Ovarian Surgery, Menopause Hormone Therapy and Contraception

Tumeurs frontières de l’ovaire. Recommandations pour la pratique clinique du CNGOF – Contraception hormonale et THM/THS après tumeur frontière de l’ovaire

BackgroundMenopause is a universal physiological transition, marked by a decline in estrogen, which has important effects on skin and mucosal health. The impact of menopause and menopausal hormone therapy (MHT) on chronic dermatoses remains incompletely defined.ObjectiveThe aim was to investigate the relationship between menopause, MHT, and common dermatological conditions.MethodsPubMed, Embase, and Web of Science were searched from inception to September 2024 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies evaluated menopause or MHT in relation to alopecia, psoriasis, acne, rosacea, melasma, and hidradenitis suppurativa (HS). Investigational cohorts largely consisted of menopausal women, although participant characteristics varied. Data on study design, population, hormonal status, and dermatological outcomes were extracted and synthesized.ResultsA total of 40 studies met inclusion criteria. Alopecia, particularly frontal fibrosing alopecia (FFA) and female pattern hair loss (FPHL), showed the strongest postmenopausal associations, with most cases presenting after menopause and earlier or surgical menopause conferring greater risk. Psoriasis frequently persisted or worsened after menopause, though objective assessments are limited. Acne and rosacea generally improved, whereas melasma showed mixed outcomes, including greater extra-facial involvement post menopause. HS responses to menopause were inconsistent. MHT was linked to increased risk of FFA and rosacea, whereas findings for other dermatoses were more variable or absent. Most of the studies involved MHT formulations that are less commonly used in current clinical practice.ConclusionMenopause influences the onset and course of several chronic dermatoses, while data on MHT remain more limited and inconsistent. Dermatologists should consider menopausal status and hormone therapy exposure when evaluating skin disease. Longitudinal, dermatology-focused studies—particularly those integrating diverse populations and updated hormone therapies—are needed to inform individualized care.

Menopausal symptoms and hormone therapy in women with multiple sclerosis: A baseline-controlled study

This study aimed to assess the association of menopausal status and menopausal hormone therapy (MHT) with cardiovascular risk factors (CVRF) prevalence. We analyzed data from women aged 40 to 70yo, without previous cardiovascular disease, enrolled in the prospective CARVAR 92 cohort study conducted in the Hauts-de-Seine department, France, between 2010 and 2023. CVRF were assessed through blood analysis and medical check-up results. Menopausal status and hormone therapy use were self-reported. Of the 16,879 subjects included in CARVAR 92, 7395 women were analyzed including 2607 non-menopausal and 4788 menopausal women. After adjusting for age, menopausal women were at higher risk of obesity (OR, 1.44 [95% CI, 1.21, 1.70]; p<0.001), waist obesity (OR, 1.33 [95% CI, 1.17, 1.53]; p<0.001), hypertension (OR, 1.17 [95% CI, 1.01, 1.36]; p=0.049), diabetes mellitus (OR, 1.84 [95% CI, 1.31, 2.61]; p<0.001), and dyslipidemia (OR, 1.74 [95% CI, 1.49, 2.03]; p<0.001) compared to non-menopausal women. However, menopausal women using MHT did not show significant differences in the prevalence of CVRF compared to non-menopausal women. These findings remained robust across various models. Menopausal women exhibited an increase in all modifiable CVRF compared to non-menopausal women. MHT use may have a beneficial effect on the prevalence of these risk factors. These findings highlight the importance of considering menopausal status and MHT use when assessing and managing cardiovascular risk in women.

Prescribing postmenopausal hormone therapy to women in their 50s in the post-Women's Health Initiative era

Introduction: Evidence from clinical trials and observational studies on the relationship between menopausal hormone therapy (MHT) and cardiovascular disease (CVD) risk has been discordant. Hypothesis: We hypothesized that the association between MHT and risk of CVD might be affected by both age at menopause and age when initiated MHT. Methods: We harmonised and pooled individual-level data from 15 studies across five countries/regions (Australia, Scandinavia, USA, Japan, and UK). Postmenopausal women who had reported their MHT status (user or non-user) and CVD status (occurred or not, including coronary heart disease (CHD) and stroke) were included. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for the association between MHT use and incident CVD. We stratified the analyses by age when initiated MHT and age at natural menopause to examine the interaction between MHT, age initiated MHT, and age at menopause on incident CVD. Results: Overall, 190 625 postmenopausal women were included. We identified 10 601 incident CVD events, including 7615 CHD and 3543 strokes. Around 39% (74 585) women were MHT users. Compared to non-users of MHT, women who were MHT users had 10% higher risk of incident CVD (HR 1.10, 95% CI 1.06-1.14), with HR (95% CI) of (1.15, 1.10-1.20) for CHD and (1.02, 0.96-1.09) for stroke. After stratifying by age at natural menopause, women who experienced menopause after age 45 years and took MHT had around 15% higher risk of CHD, while the significant association with incident stroke was only observed in women who had menopause after 55 years (1.16, 1.01-1.33). After a further stratification by age initiated MHT, we found the significant associations between MHT users and incident CVD were only observed in women who experienced menopause after age 45 years and took MHT at age 60 years or old (Table 1). Conclusions: Postmenopausal women who experienced natural menopause after age 45 years and took MHT after age 60 years had increased risk of incident CVD.

