Meta-analysisindependent cross-checkabstract checked★ key study I-ORG-138 in-depth review
Early surgical menopause and dementia
Surgical menopause in association with cognitive function and risk of dementia: A systematic review and meta-analysis.
Overview
Georgakis MK et al.. Psychoneuroendocrinology 2019 · PMID 30928686 · DOI 10.1016/j.psyneuen.2019.03.013
Removing both ovaries at 45 or younger was linked to a higher risk of dementia; surgery at any age was not clearly linked.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Pool studies on surgical menopause and cognition
- How was the study done?
Systematic review and meta-analysis
- How many people, animals or samples were studied?
11 studies, 18,867 women
- What was actually found?
Higher dementia risk only with surgery at <= 45
- How large was the observed effect?
HR 1.70 (1.07-2.69)
- What do the results mean in everyday life?
Age at surgery matters
- What are the study's limitations?
Only 2 studies for main estimate
- What does it say about Elawady's specific claim?
Supports the claim's age condition
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Cannot prove causation
Scientific in-depth review
1. Full reference
- Authors
- Georgakis MK et al.
- Journal
- Psychoneuroendocrinology
- Year
- 2019
- Identifier
- PMID 30928686 DOI 10.1016/j.psyneuen.2019.03.013
- Verification
- verified – PubMed efetch 2026-10-26; Crossref works API 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Non-commercial support (PubMed).
2. Research question
Is surgical menopause (bilateral oophorectomy before menopause) associated with dementia and cognitive decline?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis of observational studies
- Population
Women in observational studies
- Country
Multinational
- Period
Not stated in abstract
- Sample size
11 studies, N = 18,867
- Inclusion and exclusion criteria
Studies of surgical menopause and dementia/cognition
4. Methods and endpoints
- Exposure / intervention
Surgical menopause
- Comparator
Natural menopause / no surgery
- Endpoints
Dementia, cognitive performance/decline, AD neuropathology
- Statistical methods
Random-effects; Newcastle-Ottawa
5. Actual results
- Results
Surgical menopause at any age not associated with dementia (4 studies; HR 1.16, 0.96-1.43); early surgical menopause (<= 45 years) associated with higher risk (2 studies; HR 1.70, 1.07-2.69). Faster decline in verbal memory, semantic memory and processing speed; younger age at surgery associated with faster decline and more AD neuropathology. No heterogeneity.
- Absolute risks
Not reported
- Authors' conclusion
Evidence is limited but suggests surgical menopause at <= 45 years is associated with higher dementia risk and cognitive decline; replication needed.
6. Strengths
- Systematic
- Age-specific analysis
7. Weaknesses
- Only 2 studies for the early-menopause estimate
- Observational
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Few studies; quality assessed with NOS.
9. Assessment of the statistical interpretation
HR 1.70 CI log-symmetric but wide; based on 2 studies.
10. Relevance to the specific claim
Supports the age gradient described in the claim (Rocca 2007).
11. Independent contrary findings
Fu 2026 (I-ORG-139) and Uldbjerg 2022 (I-ORG-140) found no clear or imprecise associations.
12. Transferability to Germany and Europe
Includes European studies.
13. Overall methodological judgement
Supports the claim for oophorectomy at <= 45 years; not for surgery at any age.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | low |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | mixed |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Role of estrogen therapy.