Long-term outcomes of surgical menopause after risk-reducing salpingo-oophorectomy: results of the HARMOny study

Abstract

Background: Premenopausal risk-reducing salpingo-oophorectomy (RRSO), often performed for women at high familial risk of ovarian cancer, induces immediate menopause. Evidence about its long-term effects is scarce. Methods: We conducted a cross-sectional study (n = 740) nested in a nationwide cohort of women at high familial risk of ovarian cancer. Participants completed a cognition test and a questionnaire on lifestyle, sexual functioning, urinary incontinence and health-related quality of life (HRQOL, SF-36). Cardiovascular disease (CVD) risk and bone mineral density (BMD) were assessed during a clinical visit. In women aged 60–70 years at study visit (n = 330), we compared potential long-term health effects of RRSO between women who underwent the procedure before menopause (i.e. when aged ≤45 years) and those who had the procedure after menopause (when aged ≥54 years). Results: Participants' median age was 64.3 years, and the median time since premenopausal RRSO was 21 years. A comprehensive overview of our (partially published) results showed that a premenopausal RRSO compared with a postmenopausal RRSO was not associated with long-term coronary artery calcification, objective cognitive functioning, urinary incontinence or impaired health-related quality of life. However, women in the premenopausal RRSO group had lower bone mineral density and reported more vaginal dryness and sexual discomfort compared with the postmenopausal RRSO group. Conclusion: Premenopausal RRSO does not appear to be associated with long-term cardiovascular disease risk, cognition or health-related quality of life. However, it negatively influences bone mineral density and vaginal dryness.