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.