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Although HRT is frequently prescribed following BSO to mitigate surgical menopause, their combined impact on meningioma risk remains unclear. We evaluated meningioma incidence following BSO, HRT, or both.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the TriNetX database, we identified female patients for the following three categories: BSO only, HRT only, or BSO with subsequent HRT (BSO\u2009+\u2009HRT). Propensity score matching adjusted for demographics and meningioma risk factors. Outcomes included incident meningioma, cranial and spinal subtypes, time-to-event analyses, and surgical resection rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared with controls, patients who underwent BSO demonstrated a significantly lower lifetime risk of cranial meningioma (RR:0.85, 95%CI:0.74\u20130.98,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026). Patients with HRT exposure demonstrated a significantly increased lifetime risk of meningioma diagnosis (RR:1.16, 95%CI:1.09\u20131.22,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). In contrast, patients who underwent BSO\u2009+\u2009HRT demonstrated a significantly elevated 10-year hazard (HR:1.684, 95%CI:1.40\u20132.02,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001) and lifetime risk (RR:1.59, 95%CI:1.33\u20131.90,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) of meningioma diagnosis. Risk was highest among BSO\u2009+\u2009HRT patients with hormonally-driven indications, including uterine fibroids, endometriosis, and gynecologic malignancy (RRs\u2009&gt;\u20092,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Among patients who developed meningiomas, those with prior BSO\u2009+\u2009HRT were significantly less likely to undergo surgical resection (RR:0.41, 95%CI:0.23\u20130.73,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.019) compared with controls.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BSO\u2009+\u2009HRT patients have an increased risk of meningioma diagnosis. Risks were particularly elevated among women undergoing BSO for hormonally-driven indications. However, there is a lower likelihood of surgical resection among affected patients. These findings have implications for risk stratification, surveillance, and postoperative hormone management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11060-026-05517-3","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T13:17:24Z","timestamp":1773321444000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations of surgical menopause and hormone replacement therapy with meningioma development"],"prefix":"10.1007","volume":"177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7564-1843","authenticated-orcid":false,"given":"William","family":"Zeng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chloe","family":"Jedwood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Cote","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Dallas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G.","family":"Briggs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yetunde B.","family":"Omotosho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Carmichael","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Zada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"issue":"3","key":"5517_CR1","doi-asserted-by":"publisher","first-page":"pkab035","DOI":"10.1093\/jncics\/pkab035","volume":"5","author":"S Bhala","year":"2021","unstructured":"Bhala S, Stewart DR, Kennerley V, Petkov VI, Rosenberg PS, Best AF (2021) Incidence of Benign Meningiomas in the United States: Current and Future Trends. 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All authors have contributed to, reviewed, and approved of this submission to Journal of Neuro-Oncology. We do not have any financial or conflicts of interest to disclose and have adhered to guidelines, procedures, and appropriate ethical standards outlined by Journal of Neuro-Oncology.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"49"}}