From the Guidelines
Premature ovarian failure (POF) or induced menopause due to surgery at age 32 poses significant risks, including immediate menopausal symptoms and long-term consequences such as increased risk of cardiovascular disease, osteoporosis, and neurocognitive effects.
Risks and Consequences
- The risks associated with POF or induced menopause include:
- Hormone replacement therapy (HRT) is recommended to alleviate symptoms and minimize long-term effects, but it may not completely ameliorate the effects of surgery on sexual function 1
Management and Prevention
- HRT should be considered until at least the average age of natural menopause (around 51 years), in the absence of contraindications such as personal history of breast cancer or venous thromboembolism 1
- For women who are not having a hysterectomy, oestrogen must be used in combination with a progestogen to protect against endometrial cancer 1
- The intra-uterine system can be placed at the time of surgery to deliver progestogen directly into the uterus, with fewer adverse effects than systemic progestogen 1
Individualized Approach
- The decision to undergo risk-reducing surgery should be individualized, taking into account the woman's age, childbearing status, and personal circumstances 1
- Women with moderate-to-high-risk germline pathogenic variants should be offered the option of fertility preservation with IVF or oocyte freezing before undergoing surgery 1
From the Research
Risks of Premature Ovarian Failure (POF) or Induced Menopause due to Surgery at Age 32
- The risks of premature ovarian failure (POF) or induced menopause due to surgery at age 32 include a sudden reduction of ovarian sex steroid production, which can lead to premature ovarian insufficiency 2.
- Surgical menopause at any age is not associated with an increased risk of dementia, but early surgical menopause (≤45 years of age) is associated with a higher risk of dementia and cognitive decline 3.
- Premature ovarian failure (POF) is a primary ovarian defect characterized by absent menarche or premature depletion of ovarian follicles before the age of 40 years, and it can lead to infertility, neurological, metabolic, or cardiovascular consequences, and early onset of osteoporosis 4.
- Premature ovarian insufficiency (POI) has been associated with neurological dysfunction and an increased risk of dementia, perhaps due to depletion in estrogen levels, and the risk appears to be most apparent on domains of global cognitive and verbal memory tests 5.
- Treatment of POF is based on hormonal replacement therapy to avoid estrogen deficiency, suppress vasomotor symptoms, and avoid bone loss as well as cardiovascular risk, and patients with POF should be informed that spontaneous pregnancies may occur and should be oriented to a specialized unit for in vitro fertilization with oocyte donation if desired 6.
Potential Consequences of Induced Menopause at Age 32
- Induced menopause at age 32 can lead to a range of consequences, including:
Importance of Hormone Replacement Therapy (HRT)
- HRT is essential for women who have undergone surgical menopause, including those who have had bilateral salpingo-oophorectomy (BSO) before the natural age of menopause 2.
- HRT should be considered until the natural age of menopause at least, and should include consideration of androgen to address sexual function and sexual desire alterations 2.
- HRT can help to alleviate symptoms of estrogen deficiency, suppress vasomotor symptoms, and avoid bone loss as well as cardiovascular risk 6.