After Surgical Menopause, Should Menopausal Hormonal Therapy Started Only Before the Age of 45 Years?

Abstract

Natural menopause occurs at different ages in different countries ranging from as young as 46.9-47.8 years in the Middle-East region to 50.0-51.1 years in the European countries [1], and previously reported at the approximate age of 50 years in Thailand [2]. Natural menopausal age is reported to be influenced by both factors; host factors such as genetic factors, ethnicity, or body-mass index; and environmental factors such as smoking, parity, etc. Age at natural menopause was associated with subsequent risk of cardiovascular disease, low bone mass density, osteoporosis, and all-cause mortality [3]. However, surgical menopause from bilateral oophorectomy with or without hysterectomy before the age of natural menopause, which occurs at a much younger age than natural menopause, causes a more abrupt decline in ovarian hormones production especially estrogens. The majority of bilateral oophorectomy cases were reported at the ages between 3545 years or younger [4,5]. In general, surgical menopause also results in subsequent adverse health consequences such as: sleep problems [6-8], genitourinary syndrome of menopause, metabolic diseases and cardiovascular events, dementia, osteoporosis, etc. [9-16]. On the contrary, surgical menopause for benign diseases with or without estrogen therapy was also reported to improve sexuality and psychological well-being as the results of reliefs from prior depression or sexual problems [17]. In recent years, surgical menopause has been globally an area of healthcare interest and much more studied and reviewed. A retrospective cohort study of 1,000 consecutive surgical menopause patients who underwent premenopausal surgery before age 50 years for benign indications from a tertiary-care hospital in Bangkok was performed, and the results were published in 2020 [18]. The results showed that 85.5% of the patients used menopausal hormonal therapy (MHT) after surgery. From that study, those with MHT initiated soon after surgery (87% initiated within the first postsurgical year, at the mean age of 42.6 ± 5.1 years, with a median follow-up time of 12.0 years) possibly prevented subsequent osteopenia compared with MHT non-users.