Estrogens and progesterone as neuroprotectants: what animal models teach us. Stone DJ, Rozovsky I, Morgan TE, Anderson CP, Finch CE. An oophorectomy can be performed two ways: Minimally invasive laparoscopic surgery. 185 Cambridge St Suite 2200 Evans EC, Matteson KA, Orejuela FJ, Alperin M, Balk EM, El-Nashar S, Gleason JL, Grimes C, Jeppson P, Mathews C, Wheeler TL, Murphy M; Society of Gynecologic Surgeons Systematic Review Group. Women can suffer from depression as they enter into the menopause, but there are many treatments available and you might want to talk to your GYN or primary care provider about depression treatment. sharing sensitive information, make sure youre on a federal 2004; 22:1045-1054. Singapore Life Expectancy Rises From a Decade Ago Despite Covid The practice of prophylactic bilateral oophorectomy has increased over time, more than doubling between 1965 and 1999 [2], but the risk-benefit balance of prophylactic oophorectomy versus ovarian preservation remains uncertain and controversial [1,37]. But hormone replacement therapy has risks of its own. 1, 2 Bilateral oophorectomy may be performed for a benign disease or for prophylaxis against ovarian cancer, and is usually performed along with hysterectomy (in nearly 90% of cases). A CT revealed that my appendix needed to be removed. can anyone advise. Could I still conceive a child after an oophorectomy? Hormone Replacement Therapy and Life Expectancy After Prophylactic 2007; Farquhar et al. Hormone Replacement Therapy and Life Expectancy After Prophylactic Results from other studies are cited as evidence for or against each possible mechanism. For example, a study in a transgenic mouse model of Alzheimers disease showed that drugs blocking the release of LH significantly attenuated cognitive decline and decreased -amyloid deposition in treated animals compared with placebo-treated animals [57]. Inclusion in an NLM database does not imply endorsement of, or agreement with, Well it ended up being removed. The publisher's final edited version of this article is available free at. Reproductive hormone levels in gynecologic oncology patients undergoing surgical castration after spontaneous menopause. He found that in 1933, U.S. life expectancy ranked eighth highest among 16 populous countries. What is Driving Widening Racial Disparities in Life Expectancy? The joint effects of oophorectomy and genes may be much more complex than the example provided, and likely involve the interactions of several genes with each other and with hormonal factors. So, the best way to find out what you can expect is to ask your doctor. An estimate of the worldwide prevalence and direct costs of dementia in 2003. As a result, it is unknown if the estrogen therapy helped their mood. Obstet Gynecol. Do You Still Get Your Period After An Oophorectomy? Ask your doctor to refer you to a fertility specialist who can review your options with you. Oophorectomy: Purpose, Surgery, Risks & Recovery HHS Vulnerability Disclosure, Help The https:// ensures that you are connecting to the (Back history I had been told I was done with menopause as a blood test showed levels that showed I was done, I didnt have a lot of symptoms as I am Bi Polar and a lot of my symptoms could have masked the menopause) so the right ovary was found to have been a working one, eggs had been moving I guess and become encapsulated and granulated etc so it was removed. By contrast, if the ovaries are removed long after a woman has experienced natural menopause, the hormonal changes related to estrogen, progesterone, and gonadotropins may be less dramatic because estrogen and progesterone levels are already naturally reduced. Elective oophorectomy: Primum non nocere. Post-operative depressive symptoms were reported more commonly by women who already had depressive symptoms prior to the surgery than by those who did not have depressive symptoms pre-operatively (26% versus 7%, respectively). Most women experience mood changes and the worst menopausal symptoms immediately after oophorectomy. The hypothesis of a neuroprotective effect of estrogen is corroborated by several observational studies that showed a reduced risk of dementia in women treated with estrogen started early in menopause compared with women not treated [3842]. Keshavarz H, Hillis SD, Kieke BA, Marchbanks PA. Hysterectomy surveillance--United States, 19941999. Women who carry the APOE genotypes 34 or 44 have an increased risk of Alzheimers disease and dementia [58,59], and approximately 27% of women in the general population carry one of these high risk genotypes [59]. Whats the most important thing to know about oophorectomies? Androgen therapy in women: an Endocrine Society