Changes in Sex Steroids and Relation With Menopausal Complaints in Women Undergoing Risk-reducing Salpingo-oophorectomy

Abstract

Context Risk-reducing salpingo-oophorectomy (RRSO) is performed in BRCA1 or 2 mutant carriers to minimize ovarian cancer risk. Although studies have been performed investigating sex steroid levels, menopausal complaints and sexual functioning in relation to RRSO, their exact relationship remains unknown. Objectives To investigate the impact of RRSO on serum sex steroid levels and their association with menopausal complaints and sexual functioning. Methods This prospective observational cohort study included 57 pre- and 37 postmenopausal women at risk of ovarian cancer and opting for RRSO. Data collection involved validated questionnaires on sexual functioning and menopausal complaints. Testosterone, androstenedione, estradiol and estrone levels in serum determined by liquid chromatography-tandem mass spectrometry were obtained one day before, six weeks and seven months after RRSO. Results In premenopausal women, all four steroids were decreased both six weeks (p<0.01) and seven months (p<0.01) after RRSO. Furthermore, in these women, decreases in estrogens were associated with a decrease in sexual functioning seven months after RRSO (p<0.05). In postmenopausal women, only testosterone was decreased six weeks and seven months (p<0.05) after RRSO, which was associated with an increase in menopausal complaints at seven months post-RRSO (p<0.05). Conclusion Our results suggest that in premenopausal women, decreases in estrogens are related to a decrease in sexual functioning and that in postmenopausal women, testosterone is decreased after RRSO, which indicates that postmenopausal ovaries maintain some testosterone production. Furthermore, in postmenopausal women, a strong decrease of testosterone was associated with more menopausal complaints indicating that future studies investigating testosterone supplementation are warranted.

Androgen deficiency in hypopituitary women: its consequences and management

“…The major circulating androgens in women are the prohormones dehydroepiandrosterone sulfate (DHEA-S), dehydroepiandrosterone (DHEA), and androstenedione as well as the active androgens testosterone and dihydrotestosterone (DHT). DHEA-S and androstenedione are mainly of adrenal origin but are also produced by the ovaries [ 12 – 14 ]. Testosterone is produced by the ovaries and the adrenals as well as via peripheral conversion of prohormones, while DHT mainly is formed within target tissues [ 14 , 15 ].…”

“…DHEA-S and androstenedione are mainly of adrenal origin but are also produced by the ovaries [ 12 – 14 ]. Testosterone is produced by the ovaries and the adrenals as well as via peripheral conversion of prohormones, while DHT mainly is formed within target tissues [ 14 , 15 ]. In younger women, circulating testosterone derives in approximately equal amounts from the ovaries (25%) and the adrenals (25%), and around 50% derives from peripheral conversion of androstenedione [ 16 ].…”

The influence of sex hormones on musculoskeletal pain and osteoarthritis

“…Sex steroid hormones (estrogens, progestogens, and androgens; herein referred to as sex hormones) are regulated centrally by gonadotrophin-releasing hormone, which is produced by the hypothalamus, and the pituitary gonadotrophins (follicle-stimulating hormone and luteinising hormone), with enzymatic control of the synthesis and bioavailability of these hormones differing at various sites in the body (table 1; figure 1) (11). The effects of sex steroids are mediated through genomic and non-genomic pathways, involving classic membrane-bound receptors that bind to hormones at the cell surface and intracellular receptors that regulate transcription (11,12). Levels of sex hormones change over the lifecourse (figure 2).…”

“…One such scenario is surgical bilateral ovariectomy (oophorectomy). This procedure reduces not only circulating estrogens, but also circulating androgens produced by the ovarian stroma (12). In one study, 162 women with a history of hysterectomy (which would be associated with ovariectomy for many, though this was not examined) had higher frequencies of radiographic knee osteoarthritis and first carpometacarpal joint osteoarthritis (32 [20%] vs. 16 [10%]), and higher relative rates for knee osteoarthritis (4.89 (95%CI 2.21-10.80]) and first carpometacarpal joint osteoarthritis (2.28 [1.12-4.29]) than 164 age matched controls without hysterectomy.…”