Principles of management of premature and surgical menopause in women with initial reproductive health problems
Keywords:premature menopause, surgical menopause, breast cancer, CVD, oestrogens, transdermal oestrogens, hormone therapy, menopause, progesterone, sexual function, stroke
Menopausal hormone therapy remains the most effective treatment for vasomotor symptoms and genitourinary menopausal syndrome and has been shown to prevent bone loss and destruction. This circumstance makes it possible to consider menopausal hormone therapy as the main method for the treatment of premature and surgical menopause.
It is important to note that despite the similarity of the long-term consequences bilateral oophorectomy and premature fading in ovarian function differ significantly in the dynamics of the hormones concentration decrease. The risks of menopausal hormone therapy vary depending on the type, dose, duration of use, route of administration, timing of onset, and the use of estrogens and progestins. Treatment should be individualized by selecting the most appropriate formulation, dose, route of administration and duration of use, and also using the best data on maximizing benefits and minimizing possible risks with periodic reassessment of the benefits and risks of continuing or stopping the use of menopausal hormone therapy.
Key recommendations of American Association of clinical endocrinologists and the American college of endocrinology (2017) are: for women with early menopause and primary ovarian failure, there are health risks that can include persistent vasomotor symptoms, bone loss, mood changes and an increased risk of cardiovascular diseases, dementia, stroke, Parkinson’s disease, ophthalmic disorders and overall mortality. The results of studies in older women do not apply to women with early menopause, and recent evidence suggests that such patients should use menopausal hormone therapy at least until the middle age of menopause. Transdermal oestrogen preparations are less likely to develop thrombotic risk and, possibly, the risk of developing stroke and coronary heart disease compared to oral oestrogens. If a progestagenic component is required, a more safest alternative is micronized progesterone.
- Laughlin, D., Thorney Croft, I.H. “Amenorrhea.” In: DeCherney, A.H., Nathan, L., editors. Current obstetric and gynecologic diagnosis and treatment. 9th edition. New York. McGraw Hill Companies (2003): 991–1000.
- Jewelwicz, R., Schwartz, M. “Premature ovarian failure.” Bull N Y Acad Med 62 (1986): 219–36.
- Ikeme, A.C.C., Okeke, T.C., Akogu, S.P.O., Chinwuba, N. “Knowledge and perception of menopause and climacteric symptoms among a population of women in Enugu, South East, Nigeria.” Ann Med Health Sci Res 1 (2011): 31–6.
- Russell, P., Bannatyne, P., Shearman, R.P., et al. “Premature hyper‐gonadotropic ovarian failure. Clinico‐pathological study of 19 cases.” Int J Gynecol Pathol 1 (1982): 185–201.
- Mashchak, C.A., Kletzky, O.A., Davajan, V., Mishell, D.R. Jr. “Clinical and Laboratory evaluation of patients with primary amenorrhea.” Obstet Gynecol 57 (1981): 715–21.
- Baber, R., Abdalla, H., Studd, F. “The premature menopause.” In: Studd, J., editor. Progress in Obstetrics and Gynecology. Vol. 9. Edinburgh. Churchill Livingstone (1991): 209–26.
- Padubidri, V.G., Daftary, S.N., editors. “Menopause, premature menopause and post-menopausal bleeding.” In: Shaw’s Textbook of Gynecology. 13th edition. New Delhi Elsevier (2004): 56–67.
- Ke, R.W. “Management of menopause.” In: Ling, F.W., Diff, P., editors. Obstetrics and Gynecology Principles of Practice. 1st edition. New York. McGraw‐Hill Companies (2001): 1021–40.
- Panay, N., Kalu, E. “Management of premature ovarian failure.” Best Pract Res Clin Obstet Gynaecol 23 (2009): 129–40.
- Hoek, A., Schoemaker, J., Drexhage, H.A. “Premature ovarian failure and ovarian autoimmunity.” Endocr Rev 18 (1997): 107–34.
- Morrison, J.C., Gimes, J.R., Wiser, L.W., Fish, S.A. “Mumps oophoritis: A cause of premature menopause.” Fertil Steril 26 (1975): 655–9.
- Nogales‐Ortiz, F., Tarncon, I., Nogales, F.F. “The pathology of female genital tuberculosis.” Obstet Gynecol 53 (1979): 422–8.
- Jick, A., Porter, J., Morrison, A.S. “The relationship between smoking and age of natural menopause.” Lancet II (1977): 1354.
- Gulips, B.J., Mattison, D.R. “Degeneration of mouse oocytes in response to polycystic aromatic hydrocarbons.” Anat Rec 193 (1979): 863–4.
