Issues surrounding surgical menopause - Indications and procedures

More than 25% of women in the United States undergo hysterectomy by age 60. In assessing the appropriateness of this procedure, physicians should cons ider the surgical techniques available, the impact of ovary removal and the subsequent induction of menopause, and the requirement of long-term estrog en replacement. The option of ovarian preservation should also be explored. When ovaries are healthy and viable, without malignancy, preservation may be possible to ensure that the maximum natural hormonal benefits can be gai ned by the patient, thus avoiding the immediate and sharp decline in hormon e production created by surgical menopause. The long-term effects of loss o f ovarian function - including impact on cardiovascular and bone health and the immediate vasomotor symptoms and urogenital impact-are also problemati c. The loss of androgens and estrogen, the physical and psychologic implica tions, and the requirement of compliance with a hormone replacement regimen over a longer period of time should be balanced carefully. In the gynecolo gic profession, no consensus exists concerning the optimum method by which to perform a hysterectomy in different situations. The method selected depe nds more on the experience and biases of the surgeon than on a critical eva luation of operative and outcome data. This paper reviews indications for h ysterectomy, the advantages and disadvantages of various procedures, and th e circumstances in which ovarian preservation is warranted. Options and var ious procedures are discussed for treating such conditions as pelvic inflam matory disease and tuboovarian abscess, chronic pelvic pain, cancer and res idual ovary syndrome. Also discussed is the impact of various procedures on patient well-being, cost, complications and the need for additional surger y.