Objective Menopause is a significant and natural phase in a woman’s life, representing a transition that requires early understanding to manage its effects and promote overall well-being. This study aimed to evaluate the awareness, understanding and perceptions of menopause and menopausal hormone therapy (MHT) among premenopausal women in southern China. Methods A cross-sectional design was employed to enroll women aged 18–40 years (n = 1631) from August 2022 to January 2023 at a public hospital in Fujian, China. A structured questionnaire, developed from existing research and the Climacteric Scale, was used to assess women’s menopausal symptoms and MHT knowledge. Face-to-face interviews were conducted to identify factors correlated with menopausal knowledge levels. Results More than 50% of women demonstrated a comprehensive understanding of menopause. Education level was a significant predictor of menopause knowledge (p < 0.001), with women holding higher education (college degree or above) demonstrating greater knowledge than those with lower education (high school or below). High awareness of common menopausal symptoms, including irritability, sleep disturbances, fatigue, difficulty concentrating and hot flashes, was observed. Although most participants lacked detailed knowledge of MHT, they agreed on the importance of managing menopausal symptoms and recognized the usefulness of MHT for symptom management. Conclusions Premenopausal women in southern China possess a basic understanding of menopause but lack sufficient knowledge about MHT. This highlights the need for educational initiatives and targeted counseling to increase awareness of menopause and MHT, especially regarding its implications and treatment options.

Menopause and menopausal hormone therapy in women: cardiovascular benefits and risks

Background and objective Genetic predisposition and menopausal hormone therapy (MHT) are established risk and preventive factors for colorectal cancer (CRC), respectively. We aimed to evaluate the joint associations of a polygenic risk score (PRS) and MHT on CRC risk for informing CRC prevention. Methods We used data from 28,486 postmenopausal women (11,519 cases and 16,967 controls) of European descent from 38 studies. MHT use was assessed as the use of any MHT, estrogen-only (E-only) or combined estrogen-progestogen (E+P) therapy at reference time. A PRS based on 141 genetic variants previously identified by genome-wide association studies of CRC was modelled as categorical variable in quartiles and also as per-standard deviation difference between PRS and minimum of PRS [(PRS-min(PRS))/SD(PRS)] (PRS.minsd). Multiplicative interaction between PRS and MHT was evaluated using standard logistic regression. Additive interaction was measured using the relative excess risk due to interaction (RERI). Results The use of any MHT as well as E+P and E-only were associated with reduced CRC risk (Odds ratio [OR] 0.70, 0.71, 0.65, respectively). PRS was associated with increased CRC risk, whether as continuous variable (PRS.minsd) (OR 1.53) or in quartiles (OR 1.49, 1.92, 2.87, respectively). We identified statistically significant negative multiplicative interaction (OR: 0.92; 95%CI: 0.87, 0.98) as well as negative additive interaction (RERI: -0.13; 95%CI: -0.15, -0.10) between PRS.minsd and any MHT use. Results were limited to additive interactions with PRS.minsd for E-only use (RERI: -0.14; 95%CI: -0.18, -0.11) and E+P use (RERI: -0.12; 95%CI: -0.16, -0.08). The magnitude of negative additive interactions increased with higher quartiles of PRS for all MHT variables and was consistently significant for the highest quartile compared to the lowest quartile of PRS for any MHT use (RERI: -0.78; 95%CI: -1.03, -0.52), E-only use (RERI: -0.78; 95%CI: -1.18, -0.39), and also E+P use (RERI: -0.53; 95%CI: -0.96, -0.10). Negative multiplicative interaction was also observed for higher PRS quartiles of all MHT variables but significant only for the highest quartile with E-only use (OR: 0.73; 95%CI: 0.55, 0.97). These negative interactions on both multiplicative and additive scales indicate that MHT has a relatively more protective effect on CRC risk for those women with larger PRS scores. For example, compared to women in the lowest PRS quartile with no MHT use, the risk of CRC for women in higher quartiles of PRS was more strongly reduced with MHT use (ORPRS.Q3+noMHT: 1.93 vs ORPRS.Q3+MHT: 1.38, OR MHT/noMHT in PRS.Q3: 0.71; ORPRS.Q4+noMHT: 2.81 vs ORPRS.Q4+MHT: 1.77, OR MHT/noMHT in PRS.Q4: 0.63). Conclusions The protective effect of MHT use on the risk of CRC is stronger in women with higher genetic risk. Risk prediction models incorporating PRS may need to account for potential effect modification by non-genetic risk factors. Citation Format: Yu Tian, Yi Lin, Andre E. Kim, Stephanie A. Bien, Polly A. Newcomb, Graham Casey, Elizabeth A. Platz, Loic Le Marchand, Peter T. Campbell, Hermann Brenner, Michael Hoffmeister, Feng Guo, Xuechen Chen, Marc J. Gunter, Niki Dimou, Stephen B. Gruber, Andrew T. Chan, Amit D. Joshi, Sonja I. Berndt, Emily White, Victor Moreno, Ross L. Prentice, Ulrike Peters, William Gauderman, Li Hsu, Jenny Chang-Claude. Association of polygenic risk score and menopausal hormone therapy for colorectal cancer risk [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 818.

