Hormone replacement therapy in pre-menopausal women undergoing bilateral salpingo-oophorectomy for benign disease: A review of practice

Abstract

Introduction The National Institute for Health and Care Excellence (NICE) guideline on the diagnosis and management of the menopause states that women who are likely to go through the menopause as a result of surgical treatment should be offered information about the menopause and the importance of starting hormonal replacement therapy before they have their treatment. Objectives To determine compliance with NICE guidelines at the Royal Derby Hospital. Study design We undertook a retrospective review of all pre-menopausal women undergoing bilateral salpingo-oophorectomy for benign pathology between 1 January 2016 and 30 June 2016. Results Thirty-six cases were reviewed. Women were aged between 32.5 and 49.8 years old (median 45.13, inter-quartile range 42.6-47.6). The commonest indications for bilateral salpingo-oophorectomy were dysfunctional uterine bleeding (36.1%), chronic pelvic pain (30.5%), complex cyst (13.9%), and pre-menstrual syndrome (13.9%). Fifteen women (41.7%) did not have hormonal replacement therapy discussed. Only two (5.6%) had hormonal replacement therapy discussed pre-operatively. The remaining 19 had hormonal replacement therapy discussed post-operatively, either on the ward prior to discharge (n = 3) or, more commonly, in clinic six to eight weeks later. Although hormonal replacement therapy was only contraindicated in one woman (3%), it was only prescribed to five (24%). Results were slightly better for women under 40 but still only 28.6% had hormonal replacement therapy discussed with them pre-operatively. Conclusion This audit has demonstrated that compliance with the NICE guidelines is poor. We suspect similar results might be found in other gynaecology departments nationally. A hospital guideline to aid clinicians and a patient information sheet to educate women has been devised. A re-audit is planned six months after ratification of these documents.

Review of menopause advice given to patients undergoing bilateral oophorectomy

“…The number of women in this study is small, but the results are in line with similar reviews done at other general and teaching hospitals. 4,5…”

“…The number of women in this study is small, but the results are in line with similar reviews done at other general and teaching hospitals. 4,5 The immediate decline in oestrogen after bilateral oophorectomy results in acute symptoms of the menopause, the most common of which is vasomotor symptoms (hot flushes and night sweats). Other symptoms include: psychological symptoms such as depressed mood, anxiety, irritability, fatigue, reduced libido, 'brain fog' and insomnia; and symptoms of urogenital atrophy (now called genitourinary syndrome of the menopause)vaginal dryness, urinary frequency, dysuria and dyspareunia.…”