- Verp, M.S. “Environmental causes of ovarian failure.” Semin Reprod Endocrinol 1 (1983): 101–11.
- Sklar, C. “Maintenance of ovarian function and risk of premature menopause related to cancer treatment.” J Natl Cancer Inst Monogr 34 (2005): 25–7.
- Judd, H.L., Judd, G.E., Lucas, W.E., Yen, S.S. “Endocrine function of the postmenopausal ovary: concentration of androgens and estrogens in ovarian and peripheral vein blood.” J Clin Endocrinol Metab 39 (1974): 1020–4.
- Siddle, N., Sarrel, P., Whitehead, M. “The effect of hysterectomy on the age at ovarian failure: identification of a subgroup of women with premature loss of ovarian function and literature review.” Fertil Steril 47 (1987): 94–100.
- Luborsky, J.L., Meyer, P., Sowers, M.F., et al. “Premature menopause in a multi-ethnic population study of the menopause transition.” Hum Reprod 18 (2003): 199–206.
- McKinlay, J.B., McKinlay, S.M., Brambilla, D.J. “Health status and utilization behavior associated with menopause.” Am J Epidemiol 125 (1987): 110–21.
- Thompson, B., Hart, S.A., Durno, D. “Menopausal age and symptomatology in a general practice.” J Biosoc Sci 5 (1973): 71–82.
- The North American Menopause Society (NAMS). “Releases position statement on the treatment of vasomotor symptoms associated with menopause. Practice guideline.” Am Fam Physician 70 (2004): 393–9.
- Guzick, D.S., Hoeger, K. “Sex, hormones, and hysterectomies.” N Engl J Med 343 (2000): 730–1.
- Oldenhave, A., Jaszmann, L.J., Everaerd, W.T., Haspels, A.A. “Hysterectomized women with ovarian conservation report more severe climacteric complaints than do normal climacteric women of similar age.” Am J Obstet Gynecol 168 pt 1 (1993): 765–71.
- Sherwin, B.B., Gelfand, M.M. “The role of androgen in the maintenance of sexual functioning in oophorectomized women.” Psychosom Med 49 (1987): 397–409.
- Dennerstein, L., Guthrie, J.R., Clark, M., et al. “A population-based study of depressed mood in middle-aged, Australian-born women.” Menopause 11 (2004): 563–8.
- Roos, N.P. “Hysterectomies in one Canadian province: a new look at risks and benefits.” Am J Public Health 74 (1984): 39–46.
- Riedel, H.H., Lehmann-Willenbrock, E., Semm, K. “Ovarian failure phenomena after hysterectomy.” J Reprod Med 31 (1986): 597–600.
- Centerwall, B.S. “Premenopausal hysterectomy and cardiovascular disease.” Am J Obstet Gynecol 139 (1981): 58–61.
- Derby, C.A. “Cardiovascular pathophysiology.” In: Lobo, R.A., Kelsey, J., Marcus, R., eds. Menopause, Biology and Pathobiology. San Diego. Academic Press (2000): 230–3.
- Bairey Merz, C.N., Johnson, B.D., Sharaf, B.L., et al, for the WISE Study Group. “Hypoestrogenemia of hypothalamic origin and coronary artery disease in premenopausal women: a report from the NHLBI-sponsored WISE Study.” J Am Coll Cardiol 41 (2003): 413–9.
- Kritz-Silverstein, D., Barrett-Connor, E. “Early menopause, number of reproductive years and bone mineral density in postmenopausal women.” Am J Public Health 83 (1993): 983–8.
- Mack, W.J., Slater, C.C., Xiang, M., et al. “Elevated subclinical atherosclerosis associated with oophorectomy is related to time since menopause rather than type of menopause.” Fertil Steril 82 (2004): 391–7.
- Ganz, P.A. “Breast cancer, menopause and long‐term survivorship: Critical issues for the 21st century.” Am J Med 118 (2005): 136–41.
- Buijs, C., de Vries, E.G., Mourits, M.J., Willemse, P.H. “The influence of endocrine treatments for breast cancer on health‐related quality of life.” Cancer Treat Rev 34 (2008): 640–55.
- Gallagher, J.C. “Effect of early menopause on bone mineral density and fractures.” Menopause 14 (2007): 567–71.
- Lokkegaard, E., Jovanovic, Z., Heitmann, B.L., et al. “The association between early menopause and risk of ischaemic heart disease: influence of hormone therapy.” Maturitas 53 (2006): 226–33.
