Surgical menopause: A toolkit for healthcare professionals

2021 ◽  
pp. 205336912110384
Author(s):  
Akanksha Garg ◽  
Lynne Robinson
Keyword(s):  
Healthcare Professionals ◽  
Ovarian Function ◽  
Hormone Replacement ◽  
Bilateral Oophorectomy ◽  
Natural Menopause ◽  
Sudden Loss ◽  
Increased Risk ◽  
Surgical Menopause ◽  
Loss Of Libido

Surgical menopause (bilateral oophorectomy) is commonly undertaken during a hysterectomy to treat various medical conditions. Menopausal symptoms can be particularly severe due to the sudden loss of ovarian function. This clinical toolkit is intended to guide healthcare professionals caring for women undergoing surgical menopause. Women commonly experience vasomotor symptoms, sexual dysfunction and an increased risk of cardiovascular and osteoporotic disease. Compared with a natural menopause, loss of libido can be more pronounced following a surgical menopause. Hormone Replacement Therapy (HRT) plays a significant role in managing surgical menopause, especially in women aged under 45 years old. All women undergoing surgical menopause should have adequate counselling regarding the hormonal consequences of surgery and the role of HRT with a view to provide individualised, patient-centred care.

scholarly journals Type of menopause, age of menopause and variations in the risk of incident cardiovascular disease: pooled analysis of individual data from 10 international studies

2020 ◽  
Vol 35 (8) ◽  
pp. 1933-1943 ◽  
Author(s):  
Dongshan Zhu ◽  
Hsin-Fang Chung ◽  
Annette J Dobson ◽  
Nirmala Pandeya ◽  
Eric J Brunner ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Medical Research ◽  
Postmenopausal Women ◽  
Research Council ◽  
Medical Research Council ◽  
Natural Menopause ◽  
Age At Menopause ◽  
Increased Risk ◽  
Surgical Menopause

Abstract STUDY QUESTION How does the risk of cardiovascular disease (CVD) vary with type and age of menopause? SUMMARY ANSWER Earlier surgical menopause (e.g. <45 years) poses additional increased risk of incident CVD events, compared to women with natural menopause at the same age, and HRT use reduced the risk of CVD in women with early surgical menopause. WHAT IS KNOWN ALREADY Earlier age at menopause has been linked to an increased risk of CVD mortality and all-cause mortality, but the extent that this risk of CVD varies by type of menopause and the role of postmenopausal HRT use in reducing this risk is unclear. STUDY DESIGN, SIZE, DURATION Pooled individual-level data of 203 767 postmenopausal women from 10 observational studies that contribute to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE) consortium were included in the analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS Postmenopausal women who had reported menopause (type and age of menopause) and information on non-fatal CVD events were included. Type of menopause (natural menopause and surgical menopause) and age at menopause (categorised as <35, 35–39, 40–44, 45–49, 50–54 and ≥55 years) were exposures of interest. Natural menopause was defined as absence of menstruation over a period of 12 months (no hysterectomy and/or oophorectomy) and surgical menopause as removal of both ovaries. The study outcome was the first non-fatal CVD (defined as either incident coronary heart disease (CHD) or stroke) event ascertained from hospital medical records or self-reported. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CI for non-fatal CVD events associated with natural menopause and surgical menopause. MAIN RESULTS AND THE ROLE OF CHANCE Compared with natural menopause, surgical menopause was associated with over 20% higher risk of CVD (HR 1.22, 95% CI 1.16–1.28). After the stratified analysis by age at menopause, a graded relationship for incident CVD was observed with lower age at menopause in both types of natural and surgical menopause. There was also a significant interaction between type of menopause and age at menopause (P < 0.001). Compared with natural menopause at 50–54 years, women with surgical menopause before 35 (2.55, 2.22–2.94) and 35–39 years (1.91, 1.71–2.14) had higher risk of CVD than those with natural menopause (1.59, 1.23–2.05 and 1.51, 1.33–1.72, respectively). Women who experienced surgical menopause at earlier age (<50 years) and took HRT had lower risk of incident CHD than those who were not users of HRT. LIMITATIONS, REASONS FOR CAUTION Self-reported data on type and age of menopause, no information on indication for the surgery (e.g. endometriosis and fibroids) and the exclusion of fatal CVD events may bias our results. WIDER IMPLICATIONS OF THE FINDINGS In clinical practice, women who experienced natural menopause or had surgical menopause at an earlier age need close monitoring and engagement for preventive health measures and early diagnosis of CVD. Our findings also suggested that timing of menopause should be considered as an important factor in risk assessment of CVD for women. The findings on CVD lend some support to the position that elective bilateral oophorectomy (surgical menopause) at hysterectomy for benign diseases should be discouraged based on an increased risk of CVD. STUDY FUNDING/COMPETING INTEREST(S) InterLACE project is funded by the Australian National Health and Medical Research Council project grant (APP1027196). GDM is supported by Australian National Health and Medical Research Council Principal Research Fellowship (APP1121844). There are no competing interests.

