Menopause-related quality of life 5 years after salpingectomy with delayed oophorectomy vs salpingo-oophorectomy.

BACKGROUND

BRCA1/2 pathogenic variant (PV) carriers have an increased risk of tubo-ovarian cancer. They are recommended to have a risk-reducing salpingo-oophorectomy around age 40, resulting in premature menopause. The alternative risk-reducing salpingectomy (RRS) with delayed oophorectomy (DO) postpones this. We present the 5-year results of a nationwide preference trial (TUBA study) comparing menopause-related quality of life (QoL) after RRS/DO with salpingo-oophorectomy.

METHODS

Premenopausal BRCA1/2-PV carriers aged 25-40 (BRCA1) or 25-45 (BRCA2) chose RRS/DO or salpingo-oophorectomy with or without hormonal replacement therapy (HRT). We compared QoL (Greene Climacteric Scale) between RRS/DO and salpingo-oophorectomy without HRT 5 years after surgery using linear mixed models. Secondarily, RRS/DO was compared with salpingo-oophorectomy with HRT. Women who underwent oophorectomy in the RRS/DO group were excluded in a sensitivity analysis.

RESULTS

In total, 410 (71.9%) participants chose RRS/DO and 160 (28.1%) salpingo-oophorectomy. Seventy-three (17.8%) participants underwent oophorectomy within 5 years after salpingectomy. The adjusted mean difference (aMD) in QoL was 1.8 (95% CI = -0.6 to 4.3) after salpingo-oophorectomy without HRT and 1.4 (95% CI = -0.4 to 3.1) after salpingo-oophorectomy with HRT compared with RRS (with and without oophorectomy) at 5 years follow-up. The sensitivity analysis showed that QoL decreased less after RRS before oophorectomy compared with salpingo-oophorectomy without (aMD = 2.4, 95% CI = 0.1 to 4.8) and with HRT (aMD = 1.9, 95% CI = 0.1 to 3.7).

CONCLUSION

Postponing oophorectomy is key in preventing deterioration of QoL. QoL was similar 5 years after salpingectomy (with and without oophorectomy) compared with salpingo-oophorectomy (regardless of HRT use). However, QoL was higher when comparing salpingectomy without oophorectomy to salpingo-oophorectomy (regardless of HRT use).