Can fallopian tube removal lead to early menopause?

Fallopian Tube Removal and Early Menopause

Fallopian tube removal alone (salpingectomy) does not cause early menopause as it preserves the ovaries which are responsible for hormone production. However, when fallopian tubes are removed together with ovaries (salpingo-oophorectomy), this will induce surgical menopause if performed before natural menopause age.

Understanding the Procedures and Their Effects

Salpingectomy (Fallopian Tube Removal Only)

• Removes only the fallopian tubes while preserving the ovaries
• Does not affect ovarian hormone production
• No evidence of earlier onset of menopause when ovaries are preserved 1
• A large cohort study from British Columbia showed no increased risk of physician visits for menopause or hormone replacement therapy prescriptions in women who underwent opportunistic salpingectomy compared to controls 1

Salpingo-Oophorectomy (Removal of Tubes and Ovaries)

• Removes both fallopian tubes and ovaries
• Results in immediate surgical menopause if performed before natural menopause age (typically around 51 years)
• Associated with significantly increased rates of menopausal symptoms and hormone replacement therapy use (adjusted hazard ratio 3.80) 1

Consequences of Premature Menopause

When ovaries are removed before natural menopause age, women experience:

• Immediate menopausal symptoms: hot flushes, sweats, mood changes 2
• Long-term health consequences: increased risk of cardiovascular disease, osteoporosis, and neurocognitive effects 3
• Sexual dysfunction: vaginal dryness and decreased libido 3
• Increased risk of early mortality 4

Risk-Reducing Surgery Considerations

For Women with Genetic Predisposition to Ovarian Cancer

• Risk-reducing bilateral salpingo-oophorectomy (RRBSO) is recommended for carriers of BRCA1/2, BRIP1, RAD51C, RAD51D or Lynch syndrome genes 3
• Timing recommendations vary by genetic mutation:
  • BRCA1 carriers: between ages 35-40 years 3
  • BRCA2 carriers: between ages 40-45 years 3
  • RAD51C/RAD51D carriers: between ages 40-50 years 3
  • BRIP1/PALB2 carriers: between ages 45-50 years 3

Hormone Replacement Therapy After RRBSO

• HRT is recommended up to age 51 (average natural menopause age) to minimize health risks associated with early menopause 3
• HRT does not negate the reduction in ovarian cancer risk provided by surgery 3
• Women without a uterus need estrogen-only HRT; those with a uterus need combined estrogen-progestogen therapy 2

Emerging Alternative Approaches

• Salpingectomy with delayed oophorectomy is being investigated as a strategy to delay surgical menopause while still reducing ovarian cancer risk 3
• Several prospective trials (WISP, PROTECTOR, SOROCk, TUBA) are evaluating this approach 3
• Current guidelines do not yet recommend salpingectomy alone as standard of care for high-risk women, as RRBSO has stronger evidence for mortality reduction 3

Practical Implications

• Women undergoing hysterectomy for benign conditions should be offered concurrent salpingectomy as it may reduce future ovarian cancer risk without causing menopause 3
• Women considering risk-reducing surgery should receive detailed counseling about the impacts of oophorectomy on quality of life and long-term health 3
• Fertility preservation options should be discussed before risk-reducing surgery if family planning is not complete 3

In summary, fallopian tube removal alone does not cause early menopause, but removal of both tubes and ovaries does. The decision regarding risk-reducing surgery should consider cancer risk, age, and the significant health impacts of premature menopause.