scholarly journals Clinical profile of 550 cases of surgical and natural menopause

2020 ◽  
Vol 10 (3) ◽  
pp. 168-171
Author(s):  
Nusrat Mahjabeen ◽  
Shaikh Zinnat Ara Nasreen
Keyword(s):  
Ovarian Function ◽  
Natural Aging ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Bilateral Oophorectomy ◽  
Natural Menopause ◽  
Medical College ◽  
Estrogen Production ◽  
Hot Flush ◽  
Surgical Menopause

Background: Menopause represents the permanent cessation of menstrual periods and the loss of fertility due to the loss of ovarian function. It can occur spontaneously (natural menopause) or it can be surgically induced. They are different entirely. One is a natural stage of life that all women experience, the other is the result of surgery, that is, bilateral oophorectomy. Surgical menopause is when surgery, rather than the natural aging process, causes a woman to go through menopause. The ovaries are the main source of estrogen production in the female body. Their removal triggers immediate menopause, despite the age of the person having surgery. While surgery to remove the ovaries can operate as a stand-alone procedure, it is sometimes performed in addition to hysterectomy to reduce the risk of developing chronic diseases. This study was designed to compare the effects of the natural and the surgical menopause. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology of Z. H. Sikder Women’s Medical College & Hospital, Dhaka from January 2016 to December 2018. During the study period a total of 275 patients with surgical menopause (total abdominal hysterectomy with bilateral salpingo-oophorectomy was done in all cases) and 275 patients with natural menopause were enrolled. After taking written consent detailed information about the patients was collected in a predesigned data collection sheet for each patient. Results: Age of most of the patients in surgical menopause group was within 41 to 50 years and most patients were >50 years old in natural menopause group. Most of the patients were illiterate in both groups and maximum patients were in poor socio-economic condition in both groups. Hot flush (48.0% vs 28.0%), palpitation (28.0% vs 4.0%) and dryness of vagina (12.0% vs 0.0%) were higher and body ache (32.0% vs 48.0%), tiredness (8.0% vs 36.0%), insomnia (8.0% vs 28.0%), depression (4.0% vs 16.0%), lack of concentration (0.0% vs 4.0%), loss of memory (0.0% vs 16.0%) and irritability (4.0% vs 8.0%) were found significantly lower in surgical menopause than natural menopause group. Dyspareunia (72.0% vs 28.0%), dysuria (92.0% vs 40.0%) and increased frequency of urination (68.0% vs 36.0%) were significantly higher in surgical menopause than natural menopause group. Urgency, hesitancy and incontinence of urination were significantly lower in surgical menopause than natural menopause group. Conclusion: Ovaries were removed in all of the surgical menopause cases, which may be the reason of more deleterious effects in surgical menopause than natural menopause. So, it is highly recommended to preserve ovaries in hysterectomies due to benign indications. Birdem Med J 2020; 10(3): 168-171

scholarly journals Association of hormonal dysregulation with metabolic syndrome in older women: data from the InCHIANTI study

