New tool helps women decide on hormone therapy options after surgical menopause

A University of Alberta research team has created a patient decision aid that supports women making decisions on hormone therapy for the management of early surgical menopause—an induced menopause caused by the removal of both ovaries before natural menopause occurs.

Nese Yuksel, professor in the Faculty of Pharmacy and Pharmaceutical Sciences, along with her previous PhD student who worked on the project as part of her PhD thesis, Tasneem Siyam, now a faculty member at Fatima College of Health Sciences in Abu Dhabi, and their research team, published a paper today on the development of a patient decision aid (PDA), SheEmpowers, that will allow women who have had a surgical menopause to better understand, assess and decide on hormone therapy—one of the best options for managing symptoms of early surgical menopause and preventing long-term health consequences.

“Women experiencing early surgical menopause experience menopausal symptoms—like hot flashes, night sweats, sleep issues, mood effects and vaginal dryness—more abruptly and more severely compared to natural menopause,” says Yuksel. “These women can also be at risk for additional long-term health consequences from the loss of estrogen, such as osteoporosis, cardiovascular disease and cognitive decline.”

Although current guidelines recommend the use of hormone therapy in women who have early menopause to mitigate symptoms until the average age of menopause, Yuksel says it is greatly underused among surgically menopausal women.

“In a previous study we had done, only one-third of patients with early surgical menopause were using hormone therapy,” says Yuksel. “This is what set the groundwork for the development of the patient decision aid, which is a tool that fosters informed decision-making through incorporating patients’ preferences, values and decisional needs regarding medication or procedure.”

Through focus groups made up of women from the menopause clinics at the Lois Hole and Grey Nuns hospitals, the research team initially determined the decisional needs and desired information related to early surgical menopause. Women in the focus groups called for more of the resources that helped them through the experience—like those they found at the Menopause Clinics at the Lois Hole Hospital for Women and the Grey Nuns Community Hospital—and identified their learning needs related to symptoms with surgical menopause, treatment options and support resources. Based on these decisional needs, as well as current evidence and best practices, the SheEmpowers patient decision aid was developed.

“The SheEmpowers PDA includes five domains: information on surgical menopause and hormone therapy, outcomes probabilities, patient stories, explicit values clarification, and guidance in deliberation and decision-making,” says Yuksel. “It helps women to make informed decisions about their options that are aligned with their values.”

So far, the PDA has gone through the first phase of evaluation with women who have had an early surgical menopause and with clinician stakeholders. 

“The SheEmpowers PDA has had good acceptability by both patients and clinicians with our first evaluation phase,” says Yuksel. “We feel this PDA will be a great tool to guide and support women making hormone therapy decisions with early surgical menopause, and are thankful to all the women and clinician experts who participated in the development. We are looking forward to our next phase of this project.”

Next, the acceptability and feasibility of the PDA are to be evaluated in a larger cohort of women, as well as with clinicians not involved in the early development. The research team will be testing the PDA in real-life settings.