The 2017 Hormone Therapy Position Statement of The North American Menopause Society

The North American Menopause Society 2017 Hormone Therapy Position Statement Advisory Panel

Disclosures

The North American Menopause Society (NAMS). 2018;24(7):728-753. 

In This Article

Oophorectomy in Premenopausal Women

The surgical removal of both ovaries leads to a much more abrupt loss of ovarian steroids than does natural menopause and includes the loss of estrogen, progesterone, and testosterone.[100] Vasomotor symptoms as well as a variety of estrogen deficiency-related symptoms and diseases are more frequent and more severe after oophorectomy and can have a major effect on QOL[101,102] and potential AEs on the CV system, bone, mood, sexual health, and cognition, which have been shown in observational studies to be lessened by ET.[103]

Unless contraindications are present, ET is indicated for women who have had a bilateral oophorectomy and are hypoestrogenic to reduce the risk for VVA and dyspareunia[104] and osteoporosis,[105] with observational data suggesting benefit on atherosclerosis and CVD,[106] and cognitive decline and dementia[107]

Key Points

  • In women with early natural or surgical menopause or POI, early initiation of ET, with endometrial protection if the uterus is preserved, reduces risk for osteoporosis and related fractures, VVA, and dyspareunia, with benefit seen in observational studies for atherosclerosis and CVD, cognition, and dementia. Younger women may require higher doses for symptom relief or protection against bone loss.

  • Ovarian conservation is recommended, if possible, when hysterectomy for benign indications is performed in premenopausal women at average risk for ovarian cancer.

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