Barriers to Surgical Menopause Counseling in Gynecologic Cancers

A Quantitative and Qualitative Study of Patients and Providers

Connor C. Wang, MD; Dandi S. Huang, MD; Anisa M. Carlson, BA; Zhanhai Li, PhD; Ahmed Al-Niaimi, MD; Makeba Williams, MD, FACOG, NCMP


Menopause. 2022;29(8):926-931. 

In This Article

Abstract and Introduction


Objective: The objective of this study is to identify factors associated with receiving surgical menopause counseling in gynecologic cancer patients, as well as patient and provider perspectives, regarding surgical menopause counseling and management.

Methods: We conducted a single-institution mixed-method study combining retrospective chart review and patient and provider surveys. Patients younger than 51 years who experienced surgical menopause after gynecologic cancer treatment from January 2017 to December 2019 were surveyed in April 2021 about experiences with menopause counseling, barriers to care, and quality of life. We then reviewed charts of only patients who fully completed surveys. All gynecologic oncology providers were surveyed about surgical menopause practices. Logistic regression identified factors associated with receiving counseling.

Results: Sixty-six of 75 identified met inclusion criteria and received survey invitations. Thirty-five (53%) completed surveys. Sixty percent had documented surgical menopause counseling. Patients who were counseled were younger (43 vs 48.5 years, P = 0.005), more likely to have referrals for menopause care (12 vs 9, P = 0.036), more likely to have menopause providers other than oncology providers (14 vs 8, P = 0.001), and had fewer comorbidities. Decreasing age at surgery increased odds of counseling. Most reported continued menopause symptoms and quality of life disturbances. Half were satisfied with menopause care. Majority preferred counseling from oncology providers. Most providers always counseled on surgical menopause but cited lack of time as the primary obstacle for complete counseling.

Conclusions: Younger age at surgery increased odds of receiving surgical menopause counseling. Gynecologic cancer patients experienced significant menopause-related disturbances. Improved understanding of patient and provider preferences and greater emphases on surgical menopause and survivorship will improve care for gynecologic oncology patients.


Thirty to 40% of patients diagnosed with gynecologic cancers in the United States are premenopausal or perimenopausal at diagnosis.[1] Advancements in gynecologic cancer treatment, surgery, radiation, and chemotherapy have led to more cured patients or long-term survivors. [1] Surgical treatment often includes bilateral oophorectomy (BO) with or without bilateral salpingectomy, resulting in acute surgical menopause in premenopausal patients. Consequently, survivors may experience immediate, severe, and persistent menopause symptoms, like vasomotor symptoms (VMS), genitourinary changes, sleep disturbances, and cognitive, mood, neurologic, or musculoskeletal changes.[2] Surgical menopause is associated with increased severity and frequency of VMS and sexual dysfunction, as well as faster symptom onset than that with natural menopause.[1,3] Patients who experience surgical menopause are also at higher risk for accelerated decline in cardiovascular and bone health, thereby increasing their morbidity and mortality.[4]

Hormonal therapy (HT) provides symptom relief, improves quality of life (QoL) and reduces the risk of adverse health outcomes associated with premature menopause. Estrogen therapy is the most effective treatment for many bothersome menopause symptoms, such as vasomotor and genitourinary complaints.[5] The recently published clinical practice statement from the Society of Gynecologic Oncology[6] affirms previously well-described safe use of HT with certain types of gynecologic cancers.[1,7] In patients for whom HT is contraindicated, effective nonhormonal options for menopause complaints include cognitive behavioral therapy, pharmacologic medications, or vaginal moisturizers or lubricants.[8]

Counseling about and treatment of surgical menopause can have a significant impact on patients' overall health and QoL. Clinical management of induced menopause after gynecologic malignancy requires an understanding of the complexities of patients' cancer diagnoses and comorbidities, as well as the risks and benefits of hormonal and nonhormonal menopausal treatment options.[5,7] Factors influencing surgical menopause management have been recently reported in benign diagnoses;[9,10] however, little is known about the factors influencing treatment of patients with gynecologic cancers.

The objectives of this study were to identify factors associated with receipt of surgical menopause counseling in gynecologic oncology patients and to elucidate perspectives and perceived barriers to surgical menopause counseling among gynecologic oncology patients and providers.