Clinical Practice guideline. Gonadotropins and cognition in older women. In addition, we reported that those women have an increased risk of parkinsonism, cognitive impairment or dementia, and depressive and anxiety symptoms compared with referent women (see executive summary) [7,1013]. High-resolution whole-genome association study of Parkinson disease. Mattila KM, Axelman K, Rinne JO, et al. REMOVAL OF OVARIES DOES NOT AFFECT LIFE EXPECTANCY Researchers at the City of Hope National Medical Center in California studied over 130,000 women 45 years or older who had both ovaries removed. Accessed Nov. 8, 2016. The four causal mechanisms listed above have implications for medical treatment in women who must undergo early bilateral oophorectomy. After an oophorectomy, you can expect to: Most people are able to go home after oophorectomy surgery and won't need to spend the night in the hospital. 2004; 22: 1045-1054. the contents by NLM or the National Institutes of Health. By contrast, the endocrine changes of natural menopause result from a progressive decline in ovarian function. In total, approximately 600,000 women undergo bilateral oophorectomy in the U.S. every year, many before reaching natural menopause. Gibbs RG. Parkinsonism was assessed using screening and examination, through a medical records-linkage system, and through death certificates. official website and that any information you provide is encrypted How quickly you can go back to your normal activities after an oophorectomy depends on your situation, including the reason for your surgery and how it was performed. As U.S. life expectancy continues to plummet, a new report found the country has been at a life expectancy disadvantage since the 1950s, and To prepare for an oophorectomy, your doctor may ask that you: If you want to have children, talk with your doctor about your options. Hanson MA, Gluckman PD. Laparoscopic oophorectomy uses special tools inserted through multiple incisions in your abdomen to remove your ovaries. My uterus and both ovaries were removed last May 2012. Premenopausal oophorectomy causes a rapid decline in circulating ovarian estrogens and androgens, often leading to hot flashes, sleep disturbance, mood alteration and vaginal dryness with associated painful intercourse. 2023 Mar 6;15(5):1625. doi: 10.3390/cancers15051625. A meta-analysis. Regardless of the type of surgery you have, you should not lift anything heavier than 10 pounds for six weeks, to prevent the development of a hernia. Long-Term Non-Cancer Risks in People with, P01 CA087969/CA/NCI NIH HHS/United States, R01 HL034594/HL/NHLBI NIH HHS/United States, NCI CPTC Antibody Characterization Program. The associations may involve the synergistic or antagonistic interaction of bilateral oophorectomy with genetic variants (e.g.. By contrast, cognitive status or dementia, and depressive or anxiety symptoms were assessed using a structured questionnaire via a direct or proxy telephone interview. 2008) and the review article by Shifren (2007) suggest that removal of the uterus and, in particular, of both ovaries, do not increase the likelihood of depressive symptoms. Talk with your doctor about the risks as they relate specifically to your situation. Parker WH, Broder MS, Liu Z, Shoupe D, Farquhar C, Berek JS. I mean I already have mood swings, depression hence bipolar so what difference would being thrown into menopause make to a bipolar person? Huang J, Guan H, Booze RM, Eckman CB, Hersh LB. What are the possible side effects of an oophorectomy? Oophorectomy and ovarian cystectomy. Parker WH, Broder MS, Chang E, Feskanich D, Farquhar C, Liu Z, Shoupe D, Berek JS, Hankinson S, Manson JE. Epidemiology of Dementia. Multivariable-adjusteda risks of all-cause and, Figure 1. However, more clinical and epidemiologic research is needed to clarify the effects of LH and FSH on the brain. Indeed, if interventions could delay disease onset or progression by as little as 1 year, we would expect nearly 9.2 million fewer Alzheimers disease patients by the year 2050 [74]. Wilson LF, Pandeya N, Byles J, Mishra GD. A twin study showed 63% heritability for age at natural menopause and 59% heritability for hysterectomy prior to natural menopause. Ovary Removal Side Effects: 5 Things to Know About Oophorectomy Siegfried T. Neuroscience: it's all in the timing. Mood and well-being after removal of both ovaries - MGH Center for Armstrong K, Schwartz JS, Randall T, Rubin SC, Weber B. Laparoscopic or robotic oophorectomy usually offers quicker recovery, less pain and a shorter hospital stay. In addition, we propose one mechanism combining hormonal changes with underlying genetic factors. Thus, premature estrogen and