Hormone Replacement Therapy Use After Premature Surgical Menopause and Impact on Subsequent Health Services

Introduction/Background: It is well-recognized that premature surgical menopause without subsequent hormone replacement therapy (HRT) is associated with increased morbidity and mortality. Our objective was to describe HRT use in a cohort of women from British Columbia (BC), Canada with premature surgical menopause.Methodology: A population-based retrospective cohort study of women who underwent surgical menopause between ages 19-50, identified from Medical Service Plan Payment Information from BC, and linked to prescription histories from the provincial PharmaNet database from 2004-2014. Women with personal history of cancer were excluded. Results: A total of 11,864 women were included. Median age of surgical menopause was 43 years. Median follow-up duration was 5.5 years (range: 0-10 years). The majority of women did not have a BRCA mutation (99.1%). They underwent bilateral salpingo-oophorectomy (90%) or bilateral oophorectomy (10.4%), and 50.5% had concurrent hysterectomy. There were 196 (1.7%) diagnosed with malignancy. The remainder had benign diagnoses, the most common of which were adnexal masses (17%), endometriosis (17.9%), and abnormal bleeding (14.3%). During the 10-year study period, only 55.4% had ever used HRT. Use of HRT for 5 years after surgery were 38.2%, 8.9%, 32.7%, and 20.2%, respectively. Those who did not use HRT had more physician visits for cardiovascular disease (19% vs. 9%) and osteoporosis (13% vs. 9%) compared to ever-users, respectively (p = 0.002). Conclusion: In this large population-based study investigating HRT rates following premature surgical menopause, only half of these women ever used HRT, and a greater proportion of those who did not use HRT had physician visits for cardiovascular diseases and osteoporosis. These results underscore a need for education and ongoing follow-up in this patient population.