Effects of bilateral salpingo-oophorectomy on menopausal symptoms and sexual functioning among women with a BRCA1 or BRCA2 mutation

Hall, Elizabeth; Finch, Amy; Jacobson, Michelle; Rosen, Barry P.; Metcalfe, Kelly; Sun, Ping; Narod, Steven A.; Kotsopoulos, Joanne

doi:10.1016/j.ygyno.2018.10.040

Cited by 51 publications

(42 citation statements)

References 19 publications

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“…Pleasure score † 12 (9-16) 11 (9)(10)(11)(12)(13)(14) .56 11 (9)(10)(11)(12)(13)(14) 12 (9)(10)(11)(12)(13)(14)(15) .34…”

Section: Discussionunclassified

“…As expected, RRSO has been shown to decrease cancer worry and several investigators have shown decreased sexual functioning and increased vasomotor symptoms, with overall QOL in the immediate postoperative year after RRSO comparable with the general population. 11 The purpose of the current study is to describe sexual functioning, menopausal symptoms and depression in women with known BRCA1 or BRCA2 mutations at a median time of 5 years post-RRSO, and to examine factors which might impact these outcomes. Only one study of women with BRCA mutations has evaluated the impact of RRSO on sexual function over time.…”

Section: Introductionmentioning

confidence: 99%

“…Hall et al showed immediate significant decrease in sexual function after RRSO which was then stable at three years post RRSO. 11 The purpose of the current study is to describe sexual functioning, menopausal symptoms and depression in women with known BRCA1 or BRCA2 mutations at a median time of 5 years post-RRSO, and to examine factors which might impact these outcomes. Our hypothesis was that declines in sexual function would still be seen 5 years after RRSO, and that premenopausal RRSO would have more impact on sexual function, menopausal symptoms and depression compared with postmenopausal RRSO.…”

Section: Introductionmentioning

confidence: 99%

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Sexual function, menopausal symptoms, depression and cancer worry in women with BRCA mutations

Powell

Alabaster

et al. 2019

Psycho-Oncology

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Objectives: Assess sexual function, menopausal symptoms, and depression in women with BRCA mutations associated with oophorectomy and menopause status.Methods: Women age 40 and older with BRCA mutations completed a questionnaire with validated measures of sexual activity, menopausal symptoms, depression, and cancer worry. These measures were compared between those with intact ovaries and those who had undergone pre-or post-menopausal risk-reducing salpingooophorectomy (RRSO).Results: Of the 244 women, 21 had intact ovaries and 223 had undergone RRSO. Women with intact ovaries had less menopausal symptoms (Menopausal SymptomChecklist (MSCL) score 14 versus 23, P = .01) but more cancer worry than women who had undergone RRSO (median Cancer Worry Scale (CWS) score 5 versus 4, P < .0001) with no significant difference in sexual activity or function. Compared with women with postmenopausal RRSO, women with premenopausal RRSO were more likely to be sexually active (56.3% versus 42.0%, P =.04) but had similar sexual functioning, including frequency, pleasure and discomfort. Women with premenopausal RRSO were also more likely to report menopausal symptoms (MSCL score 26 versus 19, P = .04) and depression (PHQ-8 score 4 versus 2, P < .001). Factors associated with sexual activity included younger age, lower BMI, living with a partner, and lower depression scores. Higher current depression score was associated with history of depression and more menopausal symptoms.Conclusions: Risk-reducing surgery decreases cancer risk and worry in women with BRCA mutations. Among women undergoing oophorectomy, factors such as age and history of depression were related to reduced sexual activity and increased depression, but menopausal status was not related.

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“…Pleasure score † 12 (9-16) 11 (9)(10)(11)(12)(13)(14) .56 11 (9)(10)(11)(12)(13)(14) 12 (9)(10)(11)(12)(13)(14)(15) .34…”

Section: Discussionunclassified

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sexual function, menopausal symptoms, depression and cancer worry in women with BRCA mutations

Powell

Alabaster

et al. 2019

Psycho-Oncology

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“…High risk of hereditary cancer is associated with an increased frequency of disabling concerns and cancer related worries, which may be relieved by bilateral oophorectomy . Contrary to this, surgical menopause leads to troublesome vasomotor symptoms . and sexual dysfunction Furthermore, studies indicate that bilateral oophorectomy may have mood‐lowering effects .…”

Section: Introductionmentioning

confidence: 99%

“…Contrary to this, surgical menopause leads to troublesome vasomotor symptoms . and sexual dysfunction Furthermore, studies indicate that bilateral oophorectomy may have mood‐lowering effects . Depression seems to be related to declining levels of estrogen, and sudden estrogen withdrawal in perimenopause and postpartum is associated with an increased risk of depression.…”