progesterone deficiency results in increased release of gonadotropins which, in turn, affects several specific regions of the brain leading to neurological symptoms and diseases. First possible mechanistic explanation of the associations between bilateral oophorectomy and brain outcomes. The causal mechanisms discussed here have important implications for clinical practice and for research. I was diagnosed bipolar 2 in 2005 after I had a severe manic episode while taking antidepressant. Some of the arrows and boxes are speculative and are depicted only as examples of possible causal relationships. For women younger than 50 years at the time of hysterectomy, bilateral oophorectomy was associated with significantly increased mortality in women who had never used estrogen therapy but not in past and current users: assuming a 35-year lifespan after oophorectomy: number needed to harm for all-cause death=8, coronary heart disease death=33, and lung cancer death=50. Casadesus G, Webber KM, Atwood CS, et al. Bilateral oophorectomy performed before the onset of menopause is associated with an increased risk of parkinsonism and Parkinsons disease. A population-based study of depressed mood in middle-aged, Australian-born women. 2008) investigated the question of post-surgical depression by comparing mood state 12 months after surgery to mood state at baseline (shortly before the surgery). Progesterone may turn out to be the key hormone linked to my mood shifts. Rocca WA, Grossardt BR, de Andrade M, Malkasian GD, Melton LJ., 3rd Survival patterns after oophorectomy in premenopausal women: a population-based cohort study. In support of this hypothesis, there is evidence that genetic factors predispose women to hysterectomy. The peritoneum is a covering that lines the abdominal organs and is close to . Will I still have menstrual periods? Preparative counseling and management. Its the surgical removal of an ovary. I am crying a lot now.. its been 16 days since the surgery, dont care about much. Unfortunately, there is little evidence of the specific effects of bilateral oophorectomy on any of these brain regions. The results of this large Maryland Womens Health Study (Rohl et al. The risk of depression after removal of both ovaries (also called bilateral ophorectomy or surgical menopause) is a major factor for women to consider when they confront medical problems that require removal of the uterus (called a hysterectomy). Premature progesterone and testosterone deficiency could affect several specific regions of the brain, in turn causing neurological symptoms and diseases. Our results from the Mayo Clinic Cohort Study of Oophorectomy and Aging suggest that the interplay of hormonal mechanisms may be complex and may vary depending on the specific neurological disease considered. Advertising revenue supports our not-for-profit mission. This content does not have an Arabic version. New York, N.Y.: The McGraw-Hill Companies; 2016. http://accessmedicine.com. Under this hypothetical mechanism, the abrupt reduction in circulating estrogen and progesterone caused by bilateral oophorectomy prompts a disruption of the hypothalamus-pituitary-ovarian axis resulting in increased release of the gonadotropins LH and FSH by the pituitary gland. In this situation, the bilateral oophorectomy has no causal role but becomes a marker of the underlying genetic predisposition (figure 1). Although the prevalence of dementia and its associated disability increases exponentially with age [75,76], the focus of research has recently shifted towards younger persons and very early stages of cognitive decline and mild cognitive impairment. If the same genetic variants that increase the risk of benign uterine or ovarian lesions also increase the risk of neurological diseases (through unknown hormonal or non-hormonal mechanisms), the shared risk would cause confounding. Additional laboratory and clinical research is needed to clarify mechanisms and to guide treatment to restore normal physiology when oophorectomy is required. J Clin Oncol. National Library of Medicine Although the possibility that confounding is the explanation of the observed associations cannot be completely ruled out at this time, the evidence for a confounding mechanism is limited. Premature estrogen deficiency (not compensated by a sufficient duration of estrogen replacement treatment) could affect several specific regions of the brain, in turn causing neurological symptoms and diseases. I feel flat and empty inside. Learn More: Where Breast Cancer May Spread. My uterus had to go, because I had a disease that caused severe pain, but I also had my doctor remove my ovaries as I hoped it would put an end to my PCOS, severe