Menopause-related quality of life five years after salpingectomy with delayed oophorectomy versus Salpingo-Oophorectomy

Purpose 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 five year results of a nationwide preference trial (TUBA study) comparing menopause-related quality of life (QoL) after RRS/DO to salpingo-oophorectomy. Methods Premenopausal BRCA1/2-PV carriers aged 25 to 40 (BRCA1) or 25 to 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 five years after surgery using linear mixed models. Secondarily, RRS/DO was compared to 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 five years after salpingectomy. The adjusted mean difference (aMD) in QoL was 1.8 (95%-confidence interval (CI) -0.6; 4.3) after salpingo-oophorectomy without HRT and 1.4 (95%-CI -0.4; 3.1) after salpingo-oophorectomy with HRT compared to RRS (with and without oophorectomy) at five years follow-up. The sensitivity analysis showed that QoL decreased less after RRS before oophorectomy compared to salpingo-oophorectomy without (aMD 2.4, 95%-CI 0.1; 4.8) and with HRT (aMD 1.9, 95% CI 0.1; 3.7). Conclusion Postponing oophorectomy is key in preventing deterioration of QoL. QoL was similar five years after salpingectomy (with and without oophorectomy) compared to salpingo-oophorectomy (regardless of HRT use). However, QoL was higher when comparing salpingectomy without oophorectomy to salpingo-oophorectomy (regardless of HRT use).