2007 ◽  
Vol 292 (1) ◽  
pp. E353-E358 ◽  
Author(s):  
Marcello Maggio ◽  
Fulvio Lauretani ◽  
Gian Paolo Ceda ◽  
Stefania Bandinelli ◽  
Shehzad Basaria ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Older Women ◽  
Inflammatory Markers ◽  
Hormone Replacement ◽  
Sex Hormone Binding Globulin ◽  
Bilateral Oophorectomy ◽  
Age Related ◽  
Increased Risk ◽  
Igf I

Metabolic syndrome (MetS) is a strong risk factor for type 2 diabetes and cardiovascular disease. Conditions associated with hyperandrogenism are often associated with glucose intolerance and other features of MetS in young women. As the prevalence of MetS increases with age and is probably multifactorial, it is reasonable to hypothesize that age-related changes in androgens and other hormones might contribute to the development of MetS in older persons. However, this hypothesis has never been tested in older women. We hypothesized that high levels of testosterone, dehydroepiandrosterone sulfate (DHEA-S), and cortisol and low levels of sex hormone-binding globulin (SHBG) and IGF-I would be associated with MetS in a representative cohort of older Italian women independently of confounders (including inflammatory markers). After exclusion of participants on hormone replacement therapy and those with a history of bilateral oophorectomy, 512 women (≥65 yr) had complete data on testosterone, cortisol, DHEA-S, SHBG, fasting insulin, total and free IGF-I, IL-6, and C-reactive protein (CRP). MetS was defined according to ATP-III criteria. Insulin resistance was calculated according to HOMA. MetS was found in 145 women (28.3%). Participants with vs. those without MetS had higher age-adjusted levels of bioavailable testosterone ( P < 0.001), IL-6 ( P < 0.001), CRP ( P < 0.001), and HOMA ( P < 0.001) and lower levels of SHBG ( P < 0.001). After adjustment for potential confounders, participants with decreased SHBG had an increased risk of MetS ( P < 0.0001) vs. those with low SHBG. In a further model including all hormones and confounders, log SHBG was the only independent factor associated with MetS (OR: 0.44, 95% CI 0.21–0.91, P = 0.027). In older women, SHBG is negatively associated with MetS independently of confounders, including inflammatory markers and insulin resistance. Further studies are needed to support the notion that raising SHBG is a potential therapeutic target for prevention and treatment of MetS.

Psychological and Sexual Symptoms Associated with the Menopause and the Effects of Hormone Replacement Therapy

1995 ◽  
Vol 167 (2) ◽  
pp. 163-173 ◽  
Author(s):  
Jane Pearce ◽  
Keith Hawton ◽  
Fiona Blake
Keyword(s):  
Hormone Replacement Therapy ◽  
Psychiatric Disorder ◽  
Replacement Therapy ◽  
Psychological Symptoms ◽  
Hormone Replacement ◽  
Oestrogen Therapy ◽  
Natural Menopause ◽  
Hormonal Factors ◽  
Sexual Symptoms ◽  
Surgical Menopause

BackgroundThere is considerable inconsistency in the results of studies of the psychological and sexual sequelae of the menopause and their treatment.MethodA search of the literature on Medline was made of studies of psychological symptoms in women who were either naturally or surgically menopausal or who were receiving hormone replacement therapy for menopausal symptoms.ResultsThere is evidence of a small increase in psychological morbidity (not usually amounting to psychiatric disorder) preceding the natural menopause and following the surgical menopause. Psychosocial as well as hormonal factors are relevant. While the response of psychosocial symptoms to hormone replacement therapy with oestrogens is variable and most marked in the surgical menopause, in some studies the effect is little greater than that for placebo. Where sexual symptoms are present, there is more consistent evidence that hormone replacement therapy is effective.ConclusionsIn the light of the available evidence, the current use of hormone replacement therapy to treat psychological symptoms detected at the time of (but not necessarily therefore due to) the natural menopause must be questioned. It does appear that oestrogen therapy ameliorates psychological symptoms after surgical menopause.