PMS, and menopause symptoms. The nature of the effect of female gonadal hormone replacement therapy on cognitive function in post-menopausal women: a meta-analysis. The https:// ensures that you are connecting to the Variants in genes in the estrogen synthesis and responsiveness pathway and risk of Parkinson's disease: a case-control study in women. I think I will be lucky if I make it to 60. Oophorectomy (ovary removal surgery) For example, the brain regions mentioned and the corresponding diseases are given as preliminary examples of an uncertain causal map. Oophorectomy after Menopause and the Risk of Breast Cancer in Grodstein F, Clarkson TB, Manson JE. In 2006, the number of people affected by Alzheimers disease was 26.6 million worldwide and the majority of patients were women. My depression has hurt all of my relationships, including my relationship with my husband. By contrast, if some of the harmful effects of bilateral oophorectomy on the brain are caused by decreased circulating levels of progesterone or testosterone, additional hormonal treatments may be needed. Rodriguez M, et al. For example, in the first genome-wide association study of Parkinsons disease involving a mixed sample of men and women, we found 11 single nucleotide polymorphisms (SNPs) associated with Parkinsons disease. Journal of Women's Health. Taking low doses of hormone replacement drugs after surgery and until about age 50 may reduce the risk of these complications. Women were followed for a median of 25 to 30 years. An oophorectomy (oh-of-uh-REK-tuh-me) is a surgical procedure to remove one or both of your ovaries. Mayo Clinic on Incontinence - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Science Saturday: Removal of both ovaries in younger women associated with increased risk of Parkinson's, A tubo-ovarian abscess a pus-filled pocket involving a fallopian tube and an ovary, Noncancerous (benign) ovarian tumors or cysts, Reducing the risk of ovarian cancer or breast cancer in those at increased risk, Ovarian torsion the twisting of an ovary, Rupture of a tumor, spreading potentially cancerous cells, Retention of ovary cells that continue to cause signs and symptoms, such as pelvic pain, in premenopausal women (ovarian remnant syndrome), Inability to get pregnant on your own, if both ovaries are removed, Menopause signs and symptoms, such as hot flashes and vaginal dryness, Stop eating a certain number of hours before your surgery and limit liquids, Undergo imaging tests, such as ultrasound and blood tests, to help surgeons plan for the procedure, Spend time in a recovery room as your anesthesia wears off, Move to a hospital room where you may spend a few hours to a few days, depending on your procedure, Get up and about as soon as you're able in order to help your recovery. Studies with a long period of follow-up after oophorectomy are few and insufficient whereas studies with shorter follow-up may not be adequate to address the questions that remain unanswered. At 52, I seem like an elderly woman. HHS Vulnerability Disclosure, Help The study was published in the Journal of Fertility and Sterility 11/2011. We are facing a rapid aging of the population worldwide [72]. If youre not already in menopause, an oophorectomy could bring about many changes. However, these initial findings await replication. Webber KM, Casadesus G, Marlatt MW, et al. Accessibility Figure 1 through Figure 3 represent oversimplified and tentative conceptual schemes to guide our discussion. Increased cardiovascular mortality following early bilateral oophorectomy In addition, new laboratory and clinical research studies are needed to clarify the hormonal mechanisms and the possible genetic interactions. This site needs JavaScript to work properly. This research was supported by the National Institute of Neurological Disorders and Stroke (grant R01 NS33978) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant R01 AR30582). Please enable it to take advantage of the complete set of features! Each ovary is separated from the blood supply and surrounding tissue and placed in a pouch. Overview of preoperative evaluation and preparation for gynecologic surgery. This content does not have an English version. Bethesda, MD 20894, Web Policies Increases in luteinizing hormone are associated with declines in cognitive performance. 2013 Aug;122(2 Pt 1):396. doi: 10.1097/AOG.0b013e31829d438c. Henderson VW, Benke KS, Green RC, Cupples LA, Farrer LA. Fortunately, in many cases, there is little change in the rate of pregnancy for those who have had an ovary removed. Understanding the divergent data on postmenopausal hormone therapy. For all of these women, it remains unknown whether, and for how long, estrogen treatment is needed, or whether other hormonal replacement treatments are needed [6]. 