Overview: Lipoprotein(a) (Lp(a)) is a risk factor for atherosclerotic coronary artery disease (CAD). Little is known about menopausal status and hormone therapy in racial/ethnic-specific associations of elevated Lp(a) with CAD. We investigated this in an age- and racially-diverse cohort of women from the U.S.’s largest integrated healthcare system. Methods: We extracted structured cross-sectional electronic health record data for 2831 women with a laboratory result for Lp(a) between 1999-2023 in the Veterans Health Administration. We designated menopausal status (pre, surgical, natural), use of hormone contraception or menopausal hormone therapy (HT), and history of CAD as of the Lp(a) test date. Elevated Lp(a) was Lp(a) &gt;125 nmol/L. Using multivariate logistic regression with correction for multiple comparisons, we estimated association of elevated Lp(a) with prevalent CAD adjusted for age, race/ethnicity, menopausal status, and HT. Within menopausal subgroups, we conducted analogous multivariate logistic regressions. We tested for interaction between Lp(a) and menopausal status and between HT and race/ethnicity. Results: Elevated Lp(a) was associated with prevalent CAD among all women (OR=1.5, 95% CI [1.2, 1.9], p&lt;0.002). In subgroup analysis by menopause status, elevated Lp(a) was associated with prevalent CAD only for women over 60 with natural menopause (OR=2.1, 95% CI [1.5, 3.0], p&lt;0.001). An interaction model between elevated Lp(a) and menopause status on prevalent CAD was assessed with premenopausal women under 60 without elevated Lp(a) as the reference group. Premenopausal women under 60 with elevated Lp(a) had an OR of 1.4 (95% CI [0.8, 2.5] p=0.274). Women over 60 with natural menopause and without elevated Lp(a) had an OR of 4.9 (95% CI [3.4, 7.3], p&lt;0.001). Women over 60 with natural menopause and elevated Lp(a) had the highest OR of 10.4 (95% CI [6.7, 16.0], p&lt;0.001). Relative excess risk due to interaction (RERI) of 5.1 (95% CI [2.2, 9.7]) supports an additive interaction of menopausal status over/under age 60 with Lp(a) on risk of prevalent CAD. The p-value for multiplicative interaction was 0.22. In smaller-sized menopausal subgroups, no observations were observed between race/ethnicity and HT on risk of elevated Lp(a) or on prevalent CAD. Conclusions: Menopausal status over age 60 and elevated Lp(a) (&gt;125 nmol/L) interacted to modify the risk of prevalent CAD. HT use as a possible effect modifier, by race/ethnicity, warrants further exploration.

BACKGROUND: Exogenous estrogen is a double-edged sword in the realm of orthopaedic surgery, providing many musculoskeletal health benefits to menopausal women yet adding an additional risk of venous thromboembolism (VTE) in the perioperative setting for patients using certain forms of hormonal contraception and menopausal hormone therapy (MHT). The primary objective of this review is to summarize the known literature regarding the VTE risks of perioperative medications containing exogenous estrogen among orthopaedic patients. A secondary objective is to provide guidance to orthopaedic surgeons regarding perioperative management of commonly encountered forms of hormonal contraception and MHT. METHODS: A summative review of existing literature regarding VTE risk of various forms of hormonal contraception and MHT is provided, with emphasis on perioperative VTE risk surrounding major and minor orthopaedic surgery. RESULTS: Increased risk of VTE has been identified after arthroscopic knee procedures in patients utilizing oral contraceptive pills and after major lower extremity surgery in patients using MHT, yet there is not a clear standard of care as to how to manage these medications after surgery or how and when to adjust VTE prophylaxis. Regardless of the mode of delivery (pills, patches, vaginal rings), hormonal contraception with exogenous estrogen carries some associated VTE risk that can be compounded by surgery. Depo-Provera has also demonstrated increased risk. Forms of hormonal contraception without elevated VTE risk are progestin only pills and intrauterine devices (IUDs) as well as Nexplanon. MHT with systemic level doses of exogenous estrogen delivered orally has associated VTE risk. While systemic transdermal and transvaginal formulations of estrogen have not been shown to increase VTE risk in the non-surgical state, the risk when combined with the perioperative state after major operations is not yet known. Local estrogen therapies for vaginal symptoms of menopause do not increase risk of VTE. CONCLUSION: Given the frequent utilization of hormonal contraception and MHT, orthopaedic surgeons should consider the use of medications containing exogenous estrogen in the perioperative VTE risk assessment of patients. Further discussion toward the perioperative management of these medications and standardization of care for patients with increased VTE risks should be encouraged.

