What happens after menopause? (WHAM): Impact of risk-reducing salpingo-oophorectomy on depressive and anxiety symptoms at 24 months

Martha Hickey; Tuong L Nguyen; Efrosinia O Krejany; Susan M Domchek; Alison Brand; John L Hopper; Hadine Joffe

doi:10.1016/j.ygyno.2024.10.031

What happens after menopause? (WHAM): Impact of risk-reducing salpingo-oophorectomy on depressive and anxiety symptoms at 24 months

Gynecol Oncol. 2024 Nov 5:192:1-7. doi: 10.1016/j.ygyno.2024.10.031. Online ahead of print.

Authors

Martha Hickey¹, Tuong L Nguyen², Efrosinia O Krejany³, Susan M Domchek⁴, Alison Brand⁵, John L Hopper², Hadine Joffe⁶

Affiliations

¹ Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and The Royal Women's Hospital, Melbourne, Victoria, Australia. Electronic address: [email protected].
² Centre for Epidemiology and Biostatistics, University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia.
³ Department of Obstetrics, Gynaecology and Newborn Health, The Royal Women's Hospital, Melbourne, Victoria, Australia.
⁴ Basser Center for BRCA, University of Pennsylvania, Philadelphia, USA.
⁵ University of Sydney, Sydney, NSW, Australia.
⁶ Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

PMID: 39504590
DOI: 10.1016/j.ygyno.2024.10.031

Abstract

Objective: For women with pathogenic variants in BRCA1 and BRCA2, risk-reducing salpingo-oophorectomy (RRSO) at the recommended age causes surgical menopause. We previously reported elevated depressive symptoms at 6 and 12 months and elevated anxiety symptoms at 6 months after RRSO. We now report these outcomes at 24 months, their baseline and 12-month predictors and the effect of Menopausal Hormone Therapy (MHT).

Methods: Prospective controlled study of 59 premenopausal women planning RRSO and 91 comparisons who retained their ovaries. Depressive (CESD) and anxiety symptoms (GAD-7) were measured at baseline (before RRSO) and at 12 and 24 months. We used ordinary and logistic multivariable regression to estimate differences between and within groups at 24 months, before and after conditioning on baseline and 12 month measures.

Results: Overall, depressive and anxiety symptoms were not elevated above baseline at 24 months and did not differ between RRSO and comparisons, before or after adjusting for previous measures (P > 0.05). Elevated depressive symptoms at 12 months (OR = 24, P < 0.001), and elevated anxiety symptoms at 12 months (OR = 13, P < 0.001), strongly predicted 24 month measures. Elevated depressive symptoms at baseline no longer predicted 24 month symptoms once 12 month symptoms were considered, but elevated baseline anxiety still predicted anxiety at 24 months, even when 12 month anxiety was considered. No association between MHT use and depressive or anxiety symptoms was observed.

Conclusions: Depressive and anxiety symptoms are not elevated 24 months after RRSO. However, depressive symptoms at 12 months after RRSO are likely to persist at 24 months.