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The Impact of Hormone Replacement Therapy on Menopausal Symptoms in Younger High-Risk Women After Prophylactic Salpingo-Oophorectomy

Joanna B. Madalinska, Marc van Beurden, Eveline M.A. Bleiker, Heiddis B. Valdimarsdottir, Judith Hollenstein, Leon F. Massuger, Katja N. Gaarenstroom, Marian J.E. Mourits, René H.M. Verheijen, Eleonora B.L. van Dorst, Hans van der Putten, Ko van der Velden, Henk Boonstra, Neil K. Aaronson

From the Division of Psychosocial Research and Epidemiology, and Department of Gynecology, the Netherlands Cancer Institute; Department of Gynecology, Vrije Universiteit University Medical Center; Department of Gynecology, Academic Medical Center, Amsterdam; Department of Gynecology, University Medical Center Nijmegen, Nijmegen; Department of Gynecology, Leiden University Medical Center, Leiden; Department of Gynecology, University Medical Center Groningen, University of Groningen; Department of Gynecology, University Medical Center Utrecht, Utrecht; Department of Gynecology, Academic Hospital Maastricht, Maastricht, the Netherlands; and Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY

Address reprint requests to Neil K. Aaronson, PhD, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; e-mail: n.aaronson{at}nki.nl

PURPOSE: Preventive health strategies for women at increased hereditary risk of ovarian cancer include gynecologic screening (GS) and/or prophylactic oophorectomy (PBSO). Hormone replacement therapy (HRT) is often prescribed to compensate for postsurgical endocrine deficiencies. This study examined the impact of HRT use on levels of endocrine symptoms and sexual functioning among premenopausal women who have undergone PBSO. Comparisons were made with similar women undergoing GS.

PATIENTS AND METHODS: Questionnaire data on endocrine symptoms and sexual functioning were obtained from 450 premenopausal, high-risk women who had participated in this nationwide, cross-sectional, observational study.

RESULTS: Thirty-six percent of women had undergone PBSO and 64% had opted for GS. In the PBSO group, 47% of the women were current HRT users. They reported significantly fewer vasomotor symptoms than nonusers (P < .05). However, compared with premenopausal women undergoing GS, oophorectomized HRT users were more likely to report vasomotor symptoms (P < .01). HRT users and nonusers reported comparable levels of sexual functioning. Compared with women in the GS group, oophorectomized HRT users reported significantly more sexual discomfort due to vaginal dryness and dyspareunia (P < .01).

CONCLUSION: Although HRT has a positive impact on surgically induced vasomotor symptoms, it may be less effective than is often assumed. Symptom levels remain well above those of premenopausal women undergoing screening, and sexual discomfort is not alleviated by HRT. Physicians need to provide younger high-risk women considering PBSO with realistic information about both benefits and drawbacks of this preventive strategy, including information about premature menopause and HRT.

Supported by Grant No. NKI 2001-2382 from the Dutch Cancer Society.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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