Prospective follow-up of changes in menopausal complaints and hormone status after surgical menopause in a Malaysian population

Abstract

Surgical menopause, in comparison with natural menopause, has traditionally been claimed to lead to faster onset of more severe menopausal symptoms. There is little prospective research to support this view. We aimed to evaluate the speed of onset and magnitude of climacteric symptoms after oophorectomy and whether they relate to serum hormone changes. This would aide in counseling women before surgery. The Greene Climacteric Scale (GCS) was used in a sample of women before either total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) or hysterectomy with one or both ovaries preserved. After surgery, women filled out GCS questionnaires weekly until the final assessment 5 to 6 weeks after surgery. Follicle-stimulating hormone, leuteinizing hormone, and estradiol levels were determined preoperatively at day 10 and postsurgery at day 37. All study participants had high preoperative GCS scores. Scores were highest in the TAHBSO group, but by 5 to 6 weeks after surgery, ratings had returned to premenopausal levels, showing marked improvement of ratings for anxiety, depression, and somatic complaints. Vasomotor symptoms remained unchanged. Hormone levels dropped within 10 days to postmenopausal levels in women undergoing TAHBSO. Fewer than 25% of women considered themselves symptomatic, and their symptom ratings increased significantly only between 2 and 3 weeks after surgery. This study suggests that vasomotor and other symptoms do not manifest as rapidly and severely in our study population as claimed in the literature and that many women have minimal or no symptoms. Improved symptom rating may be caused by perceived improvement of overall quality of life after surgery. This supports the concept that menopausal complaints depend on a multitude of factors other than hormone levels alone.