What happens after menopause? (WHAM): A prospective controlled study of vasomotor symptoms and menopause-related quality of life 24 months after premenopausal risk-reducing salpingo-oophorectomy (RRSO)

Objective

To measure vasomotor symptoms and menopause-related quality of life up to 24 months after RRSO, and the effects of Menopausal Hormone Therapy (MHT).

Methods

Prospective observational study of 104 premenopausal women at elevated risk of ovarian cancer planning RRSO and age-matched comparators (n = 102) who retained their ovaries. Vasomotor symptoms and quality of life were measured using the Menopause-specific QoL Intervention (MENQOL-I) scale. Changes in QoL were examined using a population-averaged linear regression model. The study was registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12615000082505.

Results

At 24 months after RRSO the prevalence of vasomotor symptoms had increased from 6 % at baseline to 59 % and night sweats from 21 % to 39 %. There was a clinically and statistically significant difference of 1.14 points in MENQOL score (95 % CI 0.71, 1.57, p < 0.001) in the change from baseline to 24 months in vasomotor symptoms between the RRSO vs comparison group. Following RRSO, 61 % started MHT, most (79 %) within 3 months. At 24 months, 54 % of MHT users reported vasomotor symptoms of which around half (52 %) categorized these as “mild”. Amongst non-MHT users, 88 % reported vasomotor symptoms at 24 months of which 72 % categorized these as “mild”. Menopause-related QoL decreased after RRSO but was stable in comparators. Menopause related quality of life was higher in MHT users vs non-users.

Conclusions

Vasomotor symptoms peak by 3 months after RRSO and are stable over 24 months. MHT mitigates but does not fully resolve vasomotor symptoms and improves menopause-related QoL.