The impact of prophylactic salpingo-oophorectomy on menopausal symptoms and sexual function in women who carry a BRCA mutation
Research Highlights
► Premenopausal women experienced increased vasomotor symptoms and decreased sexual function. ► HRT after surgery mitigated these symptoms but not to pre-surgery levels. ► The decrease in sexual pleasure was not alleviated by hormone replacement therapy.
Introduction
Prophylactic salpingo-oophorectomy is recommended to women who carry a BRCA1 or BRCA2 mutation to reduce the risks of breast, ovarian and fallopian tube cancer [1], [2], [3], [4], [5]. Because the risks for these cancers in this population are substantial by the age of 40 [5], many women choose to have preventive surgery prior to menopause. Surgical menopause may impact on several aspects of health and quality of life [6], [7], [8]. Salpingo-oophorectomy performed after menopause may also affect quality of life [9].
Women who experience surgical menopause have a significant decrease in circulating levels of estrogen and testosterone [10], [11]. Hormone replacement therapy (HRT) is an option for BRCA carriers with no personal history of breast cancer, and does not alter the reduction in breast cancer risk associated with salpingo-oophorectomy [12], [13]. HRT reduces symptoms of menopause, such as hot flashes and vaginal dryness [14], [15]. However, the extent to which sexual function is improved with HRT is not clear [16], [17], [18].
Several studies have measured menopausal symptoms and sexual functioning in high-risk women after oophorectomy [14], [19], [20], [21]. However, it is optimal to compare vasomotor symptoms and sexual functioning before and after salpingo-oophorectomy. The effectiveness of hormone replacement therapy can also be evaluated. This is the first prospective study to examine the impact of prophylactic salpingo-oophorectomy on menopausal symptoms and sexual functioning among women who carry a BRCA1 or BRCA2 mutation.
Section snippets
Subjects and methods
Subjects were women who elected to undergo prophylactic salpingo-oophorectomy to reduce the risk of ovarian, fallopian tube and breast cancer due to a mutation in the BRCA1 or BRCA2 gene. Subjects were recruited from the University Health Network in Toronto between October 1, 2002 and June 26, 2008. Women were between 30 and 70 years of age at the time of surgery. Women who had been diagnosed with breast cancer prior to surgery were included. Women diagnosed with occult cancer at surgery or with
Analysis
The MENQOL-Intervention and the Sexual Activity Questionnaire were scored according to published guidelines, including the imputation of missing scores for the MENQOL-Intervention questionnaire [22], [23]. The statistical package SAS (version 9.1) was used for analysis. Student's paired t-test was used to evaluate changes in scores from baseline to follow-up for the MENQOL-Intervention Questionnaire and the Sexual Activity Questionnaire. One-way analysis of covariance was used to test for
Results
A total of 213 women underwent prophylactic salpingo-oophorectomy at the University Health Network from October 1, 2002 to June 26, 2008. 209 of 213 were contacted to participate in the study prior to surgery. 144 of 209 (68.9%) women completed the baseline questionnaires prior to surgery. Of the 144 women, 13 (9%) were not eligible; seven of these women were diagnosed with occult cancer at surgery; one woman was diagnosed with colon cancer just prior to prophylactic surgery; one woman died
Discussion
We found that women who were premenopausal at the time of prophylactic oophorectomy experienced a significant increase in hot flashes, night sweats and sweating. Women taking HRT reported fewer moderate to severe hot flashes; however HRT did not entirely relieve vasomotor symptoms. Sixty percent of women taking HRT still experienced hot flashes on a daily basis. A previous cross-sectional study of surgically-induced menopausal women by Madalinska et al. found similar results [14]. Women who
Conflict of interest statement
The authors declare that there are no conflicts of interest.
Acknowledgments
Amy Finch would like to acknowledge the support of the Canadian Institutes of Health Research, the Toronto Ovarian Cancer Research Network with funds raised by the Toronto Fashion Show, the Kristi Piia Callum Memorial Fellowship in Ovarian Cancer Research, and the University of Toronto Open Fellowship.
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