- Mondul, A.M., Rodriguez, C., Jacobs, E.J., Calle, E.E. “Age at natural menopause and cause‐specific mortality.” Am J Epidemiol 162 (2005): 1089–97.
- Jacobsen, B.K., Heuch, I., Kvale, G. “Age at natural menopause and all‐cause mortality: A 37‐year follow‐up of 19,731 Norwegian women.” Am J Epidemiol 157 (2003): 23–9.
- Rivera, C.M., Grossardt, B.R., Rhodes, D.J., et al. “Increased cardiovascular mortality after early bilateral oophorectomy.” Menopause 16 (2009): 15–23.
- Pines, A., Sturdee, W.D., Birkhauser, M.H., et al; Board of the IMS. “IMS updated recommendations on post‐menopausal hormone therapy.” Climacteric 10 (2007):181–94.
- Pitkin, J., Rees, M.C., Gray, S., et al. “Management of premature menopause.” Menopause Int 13 (2007): 44–5.
- Utian, W.H., Archer, D.F., Bachmann, G.A., et al. “Estrogen and progestogen use in post‐menopausal women: July 2008 position statement of The North American Menopause Society.” Menopause 15 (2008): 584–602.
- Rebbeck, T.R., Kauff, N.D., Domchek, S.M. “Meta‐analysis of risk reduction estimates associated with risk‐reducing salpingo‐oophorectomy in BRCA1 or BRCA2 mutation carriers.” J Natl Cancer Inst 101 (2009): 80–7.
- Writing Group for the Women’s Health Initiative. “Risks and benefits of oestrogen plus progestin in healthy postmenopausal women: Principal results from the women’s health initiative randomized control trial.” JAMA 288 (2002): 321–33.
- Whitehead, M., Studd, J.W. “Selection of patients for treatment: Which therapy and for how long?” In: Studd, J.W.W, Whitehead, M.I., editors. The Menopause. Oxford. Blackwell Science (1988): 117.
- Whitehead, M., Godfree, V. Hormone replacement therapy: Your questions answered. Edinburgh. Churchil Livingstone (1992).
- Keshavarz, H., Hillis, S.D., Kieke, B.A., Marchbanks, P.A. “Hysterectomy Surveillance – United States, 1994–1999. Surveillance summaries.” MMWR 51 (2002): 1–8.
- Sullivan, S.D., Sarrel, P.M., Nelson, L.M. “Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause.” Fertil Steril 106 (2016): 1588–99.
- Khastgir, G., Studd, J.W., Fox, S.W., et al. “A longitudinal study of the effect of subcutaneous estrogen replacement on bone in young women with Turner’s syndrome.” J Bone Miner Res 18 (2003): 925–32. DOI: 10.1359/jbmr.2003.18.5.925
- Langrish, J.P., Mills, N.L., Bath, L.E., et al. “Cardiovascular effects of physiological and standard sex steroid replacement regimens in premature ovarian failure.” Hypertension 53 (2009): 805–11. DOI: 10.1161/HYPERTENSIONAHA.108.126516
- Moorman, P.G., Myers, E.R., Schildkraut, J.M., et al. “Effect of hysterectomy with ovarian preservation on ovarian function.” Obstet Gynecol 118 (2011): 1271–9.
- Faubion, S.S., Kuhle, C.L., Shuster, L.T., Rocca, W.A. “Long-term health consequences of premature or early menopause and considerations for management.” Climacteric 18 (2015): 483–91.
- Kovanci, E., Schutt, A.K. “Premature ovarian failure: clinical presentation and treatment.” Obstet Gynecol Clin North Am 42 (2015): 153–61.
- Trabuco, E.C., Moorman, P.G., Algeciras-Schimnich, A., et al. “Association of ovary-sparing hysterectomy with ovarian reserve.” Obstet Gynecol 127 (2016): 819–27.
- Tao, X.Y., Zuo, A.Z., Wang, J.Q., Tao, F.B. “Effects of primary ovarian insufficiency and early natural menopause on mortality: a meta-analysis.” Climacteric 19 (2016): 27–36.
- Mondul, A.M., Rodriguez, C., Jacobs, E.J., Calle, E.E. “Age at natural menopause and cause-specific mortality.” Am J Epidemiol 162 (2005): 1089–97.
- Hong, J.S., Yi, S.W., Kang, H.C., et al. “Age at menopause and cause-specific mortality in South Korean women: Kangwha Cohort Study.” Maturitas 56 (2007): 411–9.
