Contrary to clinical guidelines, there has been a decrease over time in estrogen therapy use in premenopausal women undergoing bilateral oophorectomy for benign indications. This study aimed to estimate the excess morbidity and mortality associated with current patterns of estrogen therapy use in women who undergo bilateral oophorectomy with hysterectomy for benign indications. We developed 2 Bayesian sampling Markov state-transition models to estimate the excess disease incidence (incidence model) and mortality (mortality model). The starting cohort for both models were women who had undergone bilateral oophorectomy with hysterectomy for benign indications at the age of 45 to 49 years. The models tracked outcomes in 5-year intervals for 25 years. The incidence model estimated excess incidence of breast cancer, lung cancer, colorectal cancer, coronary heart disease, and stroke, whereas the mortality model estimated excess mortality due to breast cancer, lung cancer, coronary heart disease, and all-other-cause mortality. The models compared current rates of estrogen therapy use with optimal (100%) use and calculated the mean difference in each simulated outcome to determine excess disease incidence and death. By 25 years after bilateral oophorectomy with hysterectomy, there were an estimated 94 (95% confidence interval, −158 to −23) fewer colorectal cancer cases, 658 (95% confidence interval, 339–1025) more coronary heart disease cases, and 881 (95% confidence interval, 402–1483) more stroke cases. By 25 years after bilateral oophorectomy with hysterectomy, there were an estimated 189 (95% confidence interval, 59–387) more breast cancer deaths, 380 (95% confidence interval, 114–792) more coronary heart disease deaths, and 759 (95% confidence interval, 307–1527) more all-other-cause deaths. In sensitivity analyses where we defined estrogen therapy use as a duration of >2 years of use, these differences increased >2-fold. Underuse of estrogen therapy in premenopausal women who undergo oophorectomy is associated with substantial excess morbidity and mortality.

中文翻译：

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接受手术绝经的绝经前女性因雌激素替代疗法使用不足而导致发病率和死亡率过高

与临床指南相反，随着时间的推移，因良性适应症而接受双侧卵巢切除术的绝经前妇女的雌激素治疗使用量有所减少。本研究旨在评估因良性适应症而接受双侧卵巢切除术和子宫切除术的女性与当前雌激素治疗模式相关的过高发病率和死亡率。我们开发了 2 个贝叶斯采样马尔可夫状态转换模型来估计超额疾病发病率（发病率模型）和死亡率（死亡率模型）。两种模型的起始队列都是 45 至 49 岁因良性适应症接受双侧卵巢切除术和子宫切除术的女性。这些模型以 5 年为间隔跟踪结果，持续了 25 年。发病率模型估计了乳腺癌、肺癌、结直肠癌、冠心病和中风的超额发病率，而死亡率模型则估计了乳腺癌、肺癌、冠心病和所有其他原因死亡率的超额死亡率。这些模型将当前雌激素治疗使用率与最佳（100%）使用率进行比较，并计算每个模拟结果的平均差异，以确定过量的疾病发生率和死亡。到双侧卵巢切除加子宫切除术后 25 年，估计结直肠癌病例减少 94 例（95% 置信区间，-158 至 -23），冠心病病例增加 658 例（95% 置信区间，339-1025），以及 881 例（95% 置信区间，402-1483）更多中风病例。到双侧卵巢切除加子宫切除术后 25 年，估计乳腺癌死亡人数增加 189 人（95% 置信区间，59-387），冠心病死亡人数增加 380 人（95% 置信区间，114-792），冠心病死亡人数增加 759 人（95 ％置信区间，307-1527）更多的所有其他原因死亡。在敏感性分析中，我们将雌激素治疗的使用定义为使用时间>2 年，这些差异增加了>2 倍。接受卵巢切除术的绝经前妇女雌激素治疗使用不足与发病率和死亡率显着过高相关。