Repercussões e diferenças da menopausa recente pós ooforectomia bilateral comparada à menopausa natural na composição corporal, perfil metabólico, reatividade vascular, sexualidade, cognição e humor

Abstract

The actual ovarian role after menopause and consequences of low testosterone levels in women undergoing bilateral oophorectomy remains uncertain. In order to assess if low levels of testosterone produced by ovaries in recent postmenopausal women, excluded confounding factors, influence vascular, sexual and metabolic function, body composition, cognition and mood, an observational case-control study was designed. In it, 81 postmenopausal women, 36 with bilateral oophorectomy (O) and 45 controls (C) with both ovaries, adequately treated for climacteric symptoms with percutaneous estradiol, were evaluated by venous occlusion plethysmography, bioimpedance, DEXA densitometry, biochemical, hormonal and inflammatory profile. Sexual function, cognition and mood were assessed, respectively, by Female Sexual Function Index (FSFI), Mini Mental and Beck Depression Inventory (BDI). Total testosterone levels (TT) in O were 13.8±14.4 vs. 27±19.4 ng/dl in C (p=0.001). Brachial artery flow, in ml/min/100 ml tissue, was lower in O compared to C at baseline (1.89±1.23 vs. 2.20±0.92, p=0.036), following the reactive hyperemia response (endothelium-dependent flow mediated dilatation, 3.74±1.87 vs. 4.58±2.31, p=0.031) and following nitroglycerin (endothelium-independent dilation, 1.53±0.89 vs. 1.82±1.06, p=0.025). There was a positive correlation between TT levels and plethysmography basal flows (FB1 and FB2), with r = 0.235 and 0.233; p = 0.034 and 0.036, respectively. The positive correlation occurred also with post-nitroglycerin flow (FPN), r = 0.312, p = 0.004, but was not statistically significant with hyperemia post-flow (FPH), r = 0.184, p = 0.1. The levels of sVCAM1 (soluble Vascular Cell Adhesion Molecule-1) showed a negative correlation with the TT levels (r = - 0.320, p = 0.005) and levels of IGF-1 (Insulin-like Growth Factor-1), a positive correlation (r = 0.290, p = 0.013). The FSFI scores were higher in O, representing a better sexual function in this group (p = 0.003). There were no differences in body composition and questionnaires for depression and cognition. In conclusion, the absence of ovarian production of testosterone in O women is associated to worst endothelial function, or vascular reactivity, compared to C. It was not observed worst sexual function in O compared to C and there was no relation between TT and sexual function, depression or cognition scores.