Long-term health consequences of premature or early menopause and considerations for management

Abstract

Aim To review the current evidence concerning the long-term harmful effects of premature or early menopause, and to discuss some of the clinical implications. Material and methods Narrative review of the literature. Results Women undergoing premature or early menopause, either following bilateral salpingo-oophorectomy or because of primary ovarian insufficiency, experience the early loss of estrogen and other ovarian hormones. The long-term consequences of premature or early menopause include adverse effects on cognition, mood, cardiovascular, bone, and sexual health, as well as an increased risk of early mortality. The use of hormone therapy has been shown to lessen some, although not all of these risks. Therefore, multiple medical societies recommend providing hormone therapy at least until the natural age of menopause. It is important to individualize hormone therapy for women with early estrogen deficiency, and higher dosages may be needed to approximate physiological concentrations found in premenopausal women. It is also important to address the psychological impact of early menopause and to review the options for fertility and the potential need for contraception, if the ovaries are intact. Conclusions Women who undergo premature or early menopause should receive individualized hormone therapy and counseling.

Estrogen-based hormone therapy in women with primary ovarian insufficiency: a systematic review

“…Associated estrogen deficiency symptoms may also affect quality of life. These adverse outcomes have also been reported in young women with secondary POI due to bilateral oophorectomy [7], with outcome reports including overall acceleration of the aging process [8]. Although guidelines recommend continuous use of hormone therapy (HT) until the average age of menopause [2 9], studies show a mean duration of about one year [10].…”

Ovariectomy increases the age-induced hyperphosphorylation of Tau at hippocampal CA1

“…Our results may provide essential information for understanding how hyperphosphorylated Tau accumulation, resulting from aging and OVX, is related to the associative learning loss that occurs in both women (Faubion et al 2015) and rats (Espinosa-Raya et al 2011) after the decline in ovarian activity.…”

“…In this sense, several studies have shown that loss of ovaries due to an oophorectomy in premenopausal women enhance the risk of several disorders typically associated to menopause stage which includes an increase in depression, anxiety and several types of memory disorders (Rocca et al 2007;Ðoković et al 2015;Faubion et al 2015). In the search of new approaches for alleviating the above symptoms, the removal of ovaries in rats has been proposed as a model for studying several disorders associated to human menopause (Li and Satinoff 1996) including those related with the loss of memory (Carroll et al 2010;Espinosa-Raya et al 2011;Ortiz-Pérez et al 2016;Wallace et al 2006).…”

Changing the conversation about hormone therapy

“…There is minimal absorption of low-dose vaginal estrogen, with levels within normal postmenopausal levels. Based on 1-year safety studies, progestogen is not needed with low-dose vaginal estrogen 13 .…”