- Ossewaarde, M.E., Bots, M.L., Verbeek, A.L., et al. “Age at menopause, causespecific mortality and total life expectancy.” Epidemiology 16 (2005): 556–62.
- Popat, V.B., Calis, K.A., Kalantaridou, S.N., et al. “Bone mineral density in young women with primary ovarian insufficiency: results of a three-year randomized controlled trial of physiological transdermal estradiol and testosterone replacement.” J Clin Endocrinol Metab 99 (2014): 3418–26.
- Biason, T.P., Goldberg, T.B., Kurokawa, C.S., et al. “Low-dose combined oral contraceptive use is associated with lower bone mineral content variation in adolescents over a 1-year period.” BMC Endocr Disord 15 (2015): 15.
- Cibula, D., Skrenkova, J., Hill, M., Stepan, J.J. “Low-dose estrogen combined oral contraceptives may negatively influence physiological bone mineral density acquisition during adolescence.” Eur J Endocrinol 166 (2012): 1003–11.
- Castelo-Branco, C., Martinez de Osaba, M.J., Vanrezc, J.A., et al. “Effects of oophorectomy and hormone replacement therapy on pituitary-gonadal function.” Maturitas 17 (1993): 101–11.
- Kronenberg, F. “Menopausal hot flashes: a review of physiology and biosociocultural perspective on methods of assessment.” J Nutr 140 (2010): 1380S–85S.
- Gallicchio, L., Whiteman, M.K., Tomic, D., et al. “Type of menopause, patterns of hormone therapy use, and hot flashes.” Fertil Steril 85 (2006): 1432–40.
- Tucker, P.E., Bulsara, M.K., Salfinger, S.G., et al. “The effects of pre-operative menopausal status and hormone replacement therapy (HRT) on sexuality and quality of life after risk-reducing salpingo-oophorectomy.” Maturitas 85 (2016): 42–8.
- Graziottin, A., Basson, R. “Sexual dysfunction in women with premature menopause.” Menopause 11 (2004): 766–77.
- Lindsay, R. “The menopause: sex steroids and osteoporosis.” Clin Obstet Gynecol 30 (1987): 847–59.
- Hodis, H.N., Mack, W.J., Henderson, V.W., et al; ELITE Research Group. “Effects of early versus late postmenopausal treatment with estradiol.” N Engl J Med 374 (2016): 1221–31.
- Rocca, W.A., Grosshardt, B.R., Shuster, L.T. “Oophorectomy, estrogen, and dementia: a 2014 update.” Mol Cell Endocrinol 389 (2014): 7–12.
- Boardman, H.M., Hartley, L., Eisinga, A., et al. “Hormone therapy for preventing cardiovascular disease in post-menopausal women.” Cochrane Database Sys Rev 3 (2015): CD00229.
- Manson, J.E., Aragaki, A.K., Rossouw, J.E., et al. “Menopausal hormone therapy and long-term all-cause and cause-specific mortality: the Women’s Health Initiative randomized trials.” JAMA 318.10 (2017): 927–38. DOI:10.1001/jama.2017.11217
- The North American Menopause Society. “The 2017 hormone therapy position statement of The North American Menopause Society.” Menopause 24.7 (2017): 0000000000000921.
- National Institutes of Health. “National Institutes of Health state-of-the-science conference statement: management of menopause-related symptoms.” Ann Intern Med 142 (2005): 1003–13.
- Stanczyk, F.Z., Hapgood, J.P., Winer, S., Mishell, D.R. Jr. “Progestogens used in postmenopausal hormone therapy: differences in their pharmacological properties, intracellular actions, and clinical effects.” Endocr Rev 34 (2013): 171–208.
- Courtin, A., Communal, L., Vilasco, M., et al. “Glucocorticoid receptor activity discriminates between progesterone and medroxyprogesterone acetate effects in breast cells.” Breast Cancer Res Treat 131 (2012): 49–63.
- Lambrinoudaki, I. “Progestogens in postmenopausal hormone therapy and the risk of breast cancer.” Maturitas 77 (2014): 311–7.
- Sood, R., Faubion, S.S., Kuhle, C.L., et al. “Prescribing menopausal hormone therapy: an evidence-based approach.” Int J Women’s Health 6 (2014): 47–57.
- Rossouw, J.E., Anderson, G.L., Prentice, R.L., et al; Writing Group for the Women’s Health Initiative Investigators. “Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial.” JAMA 288.3 (2002): 321–33.
- Fournier, A., Berrino, F., Clavel-Chapelon, F. “Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study.” Breast Cancer Res Treat 107 (2008): 103–11.
