After Surgical Menopause, Should Menopausal Hormonal Therapy Started Only Before the Age of 45 Years?

Natural menopause occurs at different ages in different countries ranging from as young as 46.9-47.8 years in the Middle-East region to 50.0-51.1 years in the European countries [1], and previously reported at the approximate age of 50 years in Thailand [2]. Natural menopausal age is reported to be influenced by both factors; host factors such as genetic factors, ethnicity, or body-mass index; and environmental factors such as smoking, parity, etc. Age at natural menopause was associated with subsequent risk of cardiovascular disease, low bone mass density, osteoporosis, and all-cause mortality [3]. However, surgical menopause from bilateral oophorectomy with or without hysterectomy before the age of natural menopause, which occurs at a much younger age than natural menopause, causes a more abrupt decline in ovarian hormones production especially estrogens. The majority of bilateral oophorectomy cases were reported at the ages between 3545 years or younger [4,5]. In general, surgical menopause also results in subsequent adverse health consequences such as: sleep problems [6-8], genitourinary syndrome of menopause, metabolic diseases and cardiovascular events, dementia, osteoporosis, etc. [9-16]. On the contrary, surgical menopause for benign diseases with or without estrogen therapy was also reported to improve sexuality and psychological well-being as the results of reliefs from prior depression or sexual problems [17]. In recent years, surgical menopause has been globally an area of healthcare interest and much more studied and reviewed. A retrospective cohort study of 1,000 consecutive surgical menopause patients who underwent premenopausal surgery before age 50 years for benign indications from a tertiary-care hospital in Bangkok was performed, and the results were published in 2020 [18]. The results showed that 85.5% of the patients used menopausal hormonal therapy (MHT) after surgery. From that study, those with MHT initiated soon after surgery (87% initiated within the first postsurgical year, at the mean age of 42.6 ± 5.1 years, with a median follow-up time of 12.0 years) possibly prevented subsequent osteopenia compared with MHT non-users.