-
Climacteric : the Journal of the... 2015To review the current evidence concerning the long-term harmful effects of premature or early menopause, and to discuss some of the clinical implications. (Review)
Review
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.
Topics: Adult; Estrogen Replacement Therapy; Estrogens; Female; Humans; Menopause, Premature; Mental Health; Ovariectomy; Postoperative Complications; Primary Ovarian Insufficiency; Salpingectomy
PubMed: 25845383
DOI: 10.3109/13697137.2015.1020484 -
Obstetrics and Gynecology May 2022To perform an updated Markov modeling to assess the optimal age for bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy for benign indication. (Review)
Review
OBJECTIVE
To perform an updated Markov modeling to assess the optimal age for bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy for benign indication.
METHODS
We performed a literature review that assessed hazard ratios (HRs) for mortality by disease, age, hysterectomy with or without BSO, and estrogen therapy use. Base mortality rates were derived from national vital statistics data. A Markov model from reported HRs predicted the proportion of the population staying alive to age 80 years by 1-year and 5-year age groups at time of surgery, from age 45 to 55 years. Those younger than age 50 years were modeled as either taking postoperative estrogen or not; those 50 and older were modeled as not receiving estrogen. Computations were performed with R 3.5.1, using Bayesian integration for HR uncertainty.
RESULTS
Performing salpingo-oophorectomy before age 50 years for those not taking estrogen yields a lower survival proportion to age 80 years than hysterectomy alone before age 50 years (52.8% [Bayesian CI 40.7-59.7] vs 63.5% [Bayesian CI 62.2-64.9]). At or after age 50 years, there were similar proportions of those living to age 80 years with hysterectomy alone (66.4%, Bayesian CI 65.0-67.6) compared with concurrent salpingo-oophorectomy (66.9%, Bayesian CI 64.4-69.0). Importantly, those taking estrogen when salpingo-oophorectomy was performed before age 50 years had similar proportions of cardiovascular disease, stroke, and people living to age 80 years as those undergoing hysterectomy alone or those undergoing hysterectomy and salpingo-oophorectomy at age 50 years and older.
CONCLUSION
This updated Markov model argues for the consideration of concurrent salpingo-oophorectomy for patients who are undergoing hysterectomy at age 50 and older and suggests that initiating estrogen in those who need salpingo-oophorectomy before age 50 years mitigates increased mortality risk.
Topics: Aged; Aged, 80 and over; Bayes Theorem; Estrogens; Female; Humans; Hysterectomy; Middle Aged; Ovariectomy; Salpingo-oophorectomy
PubMed: 35576331
DOI: 10.1097/AOG.0000000000004732 -
JAMA Network Open Aug 2023A body of pathological and clinical evidence supports the position that the fallopian tube is the site of origin for a large proportion of high-grade serous ovarian...
IMPORTANCE
A body of pathological and clinical evidence supports the position that the fallopian tube is the site of origin for a large proportion of high-grade serous ovarian cancers. Consequently, salpingectomy is now considered for permanent contraception (in lieu of tubal ligation) or ovarian cancer prevention (performed opportunistically at the time of surgical procedures for benign gynecologic conditions).
OBJECTIVE
To evaluate the association between salpingectomy and the risk of invasive epithelial ovarian, fallopian tube, and peritoneal cancer.
DESIGN, SETTING, AND PARTICIPANTS
This population-based retrospective cohort study included all women aged 18 to 80 years who were eligible for health care services in Ontario, Canada. Participants were identified using administrative health databases from Ontario between January 1, 1992, and December 31, 2019. A total of 131 516 women were included in the primary (matched) analysis. Women were followed up until December 31, 2021.
EXPOSURES
Salpingectomy (with and without hysterectomy) vs no pelvic procedure (control condition) among women in the general population.