- Mohammed, H., Russell, I.A., Stark, R., et al. “Progesterone receptor modulates ERα action in breast cancer.” Nature 523 (2015): 313–7.
- Hellgren, M., Conard, J., Norris, L., Kluft, C. “Cardiovascular risk markers during treatment with estradiol and trimegestone or dydrogesterone.” Maturitas 62 (2009): 287–93.
- Renoux, C., Dell’aniello, S., Garbe, E., Suissa, S. “Transdermal and oral hormone replacement therapy and the risk of stroke: a nested case-control study.” BMJ 340 (2010): 2519.
- Nastri, C.O., Lara, L.A., Ferriani, R.A., et al. “Hormone therapy for sexual function in perimenopausal and postmenopausal women.” Cochrane Database Syst Rev 6 (2013): CD009672.
- Coelingh Bennink, H.J. “Are all estrogens the same?” Maturitas 47.4 (2004): 269–75.
- Shifren, J.L., Desindes, S., McIlwain, M., et al. “A randomized, open-label, crossover study comparing the effects of oral versus transdermal estrogen therapy on serum androgens, thyroid hormones, and adrenal hormones in naturally menopausal women.” Menopause 14.6 (2007): 985–94.
- Hodis, H.N., Mack, W.J., Azen, S.P., et al; Women’s Estrogen-Progestin Lipid-Lowering Hormone Atherosclerosis Regression Trial Research Group. “Hormone therapy and the progression of coronary-artery atherosclerosis in postmenopausal women.” N Engl J Med 349.6 (2003): 535–45.
- Meston, C.M. “Validation of the Female Sexual Function Index (FSFI) in women with female orgasmic disorder and in women with hypoactive sexual desire disorder.” J Sex Marital Ther 29.1 (2003): 39–46.
- Wiegel, M., Meston, C., Rosen, R. “The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores.” J Sex Marital Ther 31.1 (2005): 1–20.
- Nappi, R.E., Cucinella, L. “Advances in pharmacotherapy for treating female sexual dysfunction.” Expert Opin Pharmacother 16.6 (2015): 875–87.
- Al-Azzawi, F., Bitzer, J., Brandenburg, U., et al. “Therapeutic options for postmenopausal female sexual dysfunction.” Climacteric 13.2 (2010): 103–20.
- Taylor, H.S., Manson, J.E. “Update in hormone therapy use in menopause.” J Clin Endocrinol Metab 96.2 (2011): 255–64.
- Harman, S.M., Black, D.M., Naftolin, F., et al. “Arterial imaging outcomes and cardiovascular risk factors in recently menopausal women: a randomized trial.” Ann Intern Med 161.4 (2014): 249–60.
- MacLennan, A.H., Broadbent, J.L., Lester, S., Moore, V. “Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes.” Cochrane Database Syst Rev 4 (2004): CD002978.
- Suckling, J., Lethaby, A., Kennedy, R. “Local oestrogen for vaginal atrophy in postmenopausal women.” Cochrane Database Syst Rev 4 (2006): CD001500.
- Politano, C.A., Valadares, A.L., Pinto-Neto, A., Costa-Paiva, L. “The metabolic syndrome and sexual function in climacteric women: a cross-sectional study.” J Sex Med 12.2 (2015): 455–62.
- Merghati-Khoei, E., Sheikhan, F., Shamsalizadeh, N., et al. “Menopause negatively impacts sexual lives of middle-aged Iranian women: a cross-sectional study.” J Sex Marital Ther 40.6 (2014): 552–60.
- Valadares, A.L., Pinto-Neto, A.M., de Souza, M.H., et al. “The prevalence of the components of low sexual function and associated factors in middle-aged women.” J Sex Med 8.10 (2011): 2851–8.
- Valadares, A.L., Pinto-Neto, A.M., Osis, M.J., et al. “Prevalence of sexual dysfunction and its associated factors in women aged 40–65 years with 11 years or more of formal education: a population-based household survey.” Clinics (Sao Paulo) 63.6 (2008): 775–82.
- Cobin, R.H., Goodman, N.F. “American Association of clinical endocrinologists and American college of endocrinology position statement on menopause – 2017 Update.” Endocrine Practice 23.7 (2017): 869–80.
- Mohammed, K., Abu Dabrh, A.M., Benkhadra, K., et al. “Oral vs transdermal estrogen therapy and vascular events: a systematic review and meta-analysis.” J Clin Endocrinol Metab 100 (2015): 4012–20. DOI: 10.1210/jc.2015-2237
How to Cite
Copyright (c) 2018 С. А. Шурпяк
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.