Examining indicators of early menopause following opportunistic salpingectomy: A cohort study from British Columbia, Canada

Abstract Background The fallopian tube may often be the site of origin for the most common and lethal form of ovarian cancer, high-grade serous ovarian cancer. As a result, many Colleges of Obstetrics & Gynecology, including ACOG, are recommending surgical removal of the fallopian tube (bilateral salpingectomy) at the time of other gynecologic surgeries (particularly hysterectomy and tubal sterilization) in women at general population risk for ovarian cancer, collectively referred to as opportunistic salpingectomy. Previous research has illustrated no increased risk of complications following opportunistic salpingectomy. However, most studies examining potential hormonal consequences of opportunistic salpingectomy have had limited follow-up time and have focused on surrogate hormonal markers. Objectives We examine whether there are differences in physician visits for menopause and filling a prescription for hormone replacement therapy among women undergoing opportunistic salpingectomy in the population of British Columbia, Canada. Study Design We identified all women who were 50 years of age and younger in British Columbia who underwent opportunistic salpingectomy between 2008 and 2014. We compared women undergoing opportunistic salpingectomy at hysterectomy with women undergoing hysterectomy alone and women undergoing opportunistic salpingectomy for sterilization with women undergoing tubal ligation. We used Cox Proportional hazards models to model time to physician visits for menopause as well as filling a prescription for hormone replacement therapy. We calculated adjusted hazards ratios for these outcomes adjusting for other gynecologic conditions, surgical approach and patient age. An age-stratified analysis ( Results We included 41,413 women. There were 6,861 women who underwent hysterectomy alone, 6,500 underwent hysterectomy with opportunistic salpingectomy, 4,479 underwent hysterectomy with bilateral salpingo-oophorectomy, 18,621 underwent tubal ligation and 4,952 women underwent opportunistic salpingectomy for sterilization. In women undergoing opportunistic salpingectomy, there was no difference in time to the first physician visit related to menopause for both women undergoing hysterectomy with opportunistic salpingectomy (aHR=0.98 (0.88, 1.09)) and women undergoing opportunistic salpingectomy for sterilization (aHR=0.92 (0.77, 1.10)). There was also no difference in time to filling a prescription for hormone replacement therapy for women undergoing hysterectomy with opportunistic salpingectomy or opportunistic salpingectomy for sterlization (aHR=0.82 (0.72, 0.92) and aHR=1.00 (0.89, 1.12), respectively). In contrast, we report significantly increase hazards for time to physician visit for menopause (aHR=1.95 (1.78, 2.13))and filling a prescription for hormone replacement therapy (aHR=3.80 (3.45, 4.18) among women undergoing hysterectomy with bilateral salpingo-oophorectomy. There were no increased hazards for physician visits for menopause of initiation of hormone replacement therapy among women undergoing opportunistic salpingectomy in any of the age-stratified analyses, nor among women with at least 5 years of follow-up. Conclusions Our results reveal no indication of an earlier age of onset of menopause among the population of women undergoing hysterectomy with opportunistic salpingectomy and opportunistic salpingectomy for sterilization as measured by physician visits for menopause and initiation of hormone replacement therapy. Our findings are reassuring, given that earlier age at menopause is associated with increased mortality, particularly from cardiovascular disease.