seen in the initial study average follow-up period of 7 years, women in their fifties who had a hysterectomy and their ovaries removed appear to demonstrate a mortality benefit from estrogen therapy during long-term follow-up, i.e. an average of 18 years. They also did not seem to have harmful health effects, according to a randomized, double-blind trial.

Background information in the study notes that about one-third to one-half of women who undergo hysterectomy also have their ovaries concurrently removed with bilateral salpingo-oophorectomy to reduce their risk for future ovarian cancer. The procedures lead to early menopause and loss of estrogen, which is associated with other health risks.

The authors tout their study as the first to assess, in a randomized trial setting, whether health outcomes of menopausal estrogen therapy differ between women with or without their ovaries.

For the trial, 9,939 women aged 50 to 79 years with prior hysterectomy were included. Researchers sought to examine whether estrogen therapy outcomes differed by whether or not the participants’ ovaries were also removed and whether the effect was different based on the age at which the women began estrogen therapy.

Patients were randomly assigned to receive estrogen hormone supplements or placebo, with the study team documenting whether they developed heart disease, breast cancer, or death from any cause, among other measures.

The study team determined that menopausal estrogen-alone therapy for a median of 7.2 years was associated with reduced mortality over the long-term (18 years) and had a generally favorable safety profile when initiated before age 60 years in women who had their ovaries removed. Yet, they found, older women did not derive that benefit, whether or not their ovaries were intact. Even worse, according to the authors, women who had their ovaries removed and were above age 70 years experienced adverse effects of treatment.

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