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Abstract

We thank Piek et al for their insightful comments and clinical perspective. They bring up the very important notion of patient autonomy and a woman’s right to decide whether or not to undergo opportunistic salpingectomy (OS) at the time of routine gynecologic surgery. We completely agree with this principle, and decision aids will certainly be useful to add to our clinical armamentarium. We also acknowledge the difficulty clinicians are faced with when counseling women about the benefits and risks of OS amidst a lack of prospective evidence confirming a reduction in future ovarian cancer risk in addition to the ambiguity regarding the impact on menopause. The Cochrane review referenced by the authors shows a general trend toward lower antimüllerian hormone (AMH) levels after hysterectomy with OS compared with without OS; however, this did not reach statistical significance and the duration of follow-up was fairly limited to only 6 months.1van Lieshout L.A.M. Steenbeek M.P. De Hullu J.A. et al.Hysterectomy with opportunistic salpingectomy versus hysterectomy alone.Cochrane Database Syst Rev. 2019; 8: CD012858PubMed Google Scholar In addition, although AMH is useful in the assisted reproductive setting and may be able to identify a subset of women at high risk of premature menopause, it is not currently a suitable marker in isolation to predict the age of natural menopause in the general population. This is due to inconsistencies in performance particularly at extremes of menopausal age, individualized patterns of AMH secretion, and significant variation among laboratory assays.1van Lieshout L.A.M. Steenbeek M.P. De Hullu J.A. et al.Hysterectomy with opportunistic salpingectomy versus hysterectomy alone.Cochrane Database Syst Rev. 2019; 8: CD012858PubMed Google Scholar, 2Practice Committee of the American Society for Reproductive MedicineTesting and interpreting measures of ovarian reserve: a committee opinion.Fertil Steril. 2015; 103 (e9–17)Google Scholar, 3Depmann M. Eijkemans M.J. Broer S.L. et al.Does anti-Müllerian hormone predict menopause in the general population? Results of a prospective ongoing cohort study.Hum Reprod. 2016; 31: 1579-1587Crossref PubMed Scopus (46) Google Scholar Studies evaluating other predictors or markers of menopause, including symptomatology or physician visits for menopausal complaints, prescriptions for hormone replacement therapy, or other biomarkers such as follicle-stimulating hormone or inhibin, after OS have also yielded mixed results.4Hanley G.E. Kwon J.S. McAlpine J.N. Huntsman D.G. Finlayson S.J. Miller D. Examining indicators of early menopause following opportunistic salpingectomy: a cohort study from British Columbia, Canada.Am J Obstet Gynecol. 2020; 223: 221.e1-221.e11Abstract Full Text Full Text PDF Scopus (8) Google Scholar,5Collins E. Strandell A. Granåsen G. Idahl A. Menopausal symptoms and surgical complications after opportunistic bilateral salpingectomy, a register-based cohort study.Am J Obstet Gynecol. 2019; 220: 85.e1-85.e10Abstract Full Text Full Text PDF Scopus (10) Google Scholar Indeed, studies evaluating the effect of OS on the age of menopause are urgently needed to assess long-term safety. However, this requires a standardized and validated method to evaluate menopausal transition and long-term follow-up. The rapid adoption of opportunistic salpingectomy at the time of hysterectomy for benign gynecological disease in the United StatesAmerican Journal of Obstetrics & GynecologyVol. 223Issue 6PreviewIt is with great interest that we read the article by Mandelbaum et al1 in which they showed an enormous increase in the uptake of opportunistic salpingectomy (OS) for the prevention of ovarian carcinoma, more specifically high-grade serous carcinoma (HGSC), in the United States. This will eventually lead to a decrease in the incidence of HGSC. However, there are some concerns. First, as we have shown for the Dutch population,2 as well as in the United States, there seems to be a large variation among hospitals or even individual caretakers on the implementation of OS. Full-Text PDF