scholarly journals Serum estradiol level and postmenopausal symptoms in surgical and natural menopause

2017 ◽  
Vol 6 (9) ◽  
pp. 3920
Author(s):  
Navdeep Kaur ◽  
Veena G. Malla ◽  
Sonal Gupta
Keyword(s):  
Hormone Replacement ◽  
Estradiol Level ◽  
P Value ◽  
Fisher Exact Test ◽  
Serum Estradiol ◽  
Natural Menopause ◽  
Postmenopausal Symptoms ◽  
Surgical Menopause ◽  
The Mean ◽  
Estradiol Levels

Background: Menopause whether it occurs naturally or surgically is characterized by the reduced production of hormones by the ovaries. The study aimed at comparing the serum estradiol levels and postmenopausal symptoms in women with surgical and natural menopause.Methods: 50 women each of natural and surgical menopause were enrolled. Five ml of fasting blood sample was collected from each patient in both the groups by venepuncture in a plain tube, which was centrifuged and was analyzed for serum estradiol levels by chemiluminescence method. Levels of serum estradiol hormone for both the groups were compiled and the mean and standard deviation was calculated. Postmenopausal symptoms were also compared among two groups. Chi square and fisher exact test were used to analyze the qualitative data and t test were used to analyze the quantitative data.Results: The mean level of serum estradiol in women with surgical menopause was found to be 20.49 + 3.16 pg/ml while that in natural menopause, was 27.41 + 5.08pg/ml. The difference in mean estradiol level between the two groups was found to be statistically significant (p value <0.0001). Hot flushes and mood swings were observed in more number of women with surgical menopause.Conclusions: The statistically significant lower levels of serum estradiol in surgical menopausal group may be a reason behind increased presence of menopausal symptoms in this group. Thus, the women in this group may benefit from hormone replacement therapy, improving their quality of life, however further studies are needed to establish this role.

The role of hormone replacement therapy in women with a current or past history of endometriosis

2000 ◽  
Vol 6 (1) ◽  
pp. 19-22
Author(s):  
Andrew Prentice
Keyword(s):  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Past History ◽  
Hormone Replacement ◽  
Premenopausal Women ◽  
Bilateral Oophorectomy ◽  
Releasing Hormone ◽  
History Of ◽  
Gonadotrophin Releasing Hormone

Endometriosis is an oestrogen sensitive condition, leading to reluctance to prescribe hormone replacement therapy. Treatment of endometriosis either medically with gonadotrophin releasing hormone analogues or with surgery involving bilateral oophorectomy leads to oestrogen deficiency. While this may lead to vasomotor symptoms, the consequence which has been of most concern is a reduction in bone mass. Repeated courses of gonadotrophin releasing hormone analogues may mean that women with endometriosis enter the menopause with a below average bone density. Thus, there is a place for hormone replacement therapy both as add-back therapy in premenopausal women receiving gonadotrophin releasing hormone analogues, and in postmenopausal women with a past history of endometriosis. Addback therapy with continuous combined regimes and tibolone do not prevent disease resolution in the hypogonadal patient. The evidence regarding the use of hormone replacement therapy in patients with a history of endometriosis is poor, but suggests that we could be less conservative than we have been.

Management of menopausal symptoms and ovarian function preservation in women with gynecological cancer

2020 ◽  
pp. ijgc-2020-002032
Author(s):  
Annabelle Brennan ◽  
Donal Brennan ◽  
Margaret Rees ◽  
Martha Hickey
Keyword(s):  
Hormone Therapy ◽  
Hormone Receptors ◽  
Ovarian Function ◽  
Gynecological Cancer ◽  
Hormone Replacement ◽  
Estrogen Therapy ◽  
Menopausal Symptoms ◽  
Health Concern ◽  
Gynecological Cancers ◽  
Bilateral Oophorectomy

