Our Summary

This research paper discusses the term “Previvors,” which refers to people who do not currently have cancer but have a genetic likelihood of developing it. An example given is women who carry BRCA mutations. Often, such women choose to have their ovaries removed when they are still able to bear children to reduce their risk of cancer. However, this removal causes a sudden drop in estrogen levels and triggers immediate menopause, leading to issues related to sexuality, intimacy, and menopausal symptoms (collectively referred to as SIMS). It can also affect their body image. These issues are often not reported by the patients or diagnosed by the doctors. Hence, it is crucial to inform women about the potential physical, hormonal, and psychological effects of their surgery to reduce cancer risks. The study emphasizes the importance of the healthcare provider’s awareness, ability to identify these issues, and willingness to treat them. Various methods are available to manage these symptoms.

FAQs

  1. What is a bilateral salpingo-oophorectomy and why is it often recommended for women with BRCA mutations?
  2. What are some of the potential physiological, hormonal, and psychosocial effects of a bilateral salpingo-oophorectomy?
  3. How are Sexuality, Intimacy, and Menopausal Symptoms (SIMS) managed after a bilateral salpingo-oophorectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about salpingo-oophorectomy is to discuss the potential hormonal and psychosocial effects of the surgery, such as immediate menopause and changes in body image. It is important for patients to be informed of these potential side effects and to have a plan in place for managing any symptoms that may arise. This may include discussing hormone replacement therapy or other treatment options to help alleviate any discomfort or issues that may arise post-surgery.

Suitable For

Patients who are typically recommended for salpingo-oophorectomy include:

  1. Women with BRCA mutations or other genetic predispositions to ovarian or breast cancer
  2. Women with a strong family history of ovarian or breast cancer
  3. Women with a personal history of breast cancer or other cancers that may increase their risk of ovarian cancer
  4. Women with certain ovarian conditions, such as ovarian cysts or endometriosis, that may increase their risk of ovarian cancer
  5. Women who have completed childbearing and are at high risk for ovarian cancer

It is important for patients considering salpingo-oophorectomy to discuss the potential risks and benefits with their healthcare provider, as well as alternative options for risk reduction and management of menopausal symptoms.

Timeline

Before salpingo-oophorectomy:

  1. Patient undergoes genetic testing and receives a positive result for BRCA mutations.
  2. Patient consults with healthcare providers to discuss risk-reducing surgery options.
  3. Patient decides to undergo bilateral salpingo-oophorectomy.
  4. Patient receives counseling on the potential physical, hormonal, and psychosocial effects of the surgery.

After salpingo-oophorectomy:

  1. Surgery is performed to remove both ovaries and fallopian tubes.
  2. Patient experiences immediate menopause due to depletion of estrogen.
  3. Patient may experience symptoms such as hot flashes, vaginal dryness, mood changes, and loss of libido.
  4. Patient may also undergo changes in body image and sexuality.
  5. Patient may be underdiagnosed and undertreated for Sexuality, Intimacy, and Menopausal Symptoms (SIMS).
  6. Patient may need hormone replacement therapy or other modalities for symptom management.
  7. Healthcare providers should be aware of and willing to treat SIMS in patients who have undergone salpingo-oophorectomy.

What to Ask Your Doctor

  1. What are the risks and benefits of undergoing a salpingo-oophorectomy for someone with a genetic predisposition to cancer?

  2. How will the removal of my ovaries affect my hormone levels and menopausal symptoms?

  3. What are the potential changes in my sexuality and intimacy that I may experience post-surgery?

  4. Are there any alternative treatments or therapies available to help manage any potential side effects or symptoms after the surgery?

  5. How often should I have follow-up appointments to monitor my hormone levels and overall health after the surgery?

  6. Are there any lifestyle changes or modifications I should make to support my overall well-being after the surgery?

  7. What support resources are available for individuals who have undergone a salpingo-oophorectomy and may be experiencing physical or emotional challenges as a result of the surgery?

  8. How will the removal of my ovaries impact my risk of developing cancer in the future?

  9. What should I expect in terms of recovery time and any potential limitations on physical activity after the surgery?

  10. Are there any specific questions or concerns that I should discuss with a mental health professional or support group before or after the surgery?

Reference

Authors: Alexandre M, Black J, Whicker M, Minkin MJ, Ratner E. Journal: Maturitas. 2017 Nov;105:46-51. doi: 10.1016/j.maturitas.2017.06.003. Epub 2017 Jun 3. PMID: 28602465