Hormonal therapy in the patient with surgical menopause

Removal of both ovaries in the premenopausal patient is performed infrequently, but when it is, attention must be paid to hormone replacement. The benefits of hormone replacement include protection from osteoporosis, elimination of vasomotor symptoms, improvement in general well-being, and some decrease in the risk of cardiovascular disease. Some evidence suggests that the addition of androgen therapy to estrogen replacement in the premenopausal woman can also be beneficial. Administration of hormonal therapy to certain premenopausal patients who have had a bilateral oophorectomy is controversial. These include patients who are disease-free after surgery for endometrial carcinoma and patients who are post-therapy for breast carcinoma. The most common question is whether a progestin should be given to the patient receiving estrogen therapy after a hysterectomy. Prevention of endometrial carcinoma is unnecessary in this patient, but the effects of the progestin on the breast and the cardiovascular system should be considered.