Compliance and health consequences of menopausal hormonal therapy after surgical menopause: A retrospective study in Thailand

Abstract

© 2020 Japan Society of Obstetrics and Gynecology Aim: To study compliance with menopausal hormonal therapy (MHT) until age ≥ 50 year and health consequences after surgical menopause. Methods: A retrospective cohort study of 1000 consecutive surgically menopausal patients who underwent premenopausal surgery before 50 years of age from benign indications during 1996–2012 was performed. Main outcomes were number in year of MHT compliance and health consequences: hypertension (HT), diabetes mellitus (DM), dyslipidemia (DLP), ischemic heart disease (IHD)/myocardial infarction (MI), venous thromboembolism (VTE), stoke, osteopenia/osteoporosis, cognitive impairment/dementia/Alzheimer's disease (AD) /Parkinsonism and breast/other cancers. The MHT nonuser subgroup served as the control. Results: Of the 1000 patients, 855 cases used MHT. The median overall follow-up time from surgery for 145 MHT nonuser patients, 435 MHT users until age <50 year and 420 MHT users until age ≥50 year was 12.0 years. Compliance until age ≥50 year was only 49.1%. For MHT users, the overall median age of stopping MHT was 47.0 year with a median MHT use of 6.0 year. After age adjustment at the time of follow-up of all subgroups by forward stepwise logistic regression analysis, the only significantly different health consequence was osteopenia (32.4%, 10.6% and 21.4% in the MHT nonusers, users until age <50 year and users until age ≥50 year, respectively [P < 0.001]). Prevalence of breast cancer, colon cancer and other cancers were not different among subgroups. Conclusion: The majority of patients used MHT with low compliance until age ≥50 year. In addition, MHT initiation after surgery possibly prevented osteopenia compared with MHT nonusers.