Surgical menopause must-reads

We're delighted you've found your way here to learn more about surgical menopause, but we don't want to be the only source you're reading. It's important, when we are advocating for ourselves and the way we want to define our needs, to be aware of what the medical community is thinking and what the scientific evidence shows. Those two don't always come together in our own health care providers, however, so we also need to be able to support our preferences with sound information we can share with our caregivers to bolster our requests.

We have a whole huge body of information in our bookmarks account, all tagged by the various topics they discuss. We have the most recent additions listed in our sidebar here, but you're always encouraged to browse the full collection to expand your understanding of those topics that seem most pertinent to your own situation.

When you do, you'll see that the first tag in the list is simply "absolutely read this." That's because these particular articles provide an overview we feel especially comprehensive or critical to spelling out the situation we're working with. And we'd like to take a few moments to tell you about these valuable resources.

Individualizing Hormone Therapy for the Surgically Menopausal Woman

Individualizing Hormone Therapy for the Surgically Menopausal Woman (free signup required to read) is the motherlode of information specific to surgical as opposed to natural menopause. It's a bit dated now, published in 2004, but we're not aware of anything newer that contradicts the information it contains. In fact, more recent research has only provided more support for its points.

The article talks about how women entering surgical menopause will have a much rougher transition (ie—more severe and more numerous symptoms) if they are not supported by hrt immediately following surgery. This is an important point because it counters the assertion of many surgeons who are opposed to hrt use and instead feel that we should "wait and see" whether we need hrt. The article says that most women will in fact require hormone supplementation and there are good reasons, both in terms of comfort and health, for working from that assumption.

The article also makes a very useful analysis of the WHI Study results, specifically as they apply to breast cancer and the use of estrogen alone as hrt. While huge numbers of women—even those in surgical menopause—were forced to quit hrt due to the study's finding of increased breast cancer incidence with combined hrt, those results were not applicable to women with hysts using just estrogen. In that arm of the study, breast cancer was actually reduced by 23%, something that received, oh, about zero press in the panic frenzy. The article also notes how newer information about transdermal hrt delivery also raises the likelihood that findings of greater incidence of stroke and other forms of cardiovascular disease with hrt initiation may be controlled by route.

The other useful aspect of this article is that the authors are well aware of recent research speaking to increased mortality in women who have their ovaries removed and fail to supplement their hormones. Where much of the literature of natural menopause defines the issue as "just a few hot flashes," this article is very clear on the more significant aspects of the surgical variety.

Guidelines from the American Association of Clinical Endocrinologists

The American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Menopause (free signup required to read) is not only an excellent overview, but it carries the weight of being a major consensus document coming from the specialty group that actually is most versed in all things hormonal. While it covers primarily natural menopause, it does give several mentions to the surgical version.

This is a long article, but there's not a lot of wasted space because they cover a lot of information. They look at the reasons for using hrt and they look at alternative drugs for managing specific symptoms, all within the context of research-demonstrated efficacy.

One of the things we think is most important here is that they specifically cite the priority the body places on estrogen and the importance of meeting estrogen needs before even assessing whether other hormones require supplementation.

Further, they note that many of the indications for supplementing testosterone are exactly those of a need for estrogen, making it especially important to be certain that a raised estrogen dose will not alleviate the specific problems before moving on to add other hormones. While they by no means condemn the supplementation of testosterone, they strongly urge being quite certain that the need is actually for testosterone and not estrogen, especially given the significant cardiovascular risk potential with testosterone. If you're thinking about the need for testosterone, this is a priority read.

Guidelines from the North American Menopause Society

The NAMS menopause guidelines statement (link is to a pdf file)is another broad consensus document from a specialty medical group. Why is consensus important? Because these documents contain the things that, in a highly arguable field, a wide range of professionals all do agree on. These kinds of documents are thus the baselines from which interpretations in clinical practice arise.

This represents an updated document, some years post-WHI Study, that debunks many of the recent anti-hrt myths that arose from the panic press the study cancellation generated. It also spells out very clearly the who, how long, and why of hrt use.

One of the noteworthy topics covered is the whole issue of "bioidentical" hrts. It notes the confusion generated by the same term being employed for human-identical retail hormone preparations and the special marketing program of compounding pharmacists. It is remarkably level-headed in the whole disagreement regarding whether or not compounding should be outlawed, noting that the unrealistic marketing promises of some compounders are at the root of the FDA concerns while still acknowledging the value of compounded hrts for some women.

Guidelines from the International Menopause Society

The International Menopause Society updated recommendations are another consensus document from menopause specialists, but this time international in makeup. This was formerly one of the most conservative bodies in terms of being anti-hrt, but this revision is a lot more reasonable and less terrifying—something we obviously consider a good move.

There aren't any ground-breaking elements in this report, but the overall conclusion that "beneļ¬ts are more likely to outweigh risks for symptomatic women before the age of 60 years or within 10 years after menopause" is an important examination of the risk/benefit profile of HRT use.

Oophorectomy and mortality risk

One of the big shockers that turned around medical thinking about oophorectomy and hrt in surgical menopause in the past decade is the documentation that removing a young woman's ovaries and not supplementing her hormones results in a substantial increased risk of dying from any of a number of causes when she is compared to woman who did take hrt. This is in marked contrast to the previous guiding philosophy, which was that hormones had no use in a non-fertile body and that women would be just as well off without both ovaries and hormones. While this was known for many years to specialists, this more recent publicity is starting to reach out to physicians in general.

Prophylactic Oophorectomy in Young Women Carries Increased Mortality Risk (free signup required to read) goes into that discovery, with the notable quote here being

Women younger than 45 years who undergo prophylactic bilateral oophorectomy and do not receive adequate estrogen replacement therapy have a 70% higher mortality risk
There is also a report on this research in Science Daily, "Preventive Ovary Removal Linked To Early Death In Younger Women, Mayo Clinic Discovers."

There are a number of other resources on this topic in our bookmarks account tagged with "oophorectomy." While many of them deal with younger women, the growing body of medical opinion is that this is simply a graphic example of something that affects all women to varying degrees, no matter what their age. In other words, we need a certain post-fertile level of hormones to enable normal physical function, and when those are not provided, very significant increased mortality risk can result.

While we have long advocated that a woman's decision to supplement her hormones or not is a personal decision, we feel that every woman needs to know that the risks are very much not on just one side of the issue. Even where there are risks on the side of taking hrt, they need to be realistically balanced against the risks of not taking hrt, lest we doom ourselves to worse outcomes than the ones we fear.

And those are our surgical menopause "must reads" for helping to gain a broader understanding of not only the physiology involved in hrt use, but the recommendations and the background behind them. If we are to effectively advocate for our preferences, it is from materials like this that we most convincingly work. It's not all easy reading, but aren't we worth the effort?