Disclosure: D. Bechenati: None. R. Castaneda: None. R.D. Rivera Gutierrez: None. M.A. Espinosa: None. J.L. Villamarin: None. E. Tama: None. J.L. Meek: None. S. Faubion: Era Women’s Health Platform, PriMed, AiCME, MedAll, Medscape, Weight Watchers. C. Shufelt: Bayer Pharmaceutics. T. Rajjo: None.Given the metabolic changes associated with menopause (increased abdominal fat, decreased muscle mass, altered energy expenditure), menopause hormone therapy (MHT) may influence weight loss outcomes. Although semaglutide studies suggest a potential benefit of MHT on weight loss in postmenopausal women, the impact of tirzepatide (TZP) remains unclear. This real-world study investigates whether TZP efficacy differs between postmenopausal women using MHT (+MHT) and those not using MHT (-MHT) in the treatment of overweight or obesity. This retrospective cohort study included postmenopausal women prescribed TZP for the treatment of overweight or obesity, with or with MHT. Exclusion criteria were <12 months of TZP use, prior bariatric surgery, active malignancy, and concomitant anti-obesity medication. MHT consisted of transdermal or oral estrogen, with or without progesterone. Data, collected through November 1, 2024, were obtained from electronic medical records. To minimize confounding, 1:2 propensity score matching was used, matching each +MHT participant to two -MHT controls based on age, BMI, age at menopause, menopause type, and diabetes status. Primary endpoints were total body weight loss percentage (TBWL%) at 3, 6, 9, 12, and 15 months, and at last follow-up. Secondary endpoints included the percentage of participants achieving ≥5%, ≥10%, ≥15%, and ≥20% TBWL. Data was non-normal distributed, as such results are presented as median [interquartile range (IQR)], and group comparisons used the Wilcoxon rank-sum test. After propensity score matching of 400 postmenopausal women, 120 were included in this analysis: 40 in the +MHT group (56 [53-58] years, BMI 34 [31-37] kg/m²) and 80 in the -MHT group (57 [53-61] years, BMI 33 [29-36] kg/m²). Baseline characteristics and adiposity-related comorbidities were similar between groups. The median follow-up duration was 18 [15-22] months for the +MHT group and 18 [16-22] months for the -MHT group, with no significant difference between the groups (p=0.4). At the last follow-up, the +MHT group achieved significantly greater TBWL compared to the -MHT group: 17% [11-25] vs 14% [8-18] (p=0.01). Additionally, by the last follow-up, a higher proportion of women in the +MHT group achieved ≥20% TBWL (45% vs. 18%, p=0.001) compared to the -MHT group. In postmenopausal women with overweight or obesity treated with TZP, the use of MHT is associated with superior weight loss outcomes. Further studies with larger sample sizes are needed to confirm these findings and to explore the mechanisms driving this differential weight loss response.Presentation: Saturday, July 12, 2025

Menopausal hormone therapy (MHT) is a supplemental treatment with exogenous estrogen for women with ovarian failure to solve health problems related to low sex hormone. It is no doubt that MHT is beneficial for relieving menopausal symptoms, treating genitourinary atrophy of menopause, and preventing osteoporosis. MHT has undergone nearly 80 years of development, and understanding of its benefits and risks has been changing over time. Particularly, the publication of the report of mid-term research of Women's Health Initiative that is a randomized controlled trial in 2002 largely influenced the application of MHT globally. It was reported that the use of conjugated equine estrogens(CEE) and medroxyprogesterone acetate(MPA) was associated with increased risks of cardiovascular disease and breast cancer in old women, which reencouraged the exploration of benefits and risks of MHT to menopausal women in the past 18 years. Today, it is widely accepted that the effects of MHT are related to several factors, including age at which MHT is started, age when menopause occurs, the type, dosage and route of MHT, duration of treatment, health status, and whether MHT is standardized and well-managed. This article discussed the benefits and risks of MHT based on various guidelines, consensus and articles on MHT published in the past ten years.

The effect of menopausal hormone therapy on thyroid cancer survivors from the National Health Insurance Database in South Korea cohort.

Global Consensus Statement on menopausal hormone therapy