2023 The University of Texas MD Anderson Figure 1. Additional studies with a larger sample are needed to confirm the lack of protective effect of estrogen for some neurological outcomes. Accessed Oct. 26, 2016. Boston, MA 02114. What types of cancer are treated with an oophorectomy? This content does not have an English version. When the surgery involves removing only one ovary, it's called unilateral oophorectomy. Some genetic variants may modify the effect of bilateral oophorectomy on the brain causing a synergistic or an antagonistic joint effect (figure 3) [32]. Oophorectomy in Premenopausal Patients with Estrogen Receptor-Positive Breast Cancer: New Insights into Long-Term Effects. Rocca WA, Grossardt BR, Maraganore DM. Iivonen S, Corder E, Lehtovirta M, et al. Indeed, another study showed that women with a variant in the estrogen receptor 1 gene (ESR1; SNP rs2234693) have an increased risk of surgical menopause [28]. The hormonal changes induced by premenopausal bilateral oophorectomy are different from those occurring during natural menopause or those induced by postmenopausal bilateral oophorectomy. I was already on anti depressants for 8 years. An oophorectomy is a relatively safe procedure. An oophorectomy can also be done as part of an operation to remove the uterus (hysterectomy). I have PMDD so Im thinking that removing everything would be the way to go. Im an artist and writer, but my creativity dried up. Additional research is still needed to definitively establish the association of gynecologic surgery with mood and other aspects of quality-of-life, such as sexual health. For example, genetic variants in the estrogen synthesis or responsiveness pathway may predispose women to develop uterine abnormalities such as fibroids or adenomyosis leading to menorrhagia or metrorrhagia that, in turn, prompt the removal of the uterus. In addition, the randomization of women to prophylactic bilateral oophorectomy, or the randomization of women who underwent bilateral oophorectomy to estrogen or other hormonal replacement treatment, may raise ethical concerns. Although hormone levels and menstrual cycles are quite irregular and unpredictable during the menopausal transition, the underlying physiologic process is a progressive decrease in ovarian follicle numbers [20,21]. Removal of Ovaries and Life Expectancy - MigreLief Mayo Clinic does not endorse companies or products. Brookmeyer R, Johnson E, Ziegler-Graham K, Arrighi HM. Philadelphia, Pa: Mosby Elsevier; 2012. http://www.clinicalkey.com. With minimally invasive techniques using small incisions, you can typically go home the same day. Use of HRT after oophorectomy was associated with relatively small changes in life expectancy ( 0.17 to 0.34 years) when HRT was stopped at age 50, but larger decrements in life expectancy if HRT was continued for life ( 0.79 to 1.09 years). Talk with your doctors, so youll understand exactly what the procedure means for you. The increased risk of cognitive impairment or dementia was restricted to women who did not receive estrogen treatment [10]. Simpson ER. This is because your ovaries have already shut down, so it wont matter if one or both are removed. Matsuo K, Machida H, Shoupe D, Melamed A, Muderspach LI, Roman LD, Wright JD. Khan F, Rojas K, Schlumbrecht M, Jeudin P. Curr Oncol. The risk went down to 1.0 in women who took estrogen both early and late in life, suggesting that the two opposite effects cancelled each other (Whitmer et al., 2011). Ovarian aging and the perimenopausal transition: the paradox of endogenous ovarian hyperstimulation. Bilateral Oophorectomy and the Risk of Incident Diabetes in Michelsen TM, Rosland TE, svold BO, Pripp AH, Liavaag AH, Johansen N. Acta Obstet Gynecol Scand. HRT was associated with a gain in life expectancy of between 0.39 and 0.79 years for mutation carriers Oophorectomy: Procedure, recovery time, and side effects Finally, other non-genetic factors (e.g., smoking, obesity) may modify the effect of oophorectomy and of several genetic variants (figure 3). One recent analysis of the large Maryland Womens Health Study (Rohl et al. Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause. Wimo A, Jonsson L, Winblad B. Obstet Gynecol. J Clin Oncol. Estrogen, menopause, and the aging brain: how basic neuroscience can inform hormone therapy in women. Your gift will help support our mission to end cancer and make a difference in the lives of our patients. 