(026) Hormonal Therapy and Sexual Dysfunction After Early Surgical Menopause

Abstract Introduction Natural early menopause, occurring before age 45, involves a gradual reduction in sex hormones contributing to sexual dysfunction. The abrupt decline of these hormones with surgical early menopause is associated with increased symptom severity. Hormonal therapy is used to treat menopausal symptoms, though its impact on sexual health in young women remains incompletely understood. Objective To compare short-term and long-term incidence of sexual dysfunction among women younger than 45 at time of surgical menopause by bilateral salpingo-oophorectomy (BSO), stratified by post-surgical hormonal therapy: estrogen-only, combined estrogen-progesterone, testosterone-containing, or no hormonal therapy. Methods Retrospective cohort study of available records from TriNetX database 10/29/2025. Women who underwent surgical menopause by BSO before age 45 were stratified by post-surgical hormonal therapy regimen. Regimens were identified by RxNorm codes initiated after surgery and contained systemic estrogens, combined estrogen-progestins, testosterone- or androgen-containing therapies, or no hormonal therapy. Sexual dysfunction was defined using ICD-10 codes for sexual dysfunction, dyspareunia, pelvic and perineal pain, vaginismus, and vulvodynia (F52, R37, N95.2, N94.1, R10.2, N94.2, N94.81) that were first documented after both BSO and initiation of post-surgical hormonal therapy. Patients with documented sexual dysfunction codes prior to date of BSO were excluded. Post-surgical sexual dysfunction outcomes were compared between groups with short-term (≤ 3 years) and long-term (> 3 years) analyses. Propensity score matching balanced demographic and clinical characteristics across cohorts and comparative analyses were performed to estimate risk differences and 95% confidence intervals (p < 0.05). Results In short-term analysis, the incidence of sexual dysfunction ranged from approximately 5% to 11% across all hormonal therapy groups. Estrogen-only therapy was associated with a significantly higher incidence of sexual dysfunction compared with combined estrogen-progesterone therapy (p = 0.0356). Comparisons of sexual dysfunction between therapy groups with testosterone-containing cohorts and cohorts receiving no hormonal therapy did not yield significant differences. In long-term analysis, the overall incidence of sexual dysfunction increased, ranging from 10% to 16% across groups. The estrogen-only cohort continued to show a trend toward higher incidence compared to combined estrogen-progesterone therapy, though this was not statistically significant (p = 0.3421). No significant differences were observed between estrogen-only, combined estrogen-progesterone, testosterone-containing, or no hormonal therapy cohorts. Conclusions Among women under 45 undergoing surgical menopause by BSO, sexual dysfunction was a common outcome, affecting approximately 5-11% of women within three years of surgery and 10-16% beyond three years after surgery. Comparing sexual dysfunction outcomes by post-surgical hormonal therapy regimen, estrogen-only therapy was associated with a higher short-term incidence of sexual dysfunction compared with combined estrogen-progesterone therapy, though this difference was not maintained in long-term analysis. No other significant differences were observed across hormonal therapy regimens, including those containing testosterone or no hormonal therapy. These findings highlight sexual dysfunction as a prevalent and persistent consequence of early surgical menopause, regardless of post-surgical hormonal treatment strategy. However, as hormonal therapy is commonly prescribed to address symptomatic and long-term health consequences of early menopause, further studies should assess optimization of interventions to support sexual function and quality of life in young women undergoing BSO. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Astellas and Johnson & Johnson Global Public Health.