Gynecological cancers affect a growing number of women globally, with approximately 1.3 million women diagnosed in 2018. Menopausal symptoms are a significant health concern after treatment for gynecological cancers and may result from oncologic treatments such as premenopausal bilateral oophorectomy, ovarian failure associated with chemotherapy or radiotherapy, and anti-estrogenic effects of maintenance endocrine therapy. Additionally, with the growing availability of testing for pathogenic gene variants such as BRCA1/2 and Lynch syndrome, there is an increasing number of women undergoing risk-reducing oophorectomy, which in most cases will be before age 45 years and will induce surgical menopause. Not all menopausal symptoms require treatment, but patients with cancer may experience more severe symptoms compared with women undergoing natural menopause. Moreover, there is increasing evidence of the long-term implications of early menopause, including bone loss, cognitive decline and increased cardiovascular risk. Systemic hormone therapy is well established as the most effective treatment for vasomotor symptoms and vaginal (topical) estrogen therapy is effective for genitourinary symptoms. However, the role of hormone receptors in many gynecological cancers and their treatment pose a challenge to the management of menopausal symptoms after cancer. Consequently, the use of menopausal hormone therapy in this setting can be difficult for clinicians to navigate and this article aims to provide current, comprehensive guidance for the use of menopausal hormone replacement therapy in women who have had, or are at risk of developing, gynecological cancer to assist with these treatment decisions.

Abstract MP25: Is Surgical Menopause Associated With Future Cardiovascular Risk Factors Independent Of Antecedent Levels? The Cardia Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Duke Appiah ◽  
Pamela J Schreiner ◽  
Julie K Bower ◽  
Barbara Sternfeld ◽  
Cora E Lewis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rate Of Change ◽  
Cvd Risk Factors ◽  
Bilateral Oophorectomy ◽  
Cvd Risk ◽  
Natural Menopause ◽  
Mean Values ◽  
Index Visit ◽  
Surgical Menopause

Objective: The aim of this study was to compare changes in selected CVD risk factors prior to and after natural or surgical (hysterectomy with or without bilateral oophorectomy) menopause. Methods: Data were obtained from women aged 18 to 30 years at baseline without hysterectomy enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study and followed for 25 years. Piecewise linear mixed effects models were used to examine changes in waist circumference (WC) and HDL-cholesterol (HDL-c) from baseline to index visit (first visit after the date of natural or surgical menopause) and after index visit to the end of observation. Results: During follow up, 639 women reached natural menopause (NM), 304 reported hysterectomy with one or both ovaries conserved (HO) and 153 reported hysterectomy with bilateral oophorectomy (HBO). Baseline mean values of WC were 73.9, 76.4, 75.9 cm, p=0.005 for NM, HO, and HBO respectively while those for HDL-c were 57.6, 54.6, 54.2 mg/dL, p=0.001. After adjustment for race, education, field center, traditional CVD risk factors, lipid-lowering medication, age at and time since menopause, the mean values of WC at the index visit were 88.8, 92.4, 92.0 cm, p=0.001 for NM, HO, and HBO respectively while those for HDL-c were 61.5, 57.0, 57.8 mg/dL, p=0.006. Compared to women with natural menopause, surgically menopausal women (regardless of ovarian status) had higher annual rate of change for WC (0.74 vs. 0.63 cm, p=0.002) as well as lower rate of change for HDL-c (0.15 vs. 0.30 mg/dL, p=0.001) from baseline to index visit. No statistically significant differences in the annual rate of change after index visit to the end of follow up were observed between these two groups for either WC or HDL-c. Conclusion: While surgical menopause is commonly believed to worsen CVD risk, in this population-based sample, we found that women who undergo hysterectomy with or without bilateral oophorectomy had more adverse values for central adiposity and lipids at baseline compared to women with natural menopause. However, antecedent risk factor levels were strongly associated with postmenopausal levels in all women.

scholarly journals Estrogen promotes cutaneous wound healing via estrogen receptor β independent of its antiinflammatory activities