2006). An oophorectomy is most commonly used to treat ovarian cancer, but it can also be used to treat different types of cancer that have spread to the ovary. Shoupe D, Parker WH, Broder MS, Liu Z, Farquhar C, Berek JS. Yes, but its usually removed with the nearby fallopian tube. This makes ovarian cancer less likely to occur, but it does not remove all risk. Genetic effects may also involve epigenetic mechanisms [70,71]. Rivera CM, Grossardt BR, Rhodes DJ, et al. Similarly, genetic variants that predispose women to ovarian cysts or endometriosis may prompt a bilateral oophorectomy to treat the lesions, to prevent recurrences, or to prevent subsequent ovarian cancer. Methods: This hypothesis is supported by the failure of estrogen treatment to offset the increased risk of parkinsonism and of depressive and anxiety symptoms in the Mayo Clinic Cohort Study of Oophorectomy and Aging [11,13]. Is an ovary the only part of the female reproductive system thats removed during an oophorectomy? Thus, bilateral oophorectomy would be a marker of risk but not a causal factor. Under this hypothetical mechanism, the abrupt reduction in circulating estrogen caused by bilateral oophorectomy is the initial step in a chain of causality leading to aging-related neurological diseases (figure 2). US life expectancy problem is 'bigger than we ever thought - MSN While there have been large gains in life . The camera transmits video to a monitor in the operating room that the surgeon uses to guide the surgical tools. Tanideh N, Daneshmand F, Karimimanesh M, Mottaghipisheh J, Koohpeyma F, Koohi-Hosseinabadi O, Tanideh R, Irajie C, Iraji A. Heliyon. New York, N.Y.: The McGraw-Hill Companies; 2013. http://www.accessmedicine.com. How long will it take to recover? Postmenopausal hormone therapy: new questions and the case for new clinical trials. Menopause. Espeland MA, Rapp SR, Shumaker SA, et al. Before However, the postoperative drop in testosterone levels is abrupt and may have clinical consequences [15]. Choose from 12 allied health programs at School of Health Professions. Does a Hysterectomy before 50 Shorten Lifespan? - The ObG Project It varies quite a bit, though. Hogervorst E, Bandelow S. Should surgical menopausal women be treated with estrogens to decrease the risk of dementia? Your ovaries contain eggs and produce hormones that control your menstrual cycle. Kanehisa M, Goto S, Hattori M, et al. Many women are advised to consider having their ovaries removed when they are having the uterus removed. Results of a meta-analysis. Hoffman BL, et al. I had a hysterectomy for massive fibroids at age 53 years in 2016, and a bilateral oophorectomy at the same time (my mum died of ovarian cancer). This was a prospective cohort study of 30,117 Nurses' Health Study participants undergoing hysterectomy for benign disease. and I am now trialling hormone replacement (and any accompanying risk of breast cancer) with effect. http://www.uptodate.com/home. For example, we do not know the impact of these surgeries on mood for women who have been diagnosed with clinical depression prior to the operation. We dont have a lot of data on what happens immediately after a total hysterectomy in terms of mood. For women who cannot use estrogen replacement therapy because of cancer risk, it may be possible to manage some of the symptoms using other non-hormonal treatments. The associations involve the synergistic or antagonistic interaction of the hormonal effects of bilateral oophorectomy with genetic variants or with non-genetic factors. Estradiol replacement increases the low-density lipoprotein receptor related protein (LRP) in the mouse brain. During oophorectomy surgery you'll receive anesthetics to put you in a sleep-like state. All rights reserved. Singh M, Sumien N, Kyser C, Simpkins JW. Fifth possible mechanistic explanation of the associations between bilateral oophorectomy and brain outcomes. doi: 10.1016/j.heliyon.2023.e15557. Bad reaction to anesthesia. Am J Obsetet Gynecol 2008; 199:22.e1-22.e5. Montgomery GW, Nyholt DR, Zhao ZZ, et al. Oncol., 22 (2004), pp. Snieder H, MacGregor AJ, Spector TD. ACOG. In contrast, the proportion of women with depressive symptoms decreases after surgery, even among those who have depressive symptoms before their surgery, and does not seem to be related to removal of both ovaries. Bilateral oophorectomy and depressive symptoms 12 months after hysterectomy. Gaba F, Blyuss O, Tan A, Munblit D, Oxley S, Khan K, Legood R, Manchanda R. Cancers (Basel). Multivariable-adjusteda risks of all-cause and cause-specific deaths for women with bilateral oophorectomy compared, MeSH Cycle and hormone changes during perimenopause: the key role of ovarian function. In a study of 85 people in the United States with triple-positive breast cancer, 58.9% had cancer in their lymph nodes when they were first diagnosed.