Section: Introductionmentioning

confidence: 99%

Use of antidepressants in women after prophylactic bilateral oophorectomy: A Danish national cohort study

et al. 2020

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Objective: To investigate the association between prophylactic bilateral oophorectomy and use of antidepressants in women with a family history of cancer.Methods: Nationwide population-based cohort study using Danish National Registries including women oophorectomized due to a family history of cancer (n = 2,002) and an age matched reference group (n = 18,018). Analyses were stratified by age at time of bilateral oophorectomy and use of hormone replacement therapy (HRT).Results: Women oophorectomized at age ≤ 45 years were more likely to use antidepressants from the first year after bilateral oophorectomy (OR = 1.34; 95 % CI: 1.08-1.65) compared to the reference group. Women oophorectomized at age 46-55 years and at age >55 years had no significantly increased use of antidepressants (OR = 0.90; 95 % CI: 0.68-1.18 and OR = 1.14; 95 % CI: 0.81-1.61). The increased use of antidepressants in women oophorectomized at age ≤ 45 years was limited to women treated with HRT (OR = 1.51; 95 % CI: 1.18-1.94) whereas women oophorectomized at age ≤ 45 years not treated with HRT had no increased use of antidepressants (OR = 1.03; 95 % CI: 0.70-1.51). Conclusions:Women oophorectomized due to a family history of cancer at age ≤ 45 years were more likely to use antidepressants after bilateral oophorectomy.The increased use of antidepressants was limited to women treated with HRT. The study calls for further large-scale studies to understand how bilateral oophorectomy and concomitant HRT affects risk of depression in women with a family history of cancer. K E Y W O R D SCancer, oncology, family history of cancer, prophylactic bilateral oophorectomy, antidepressants, hormone replacement therapy 1 | BACKGROUND Women with a family history of breast and/or ovarian cancer have a substantially increased risk of these cancers 1,2 and germline mutations in BRCA 1 and 2 genes leads to a cumulative breast cancer risk of above 60 % and an ovarian cancer risk of between 10-45 %. 3 Cancer risk increases considerably with age. 3 Thus, prophylactic bilateral oophorectomy is recommended prior to natural menopause leading to a significant reduction in risk of cancer. 4,5 High risk of hereditary cancer is associated with an increased frequency of disabling concerns and cancer related worries, which may be relieved by bilateral oophorectomy. 6 Contrary to this, surgical menopause leads to troublesome vasomotor symptoms. 6-8 and sexual dysfunction 6-9 Furthermore, studies indicate that bilateral oophorectomy may have mood-lowering effects. 10-13 Depression seems to be related to declining levels of estrogen, and sudden estrogen withdrawal in perimenopause 14,15 and postpartum 16 is associated with an increased risk of depression. In contrast to this,

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Changes in Bone Mineral Density After Prophylactic Bilateral Salpingo-Oophorectomy in Carriers of a BRCA Mutation

et al. 2019

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IMPORTANCE Preventive surgery is strongly recommended for individuals with a BRCA mutation at a young age to prevent ovarian cancer and improve overall survival. The overall effect of early surgical menopause on various health outcomes, including bone health, has not been clearly elucidated. OBJECTIVE To evaluate the association of prophylactic bilateral salpingo-oophorectomy with bone mineral density (BMD) loss among individuals with a BRCA mutation. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of participants with a BRCA mutation who underwent oophorectomy through the University Health Network, Toronto, Ontario, Canada, recruited participants from January 2000 to May 2013. Eligibility criteria included having a BRCA mutation, at least 1 ovary intact prior to surgery, and no history of any cancer other than breast cancer. Bone mineral density was measured using dual-energy x-ray absorptiometry before and after surgery. Data analysis began in December 2018 and finished in January 2019. MAIN OUTCOMES AND MEASURES The annual change in BMD from baseline to follow-up was calculated for the following 3 anatomical locations: (1) lumbar spine, (2) femoral neck, and (3) total hip. RESULTS A total of 95 women had both a baseline and postsurgery BMD measurement with a mean (SD) follow-up period of 22.0 (12.7) months. The mean (SD) age at oophorectomy was 48.0 (7.4) years. Among women who were premenopausal at time of surgery (50 [53%]), there was a decrease in BMD from baseline to follow-up across the lumbar spine (annual change, −3.45%; 95% CI, −4.61% to −2.29%), femoral neck (annual change, −2.85%; 95% CI, −3.79% to −1.91%), and total hip (annual change, −2.24%; 95% CI, −3.11% to −1.38%). Self-reported hormone therapy use was associated with significantly less bone loss at the lumbar spine (−2.00% vs −4.69%; P = .02) and total hip (−1.38% vs −3.21; P = .04) compared with no hormone therapy use. Among postmenopausal women at time of surgery (45 [47%]), there was also a significant decrease in BMD across the lumbar spine (annual change, −0.82%; 95% CI, −1.42% to −0.23%) and femoral neck (annual change, −0.68%; 95% CI, −1.33% to −0.04%) but not total hip (annual change, −0.18%; 95% CI, −0.82% to 0.46%). CONCLUSIONS AND RELEVANCE This study found that oophorectomy was associated with postoperative bone loss, especially among women who were premenopausal at the time of surgery. Targeted management strategies should include routine BMD assessment and hormone therapy use to improve management of bone health in this population.

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Effects of bilateral salpingo-oophorectomy on menopausal symptoms and sexual functioning among women with a BRCA1 or BRCA2 mutation

Cited by 51 publications

References 19 publications

Sexual function, menopausal symptoms, depression and cancer worry in women with BRCA mutations

Sexual function, menopausal symptoms, depression and cancer worry in women with BRCA mutations

Use of antidepressants in women after prophylactic bilateral oophorectomy: A Danish national cohort study

Changes in Bone Mineral Density After Prophylactic Bilateral Salpingo-Oophorectomy in Carriers of a BRCA Mutation

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