Disputation: Nora Johansen – Gynecology

Cand.med. Nora Johansen at Institute of clinical medicine will be defending the thesis “Late effects in women after risk-reducing salpingo-oophorectomy to prevent hereditary ovarian cancer: Cardiovascular risk, sexual functioning, and use of hormone replacement therapy” for the degree of Philosophiae doctor (PhD).

Photo: Øystein Horgmo, UiO

Trial lecture - time and place

See trial lecture.

Adjudication committee

  • First opponent: Professor Angelica Lindén Hirschberg, Karolinska Institutet
  • Second opponent: Professor Mette H. Moen, Norwegian University of Science and Technology
  • Committee chair: Professor II Jens Bollerslev, University of Oslo

Chair of defence

Associate Professor Kristin Reimers Kardel, University of Oslo

Principal supervisor

Senior Consultant Trond Melbye Michelsen, Oslo University Hospital


Women with inherited increased risk of ovarian cancer are recommended to undergo risk-reducing removal of both ovaries and fallopian tubes. For optimal risk reduction, the preventive surgery should be performed between the ages of 35 and 45 years. However, the following premature loss of ovarian hormones may cause late effects if hormones are not replaced. Therefore, women below the age of natural menopause are recommended to take hormone replacement therapy (HRT) if no history of breast cancer.

Aims of the thesis of Nora Johansen, MD, were to examine risk of cardiovascular disease (CVD), sexual functioning, and the use of HRT in women after preventive removal of the ovaries.

These long-term effects were determined by questionnaires, clinical examinations, and analyses of blood samples. In the studies of CVD risk, sexual functioning, and use of HRT, comparisons were made with women from the general population.

Only half of the women that were eligible for HRT actually used HRT.

Women who had undergone preventive oophorectomy had less sexual pleasure and more sexual discomfort compared to women from the general population. After the preventive surgery, use of systemic HRT was associated with less sexual discomfort.

The CVD risk at a mean of four years after the preventive surgery was comparable to the CVD risk among age-matched women with intact ovaries.

In summary, probably too few women used HRT after the preventive surgery, which implies that many of these women unnecessarily experience postmenopausal symptoms and are at increased risk of late effects. Women who consider preventive surgery should be informed about the possible effect on sexual functioning, and that use of HRT may be associated with less sexual discomfort. The findings of comparable CVD risk in women after preventive oophorectomy and control women may be reassuring information, but the follow-up may have been too short to reveal differences in CVD risk.

Additional information

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Published Jan. 31, 2019 2:28 PM - Last modified Feb. 4, 2019 2:12 PM