MAIN OUTCOMES AND MEASURES
Women with a unilateral or bilateral salpingectomy in Ontario between April 1, 1992, and December 31, 2019, were matched 1:3 to women with no pelvic procedure from the general population. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95% CIs for ovarian, fallopian tube, and peritoneal cancer combined.
RESULTS
Among 131 516 women (mean [SD] age, 42.2 [7.6] years), 32 879 underwent a unilateral or bilateral salpingectomy, and 98 637 did not undergo a pelvic procedure. After a mean (range) follow-up of 7.4 (0-29.2) years in the salpingectomy group and 7.5 (0-29.2) years in the nonsurgical control group, there were 31 incident cancers (0.09%) and 117 incident cancers (0.12%), respectively (HR, 0.82; 95% CI, 0.55-1.21). The HR for cancer incidence was 0.87 (95% CI, 0.53-1.44) when comparing those with salpingectomy vs those with hysterectomy alone.
CONCLUSIONS AND RELEVANCE
In this cohort study, no association was found between salpingectomy and the risk of ovarian cancer; however, this observation was based on few incident cases and a relatively short follow-up time. Studies with additional years of follow-up are necessary to define the true level of potential risk reduction with salpingectomy, although longer follow-up will also be a challenge unless collaborative efforts that pool data are undertaken.
Topics: Female; Humans; Adult; Retrospective Studies; Cohort Studies; Ontario; Ovarian Neoplasms; Salpingectomy; Peritoneal Neoplasms
PubMed: 37566421
DOI: 10.1001/jamanetworkopen.2023.27198 -
Ugeskrift For Laeger Nov 2023
Topics: Female; Humans; Male; Orchiectomy; Hysterectomy; Salpingectomy; Laparoscopy
PubMed: 38018743
DOI: No ID Found -
CMAJ : Canadian Medical Association... Nov 2021
Topics: Canada; Combined Modality Therapy; Early Detection of Cancer; Endometrial Neoplasms; Female; Humans; Hysterectomy; Neoplasm Grading; Neoplasm Staging; Risk Factors; Salpingo-oophorectomy
PubMed: 34782385
DOI: 10.1503/cmaj.202731-f -
Acta Obstetricia Et Gynecologica... Jul 2017Although there has been a growing concern over the possible damaging effect of salpingectomy on ovarian reserve, this issue remains uncertain. The purpose of this... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Although there has been a growing concern over the possible damaging effect of salpingectomy on ovarian reserve, this issue remains uncertain. The purpose of this meta-analysis was to test the hypothesis that salpingectomy may compromise ovarian reserve.
MATERIAL AND METHODS
A detailed search was conducted using MEDLINE, Embase, Dynamed Plus, ScienceDirect, TRIP database and the Cochrane Library from January 2000 to November 2016. All cohort, cross-sectional and randomized controlled studies investigating changes in circulating anti-Müllerian hormone (AMH) after salpingectomy were considered. Thirty-seven studies were identified, of which eight were eligible. Data were extracted and entered into RevMan software for calculation of the weighted mean difference (WMD) and 95% CI. Two groups of studies were analyzed separately: group 1 (six studies, n = 464) comparing data before and after salpingectomy and group 2 (two studies) comparing data in women who have undergone salpingectomy (n = 169) vs. healthy controls (n = 154).
RESULTS
Pooled results of group 1 studies showed no statistically significant change in serum AMH concentration after salpingectomy (WMD, -0.10 ng/mL; 95% CI -0.19 to 0.00, I = 0%). Similarly, meta-analysis of group 2 showed no statistically significant difference in serum AMH concentration between salpingectomy group and controls (WMD, -0.11 ng/mL; 95% CI -0.37 to 0.14, I = 77%). Subgroup analyses based on laterality of surgery, type of AMH kit and participants' age (<40 years) still showed no statistically significant changes in circulating AMH.
CONCLUSION
Salpingectomy does not seem to compromise ovarian reserve in the short-term. However, the long-term effect of salpingectomy on ovarian reserve remains uncertain.
