Trends show decline in ET use in surgically menopausal women
Suzuki Y, Huang Y, Melamed A, et al. Use of estrogen therapy after surgical menopause in women who are premenopausal. Obstet Gynecol. 2022;139:756-763. doi: 10.1097/AOG.0000000000004762.
In addition to highlighting the risks associated with premenopausal BSO in women at average risk for ovarian cancer, the reports referred to above also underscore that the use of replacement menopausal HT in premenopausal women who undergo BSO prevents morbidity and mortality that otherwise accompanies surgical menopause. In addition, the North American Menopause Society (NAMS) recommends replacement menopausal HT in the setting of induced early menopause when no contraindications are present.18
To assess the prevalence of HT use in surgically menopausal women, investigators at Columbia University College of Physicians and Surgeons used a national database that captures health insurance claims for some 280 million US patients, focusing on women aged 18 to 50 years who underwent BSO from 2008 to 2019.30 The great majority of women in this database have private insurance. Although the authors used the term estrogen therapy in their article, this term refers to systemic estrogen alone or with progestogen, as well as vaginal ET (personal communication with Jason Wright, MD, a coauthor of the study, May 19, 2022). In this Update section, we use the term HT to include use of any systemic HT or vaginal estrogen.
Prevalence of HT use changed over time period and patient age range
Among almost 61,980 evaluable women who had undergone BSO (median age, 45 years; 75.1% with concomitant hysterectomy; median follow-up time, 27 months), with no history of gynecologic or breast cancer, HT was used within 3 years of BSO by 64.5%. The highest percentage of women in this cohort who used HT peaked in 2008 (69.5%), declining to 58.2% by 2016. The median duration of HT use was 5.3 months. The prevalence of HT use 3 years after BSO declined with age, from 79.1% in women aged 18–29 to 60.0% in women aged 45–50.30
This report, published in the June 2022 issue of Obstetrics and Gynecology, makes several sobering observations: Many surgically menopausal women aged 50 years and younger are not prescribed HT, the proportion of such women receiving a prescription for HT is declining over time, and the duration of HT use following BSO is short. ●
WHAT THIS EVIDENCE MEANS FOR PRACTICE
As ObGyn physicians, we can play an important role by educating healthy women with induced menopause who are younger than the average age of spontaneous menopause, and who have no contraindications, that the benefits of HT far outweigh risks. Many of these women will benefit from longer-term HT, using doses substantially higher than are used in women who undergo spontaneous menopause.31,32 After reaching the age of menopause, healthy women without contraindications may continue to benefit from HT into their 50s or beyond if they have vasomotor symptoms, bone loss, or other indications for treatment.18,19
As ObGyn physicians, we can play an important role by educating healthy women with induced menopause who are younger than the average age of spontaneous menopause, and who have no contraindications, that the benefits of HT far outweigh risks. Many of these women will benefit from longer-term HT, using doses substantially higher than are used in women who undergo spontaneous menopause.31,32 After reaching the age of menopause, healthy women without contraindications may continue to benefit from HT into their 50s or beyond if they have vasomotor symptoms, bone loss, or other indications for treatment.18,19