I have a patient who is in surgical menopause at age 44 years. Our first-line treatment has been oestrogen-only therapy due to no uterus. The patient has produced research indicating oestrogen and testosterone should be used, along with benefits of progesterone in some women. She wants to trial all three.
Is there support for this and, if so, what is a suggested method and timeline of treatment?
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From Jean Hailes Endocrinologist Dr Sonia Davison.
You can find some guidance for the management of women after surgical menopause via the Australasian Menopause Society and the British Menopause Society's toolkit (PDF).
Testosterone can be added to oestrogen, as there will be at least a 50% reduction of testosterone levels following bilateral oophorectomy. The current guidelines suggest that testosterone is useful for the treatment of hypoactive sexual desire disorder, but one could argue for the use of it in this woman who had an early menopause, being less than 45 years of age.
If she has lowered libido, low motivation and flattened mood or lowered wellbeing, testosterone may be effective. She needs to be made aware of the pros and cons of testosterone, including potential irreversible risks, and to know that levels have to be measured for testosterone to ensure safety, with an aim of achieving peak female reproductive levels.
If she has had a full hysterectomy, she doesn’t need progesterone, which in theory will increase her breast cancer risk. The exception being past extensive endometriosis, which may need the addition of progesterone to reduce the risk of endometriosis recurrence.
My approach would be to add the oestrogen for three months, see how she goes, and then possibly add testosterone. She may not need testosterone if she does well on oestrogen-only treatment.