Role of androgens in surgical menopause

For the patient who has had her ovaries and uterus removed, the acute onset of surgical menopause is of primary concern during the immediate postoperative period. The initiation of hormone replacement therapy at this time eliminates most symptoms that result from the abrupt onset of menopause. Thus the patient can deal with the side effects from her operation without the added burden caused by the physiologic changes from the loss of her gonadal hormones. Most patients who undergo surgical menopause (total abdominal hysterectomy with bilateral salpingo-oophorectomy) at the McGill University Menopause Clinic receive estrogen-androgen replacement therapy in the recovery room. This occurs provided that the diagnosis is not cancer of the uterus and there are no other serious contraindications to hormone replacement therapy. Vasomotor flushes are almost entirely eliminated with estrogen-androgen replacement therapy. In addition, the androgen component of this regimen provides an increased healing effect because of its anabolic property. After 6 months we discuss whether estrogen-androgen replacement therapy should be continued or the therapy should be changed to estrogen replacement therapy only. Sexual desire and arousal, well-being, and energy level are enhanced by the addition of androgen. Side effects such as mild hirsutism are dose related and can be managed easily by dose reduction. Treatment with estrogen-androgen replacement therapy may be continued indefinitely if guidelines are followed and the patient is satisfied.