Bilateral salpingo-oophorectomy

There is strong evidence that ovarian conservation is favored in the absence of a clear indication for bilateral saplingo-oophorectomy (BSO) such as a genetic variant conferring a high risk ovarian cancer.

Surgical menopause is described as (with or without concurrent hysterectomy), prior to menopause.

For women who undergo natural menopause, compared to those with surgical menopause, the latter experience more rapid decline in the levels of estradiol and other ovarian hormones that can cause more severe vasomotor symptoms, such as hot flashes, and night sweats. 

In addition,  there is a higher rate of mood disorders, sleep disturbances, sexual dysfunction, arthralgias, and reduced quality life in those who undergo surgical menopause compared to women who undergo natural menopause.

Early estrogen deprivation related to premenopausal BSO is associated with increased long-term adverse health outcomes.

Observational studies show that women who undergo undergo BSO before menopause have a lower incidence of and mortality from breast and ovarian cancers.

However BSO before menopause is also linked with higher rates of all-cause mortality, coronary heart disease, parkinsonism, cognitive decline, osteoporosis, and accelerated accumulation of multimorbidity defined by 18 chronic conditions associated with aging including cardiovascular, cv metabolic, and mental health conditions, as well as arthritis and osteoporosis.

Some studies suggest that the adverse long-term health outcomes associated with early estrogen deprivation can be mitigated by the use of menopausal hormonal therapy: estrogen alone in women who undergo hysterectomy, or estrogen with progesterone in women with an intact uterus.

There is an increased risk of cardio metabolic morbidity with early estrogen deprivation that includes: adverse lipid changes, insulin resistance, and increased central adiposity.

No randomized clinical trials have been conducted assessing the effect of menopause hormone therapy on disease outcomes including cardiovascular disease, fractures, breast cancer, or dementia in women undergoing BSO before menopause.

Observational studies suggest that by replacing the hormones the ovaries would have continued to produce, menopausal hormone therapy lowers the risk of long-term abilities associated with premature or early menopause.

It is recommended that menopausal hormone therapy should be prescribed for women with surgical menopause before age 45 even in the absence of typical menopause related symptoms such as hot flashes, night sweats, and sleep and mood disorders. 

In the above setting menopausal hormonal therapy should be continued at least till age 52 years the average age of menopause.

Data suggesting which hormone therapy/dose for women with premature early menopause are lacking.

Transdermal  estrogen has less risk of venous thromboembolism compared with oral administration and does not Increase the level of triglycerides.

Transdermal estrogen is preferred for obese as well as women with metabolic syndrome or diabetes.

Estrodial patches are the most commonly used form of transdermal estrodial, gels and spray are available.

Surgically induced menopausal women with a uterus should also receive progestogen along with estrogen to prevent endometrial neoplasia.

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