Factors associated with counseling and postoperative hormone therapy use in surgically menopausal women

To determine the rates of and factors associated with preoperative counseling about menopausal symptoms and use of hormone therapy postoperatively in surgically menopausal women.

This retrospective chart review included patients who underwent bilateral oophorectomies before age 52 at an academic institution during a 3-year period. We used descriptive analyses to characterize the sample and logistic regression to identify factors associated with preoperative counseling about and postoperative systemic hormone therapy for menopausal symptoms.

This review included 152 patients with a mean age of 44 ± 5 years (range 28-51). The indications for surgery were risk reduction (66%), BRCA positive (35%), and history of breast cancer (38%). One-third of women were not counseled preoperatively about menopausal symptoms. Women with cardiovascular disease and older age were less likely to receive preoperative counseling. Preoperative counseling was positively associated with risk reducing surgery.Out of 124 women with postoperative data regarding symptoms and treatment, 90 (73%) experienced vasomotor symptoms, 33 (27%) received hormone therapy (systemic or vaginal), 61 (49%) received other therapies, and 41 (33%) did not receive therapy. Younger age and negative history of breast cancer were significantly associated with systemic estrogen therapy use.

Within our cohort, 66% had no documentation of counseling about menopausal symptoms before surgical menopause. Most women experienced symptoms postoperatively, but less than one-third of symptomatic women received hormone therapy. We have an opportunity to improve anticipatory guidance and informed consent for women undergoing surgical menopause.