Hormone Replacement Therapy Prescription after Premature Surgical Menopause

Abstract

Study Objective: To assess hormone replacement therapy (HRT) prescription pattern in patients undergoing premature surgical menopause on the basis of surgical indication. Design: Retrospective cohort study. Setting: Academic tertiary care center. Patients: Surgically menopausal patients aged ≤45 years who underwent a minimally invasive hysterectomy with salpingooophorectomy. Interventions: HRT prescription in the 6-week postoperative period. Measurements and Main Results: A total of 63 patients met inclusion criteria. Of these, 52% (n = 33) were prescribed HRT in the 6-week postoperative period. Indications for surgical menopause included pelvic pain or endometriosis (31.7%), gynecologic malignancy (20.6%), BRCA gene mutation (17.4%), breast cancer (9.5%), Lynch syndrome (4.8%), and other (15.8%). In total, 80% of patients with pelvic pain, 25% with gynecologic malignancies, 45% with BRCA gene mutations, 33.3% with breast cancer, and 66.6% with Lynch syndrome used HRT postoperatively. In patients who used HRT postoperatively, 76% were offered preoperative HRT counseling. This is in contrast with those patients who did not use HRT postoperatively, of whom only 33% were offered HRT counseling (p <.001). Perioperative complications were not predictive of HRT use postoperatively. In patients who did not use HRT postoperatively, 13.3% used alternative nonhormonal therapy. Conclusion: In patients who underwent premature surgical menopause, 52% used HRT postoperatively. Patients with pelvic pain and Lynch syndrome were more likely to use HRT, whereas those with gynecologic or breast malignancies and BRCA gene mutations were less likely to use HRT. Preoperative HRT counseling was associated with postoperative HRT use.

Premature and early menopause among US women with or at risk for HIV

“…In Canadian and US samples of women undergoing premature surgical menopause, approximately half received any hormonal medication, although the duration of therapy was short, often 1 year or less. 15,16 Initiation of hormonal medications was less frequent in our sample, though the relatively short duration may be similar given the low percentage of visits where hormone use was reported, suggesting even greater unmet need. Notably, participants in the Canadian study had higher income than participants in the WIHS, and participants in the US study were majority White compared to the WIHS's majority Black population.…”

“…To our knowledge, there are no prior studies of hormone use among all premature and early menopausal people in the US for comparison. In Canadian and US samples of women undergoing premature surgical menopause, approximately half received any hormonal medication, although the duration of therapy was short, often 1 year or less 15,16 . Initiation of hormonal medications was less frequent in our sample, though the relatively short duration may be similar given the low percentage of visits where hormone use was reported, suggesting even greater unmet need.…”

“…9,10 For these reasons, US and international professional organizations recommend continuous exogenous estrogen replacement either in the form of systemic menopausal hormone therapy (MHT) or combined hormonal contraceptives from the onset of premature or early menopause until approximately age 51. 11,12 Though population-level data on uptake of MHT among premature and early menopausal people in the US is limited, expert opinion 12,13 and data from Sweden, 14 Canada, 15 and the US 16 suggest that prescription of MHT following both surgical and nonsurgical premature and early menopause is underutilized.…”

Authors’ Reply

“…(2) Endometriosis has an embryonic and therefore genetic origin. Without robust photomicrographic proof of attachment, proliferation, and invasion, "the implantation theory will remain a gynecologic windmill before which successive generations of theorists will joust" [1].…”

“…It's a pleasure to respond to the letter by Iavazzo et al regarding our previously published article, "Hormone Replacement Therapy Prescription After Premature Surgical Menopause." [1] In the article, we describe prescription patterns for hormone replacement therapy (HRT) in patients with premature surgical menopause, including those undergoing surgery for cancer diagnosis.…”