The 2015 North American Menopause Society Annual Meeting shed some light on a very controversial issue about estrogen hormone therapy. Dr. Walter A. Rocca, MD, MPH discussed the risks associated with premature menopause. He also covered some of the studies and opinions on why women should use estrogen replacement therapy after a hysterectomy.
Risks Associated with Early Menopause
When a woman enters menopause before the age of 40, it’s considered an early menopause. Premature ovarian failure, also known as early menopause, can happen after a bilateral oophorectomy, which is a hysterectomy that include the removal of both ovaries. It can also happen as a result of genetics or an autoimmune disease.
The drop of estrogen seems to be the culprit for many of the illnesses women face during and after early menopause.
Rocca discussed the study from Vujovic et al., Maturitas 2010.
This study concluded that women with early natural or surgical menopause have increased mortality and morbidity. It also indicated that women with untreated POF are at increased risk of developing osteoporosis, cardiovascular disease, osteoporosis, dementia, cognitive decline and Parkinsonism.
Additionally, Rocca discussed the study by Schierbeck, L., Climacteric 2015.
This study outlines the positive effect of ERT on the long-term consequences of premature or early menopause. The use of hormone therapy has been shown to lessen some of these risks such as negative effects on cognition, mood, cardiovascular, bone and sexual health, and increased risk of early death.
Is the Hysterectomy Really Needed?
In discussing estrogen as pertaining to beneficial hormone therapy, the issue was raised as to whether young women should be getting hysterectomies.
Rocca concluded that one way for women to reduce medical issues and problems (due to a drop of estrogen) was for doctors to reduce the number of hysterectomies they perform. He stated that women and doctors should avoid unjustified hysterectomies, particularly when it includes the removal of the ovaries.
Conclusions and Recommendations
As stated in the study by Faubion et al., Climacteric 2015, women who experience premature or early menopause should receive individualized hormone therapy and counseling. ERT after a hysterectomy can reduce some of the risks associated with the drop in estrogen such as cardiovascular disease, stroke and cognitive impairment or dementia.
Rocco believes that the focus should also include educating women and gynecologists on avoiding unnecessary hysterectomies in the first place. He said that there is a definite disconnect between evidence and practice, when it comes to ERT and the benefits it can provide for women facing early menopause after a hysterectomy.
1) Vujovic, S. et al. EMAS position statement: Managing women with premature ovarian failure. Maturitas. 2010 Sep;67(1):91-3. doi: 10.1016/j.maturitas.2010.04.011. Epub 2010 Jun 3.
2) Schierbeck, L. Primary prevention of cardiovascular disease with hormone replacement therapy. Climacteric. 2015;18(4):492-7. doi: 10.3109/13697137.2015.1034098. Epub 2015 Apr 16.
3) Faubion, SS et. al. Long-term health consequences of premature or early menopause and considerations for management. Climacteric. 2015;18(4):483-91. doi: 10.3109/13697137.2015.1020484. Epub 2015 Apr 7.
Reviewed November 16, 2015
By Michele Blacksberg RN
Edited by Jody Smith