2010 ◽  
Vol 207 (9) ◽  
pp. 1825-1833 ◽  
Author(s):  
Laura Campbell ◽  
Elaine Emmerson ◽  
Faith Davies ◽  
Stephen C. Gilliver ◽  
Andre Krust ◽  
...  
Keyword(s):  
Wound Healing ◽  
Antiinflammatory Activity ◽  
Hormone Replacement ◽  
Skin Wound ◽  
The Body ◽  
Estrogen Replacement ◽  
Skin Wound Healing ◽  
Skin Repair ◽  
Increased Risk

Post-menopausal women have an increased risk of developing a number of degenerative pathological conditions, linked by the common theme of excessive inflammation. Systemic estrogen replacement (in the form of hormone replacement therapy) is able to accelerate healing of acute cutaneous wounds in elderly females, linked to its potent antiinflammatory activity. However, in contrast to many other age-associated pathologies, the detailed mechanisms through which estrogen modulates skin repair, particularly the cell type–specific role of the two estrogen receptors, ERα and ERβ, has yet to be determined. Here, we use pharmacological activation and genetic deletion to investigate the role of both ERα and ERβ in cutaneous tissue repair. Unexpectedly, we report that exogenous estrogen replacement to ovariectomised mice in the absence of ERβ actually delayed wound healing. Moreover, healing in epidermal-specific ERβ null mice (K14-cre/ERβL2/L2) largely resembled that in global ERβ null mice. Thus, the beneficial effects of estrogen on skin wound healing are mediated by epidermal ERβ, in marked contrast to most other tissues in the body where ERα is predominant. Surprisingly, agonists to both ERα and ERβ are potently antiinflammatory during skin repair, indicating clear uncoupling of inflammation and overall efficiency of repair. Thus, estrogen-mediated antiinflammatory activity is not the principal factor in accelerated wound healing.

scholarly journals Age at menopause and lifetime cognition

Neurology ◽  
2018 ◽  
Vol 90 (19) ◽  
pp. e1673-e1681 ◽  
Author(s):  
Diana Kuh ◽  
Rachel Cooper ◽  
Adam Moore ◽  
Marcus Richards ◽  
Rebecca Hardy
Keyword(s):  
Hormone Replacement Therapy ◽  
Cognitive Ability ◽  
Replacement Therapy ◽  
Verbal Memory ◽  
Hormone Replacement ◽  
Birth Cohort Study ◽  
Natural Menopause ◽  
Age At Menopause ◽  
Surgical Menopause ◽  
Childhood Cognitive Ability

ObjectiveWe investigated whether cognitive performance between ages 43 and 69 years was associated with timing of menopause, controlling for hormone replacement therapy, childhood cognitive ability, and sociobehavioral factors.MethodsWe used data from 1,315 women participating in the Medical Research Council National Survey of Health and Development (a British birth cohort study) with known age at period cessation and up to 4 assessments of verbal memory (word-learning task) and processing speed (letter-cancellation task) at ages 43, 53, 60–64, and 69. We fitted multilevel models with linear and quadratic age terms, stratified by natural or surgical menopause, and adjusted for hormone replacement therapy, body mass index, smoking, occupational class, education, and childhood cognitive ability.ResultsVerbal memory increased with later age at natural menopause (0.17 words per year, 95% confidence interval [CI]: 0.07–0.27, p = 0.001); an association remained, albeit attenuated, after full adjustment (0.09, 95% CI: 0.02–0.17, p = 0.013). Verbal memory also increased with later age at surgical menopause (0.16, 95% CI: 0.06–0.27, p = 0.002), but this association was fully attenuated after adjustment. Search speed was not associated with age at menopause.ConclusionOur findings suggest lifelong hormonal processes, not just short-term fluctuations during the menopause transition, may be associated with verbal memory, consistent with evidence from a variety of neurobiological studies; mechanisms are likely to involve estrogen receptor β function. Further follow-up is required to assess fully the clinical significance of these associations.

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