Topics: Female; Fertility Preservation; Humans; Ovarian Reserve; Randomized Controlled Trials as Topic; Salpingectomy
PubMed: 28471535
DOI: 10.1111/aogs.13133 -
Fertility and Sterility Jul 2020
Topics: Female; Humans; Salpingectomy; Sterilization, Tubal
PubMed: 32622416
DOI: 10.1016/j.fertnstert.2020.04.035 -
Medicina (Kaunas, Lithuania) Feb 2023Hereditary women's syndromes due to inherited mutations result in an elevated risk of developing gynecological cancers over the lifetime of affected carriers. The BRCA 1... (Review)
Review
Hereditary women's syndromes due to inherited mutations result in an elevated risk of developing gynecological cancers over the lifetime of affected carriers. The BRCA 1 and 2 mutations, Lynch syndrome (LS), and mutations in rare hereditary syndromes increase this risk and require more effective management of these patients based on surveillance and prophylactic surgery. Patients need counseling regarding risk-reducing surgery (RRS) and the time required to perform it, considering the adverse effects of premenopausal surgery and the hormonal effect on quality of life, bone density, sexual activity, and cardiological and vascular diseases. Risk-reducing salpingo-oophorectomy (RRSO) is the gold standard for BRCA-mutated patients. An open question is that of endometrial cancer (EC) risk in patients with BRCA1/2 mutation to justify prophylactic hysterectomy during RRSO surgical procedures. RRS provides a 90-95% risk reduction for ovarian and breast cancer in women who are mutation carriers, but the role of prophylactic hysterectomy is underinvestigated in this setting of patients. In this review, we evaluate the management of the most common hereditary syndromes and the benefits of risk-reducing surgery, particularly exploring the role of prophylactic hysterectomy.
Topics: Female; Humans; Quality of Life; Syndrome; Salpingo-oophorectomy; Hysterectomy; Mutation; Endometrial Neoplasms; Breast Neoplasms; Ovarian Neoplasms; Genetic Predisposition to Disease
PubMed: 36837501
DOI: 10.3390/medicina59020300 -
Cancer May 2017Because there is no screening test for ovarian cancer, effective prevention strategies may be the best way to reduce the mortality of this most lethal gynecologic... (Review)
Review
Because there is no screening test for ovarian cancer, effective prevention strategies may be the best way to reduce the mortality of this most lethal gynecologic malignancy. Increasing evidence supports the hypothesis that the fallopian tube is the site of origin for the vast majority of high-grade serous carcinomas. Our growing understanding of the pathogenesis of this disease offers a rare opportunity to explore new preventive measures, such as bilateral salpingectomy, which may provide great benefit without compromising ovarian function. If the tubal paradigm is accurate, then the impact of bilateral salpingectomy could extend to BRCA1 and BRCA2 mutation carriers, high-risk noncarriers, and average-risk women. The authors present a review of the literature on the role of risk-reducing salpingectomy in all women and in high-risk groups, with a focus on morbidity, ovarian function, potential clinical applicability, and epidemiological considerations. Cancer 2017;123:1714-1720. © 2017 American Cancer Society.
Topics: Carcinoma, Ovarian Epithelial; Female; Genes, BRCA1; Genes, BRCA2; Genital Diseases, Female; Hereditary Breast and Ovarian Cancer Syndrome; Humans; Menopause, Premature; Mutation; Neoplasms, Glandular and Epithelial; Ovarian Neoplasms; Prophylactic Surgical Procedures; Risk Assessment; Salpingectomy
PubMed: 28334425
DOI: 10.1002/cncr.30528 -
Journal of the National Cancer Institute Sep 2015
Topics: BRCA1 Protein; BRCA2 Protein; Breast Neoplasms; Female; Heterozygote; Humans; Ovariectomy; Risk Reduction Behavior; Salpingectomy
PubMed: 26264691
DOI: 10.1093/jnci/djv218