Cardiovascular outcomes of bilateral oophorectomy: A systematic review and meta-analysis

Abstract

Background: Cardiovascular disease (CVD) risk significantly increases in women after menopause. However, the cardiovascular (CV) outcomes in women who undergo bilateral oophorectomy remain unclear. This study aimed to evaluate the CV outcomes associated with bilateral oophorectomy. Methods: A systematic search was conducted across 4 databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, from inception to March 25, 2025, without language restrictions. Studies comparing CV outcomes in women who underwent bilateral oophorectomy versus those who did not were included. A random-effects model was used for meta-analysis. Results: A total of 18 studies, comprising a total of 2,414,600 participants, were included. Bilateral oophorectomy was associated with a marginally increased risk of CVD compared to control (pooled HR 1.05, 95 %CI 1.00–1.11, p = 0.05). Bilateral oophorectomy was also associated with a higher risk of heart failure (pooled HR 2.25, 95 %CI 1.15–4.41, p = 0.02). When stratified by age at surgery, bilateral oophorectomy performed at a premenopausal age was associated with a higher risk of CVD (pooled HR 1.15, 95 %CI 1.02–1.30, p = 0.03) and coronary artery disease (pooled HR 1.26, 95 %CI 1.15–1.39, p < 0.01). In contrast, bilateral oophorectomy performed at postmenopausal age was not associated with an increased risk of CV events. Conclusions: Bilateral oophorectomy is associated with an increased risk of CV events, particularly when performed at a premenopausal age. Further research is warranted to determine appropriate prevention strategies and risk stratification in this population.