Angelina Jolie Pitt's surgery to remove her ovaries has the side effect of putting her into early menopause, a condition which itself comes with some health risks, experts say.
On Tuesday, Jolie Pitt revealed that she had surgery to remove her ovaries and fallopian tubes to prevent ovarian cancer. The actress said she carries a genetic mutation in the BRCA1 gene, which significantly increases her risk of breast and ovarian cancer, and she has previously undergone a double mastectomy to prevent breast cancer.
Removing the ovaries reduces her risk of ovarian cancer by 85 to 90 percent, but it will also put her into menopause immediately, at age 39, around a decade before the average woman enters menopause naturally. (The average age for menopause in the United States is 51, according to the National Institute on Aging.)
There are a few reasons, in addition to preventive surgery like Jolie Pitt's, women might enter menopause early; for example, their bodies may spontaneously stop ovulating, or they may undergo cancer chemotherapy treatment that disrupts their reproductive organs. But whatever the cause, early menopause, or menopause before age 40, is linked with an increased risk of heart disease, neurological problems, osteoporosis (brittle bones), and depression and anxiety, according to a 2009 review article.
Taking the hormone estrogen after removal of the ovaries, which Jolie Pitt is doing, can reduce some, but not all, of these risks, according to the review.
The ovaries produce estrogen, which is critical for bone health, and so low estrogen levels can lead to the development of osteoporosis. If nothing is done to prevent bone loss — either through medications or lifestyle changes — then women are virtually certain to experience bone loss after early menopause, said Dr. Elizabeth Poynor, a gynecologic oncologist and pelvic surgeon at Lenox Hill Hospital in New York.
Researchers are still trying to understand why early menopause is linked with an increased risk of heart disease. But one theory is that estrogen helps prevent plaques from forming in blood vessels, Poynor said. So a loss of estrogen could increase plaque buildup in the arteries, leading to the hardening of these vessels.
The risk of heart disease doubles for women who have their ovaries removed at a young age, Poynor said.
Still, for women who face a high risk of developing ovarian cancer, a potentially lethal disease, the benefits of the surgery to remove the ovaries often outweigh the risks of early menopause, Poynor said. Jolie Pitt said her risk of ovarian cancer, which killed her mother, was 50 percent. [5 Things Women Should Know About Ovarian Cancer]
Women in menopause can also experience symptoms that affect their quality of life, such as hot flashes, mood changes, vaginal dryness and memory loss, Poynor, said. For women who've had their ovaries removed surgically, the transition into menopause, and the potential side effects, are more abrupt compared to the transition of women who go through menopause naturally, Poynor said.
But this doesn't mean that women who have their ovaries removed will experience more severe symptoms of menopause. "I think that everyone's really different," Poynor said. It is often unpredictable how a woman's body is going to respond when the ovaries are removed, Poynor said. Women who are considering this surgery should ask their doctors to review the possible side effects of early menopause with them beforehand, so they know what to look for after surgery, she said.
The decision to use hormone treatments (also known as hormone replacement therapy) for women in early menopause is made on a case-by-case basis, Poynor said. Doctors will take into account a woman's age (with younger women more likely to use hormone treatments), her menopausal symptoms and her personal history, including whether she has a history of breast cancer, Poynor said. Hormone replacement therapy has been linked with an increased risk of breast cancer, and estrogen can stimulate the growth of breast cells, so a woman with a history of breast cancer would not be recommended to take hormone replacement therapy.
Women who've had a mastectomy to prevent breast cancer still have a small risk of developing the disease in their lifetimes, because some breast tissue remains even after the surgery, Poynor said. So women who take hormone replacement therapy should be followed closely, even if they have had a mastectomy, she said.