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Hormone Replacement Therapy Prescription After Premature Surgical Menopause

Garg N1Behbehani S2Kosiorek H3Wasson M4.

J Minim Invasive Gynecol. 2020 Mar 12. pii: S1553-4650(20)30124-2. doi: 10.1016/j.jmig.2020.03.002. [Epub ahead of print]

 

Abstract

STUDY OBJECTIVE:

To assess hormone replacement therapy (HRT) prescription pattern in patients undergoing premature surgical menopause based on surgical indication.

DESIGN:

Retrospective cohort study SETTING: Academic tertiary care center PATIENTS: Surgically menopausal patients age ≤45 years who underwent minimally invasive hysterectomy with salpingo-oophorectomy.

INTERVENTIONS:

HRT prescription in the 6-week postoperative period.

MEASUREMENTS AND MAIN RESULTS:

Sixty-three patients met inclusion criteria. Of those, 52% (n=33) were prescribed HRT in the 6-week postoperative period. Indications for surgical menopause included pelvic pain/endometriosis (31.7%), gynecological malignancy (20.6%), BRCA gene mutation (17.4%), breast cancer (9.5%), Lynch syndrome (4.8%), and other (15.8%). Eighty percent of pelvic pain patients, 25% of gynecological malignancy, 45% of BRCA patients, 33.3% of breast cancer patients, and 66.6% of Lynch syndrome patients used HRT postoperatively. In patients who utilized HRT postoperatively, 76% were offered preoperative HRT counseling. This is in contrast those who did not utilize HRT postoperatively, in which only 33% of patients were offered HRT counseling (p<0.001). Perioperative complications were not predictive of HRT use postoperatively. In patients who did not use HRT postoperatively 13.3% utilized alternative non-hormonal therapy.

CONCLUSIONS:

In patients who underwent premature surgical menopause, 52% utilized HRT postoperatively. Patients with pelvic pain and Lynch syndrome were more likely to use HRT, whereas those with gynecologic or breast malignancy and BRCA gene mutations were less likely to use HRT. Preoperative HRT counseling is associated with postoperative HRT use.