Premenopausal women at high genetic risk for ovarian cancer who undergo risk-reducing salpingo-oophorectomy (RRSO) may still have moderate to severe menstrual symptoms even a decade or more after surgery, a Dutch study indicates.
To improve quality of life for these women, “follow-up care after RRSO should focus on these symptoms and be accessible for many years after RRSO,” advise the researchers from University Medical Center Groningen and University of Groningen.
Women with a BRCA1 or 2 mutation have a significantly greater risk of developing ovarian cancer by age 70 than the general population. To reduce the risk of ovarian cancer, women with BRCA1/2 mutations are advised to undergo RRSO before menopause - at age 35 to 40 for BRCA1 carriers and age 40 to 45 for BRCA2 carriers.
The reported severity and duration of menopausal symptoms after surgical menopause varies widely, and the literature on predictors is scarce, Annechien Stuursma and colleagues note in Maturitas, online January 12.
To investigate, they did a cross-sectional study of 199 women who had RRSO before age 52. They used the Menopause Rating Scale (MRS) to gauge the level of psychological, somato-vegetative and urogenital symptoms (no/little, mild, moderate, or severe).
They found that the majority of women (69%) reported moderate or severe symptoms on the MRS an average of 7.9 years after RRSO. More than half of these women (57%) had severe urogenital symptoms including dysuria, vaginal dryness, itching, burning and dyspareunia, and about one-quarter reported severe psychological and/or somato-vegetative symptoms. Only psychological symptoms tended to improve over time.
A history of breast cancer was independently associated with having moderate or severe menopausal symptoms (odds ratio, 3.4). The researchers excluded women who were currently being treated for cancer; “therefore, only long-term effects of past endocrine and chemotherapy use could be tested, which were not independently associated with severity of menopausal symptoms after RRSO,” they note.
The researchers say the proportion, severity and duration of menopausal symptoms observed after surgical menopause is “much higher than has been observed in natural induced menopausal women.”
They also note that hormone-replacement therapy (HRT) was not an independent determinant of severity of menopausal symptoms following RRSO, “which indicates that the symptom-reducing effect of HRT might be limited for some symptoms.”
Summing up, the researchers say “women who undergo premenopausal RRSO are at high risk for experiencing moderate or severe menopausal symptoms. Before surgery, women should be informed that especially urogenital symptoms after RRSO may be severe and of long duration. Further research is needed to investigate safe interventions targeted at women with severe menopausal symptoms who have a contraindication to use HRT.”
The study had no specific funding, and the authors have declared no conflicts of interest.
SOURCE: http://bit.ly/2n5qzGq
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