Introduction/Background Women carrying BRCA1/2 pathogenic variants are advised to undergo premenopausal risk-reducing salpingo-oophorectomy (RRSO) to reduce their risk of ovarian cancer. Our aim was to study the impact of a premenopausal RRSO (before the age of 46 years) on urinary incontinence at least 10 years later, compared to a postmenopausal RRSO, at the age of 54 years or later.

Methodology Between 2018 and 2021, 368 women with a high familial risk of breast/ovarian cancer participated in the study (premenopausal group, n=226, postmenopausal group, n=142). Women completed the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire short form (IIQ-SF). Differences between groups were analyzed using multiple regression analyses adjusting for current age, breast cancer history, use of hormone replacement therapy, BMI, hysterectomy, parity, delivery mode and type 2 diabetes. We defined symptomatic urinary incontinence (UI) as an UDI-6 score higher than 33.3.

Results Mean time since RRSO was 20.6 years in the premenopausal group and 10.7 years in the postmenopausal group (p<.001). In the premenopausal group, mean age at questionnaire completion was 62.7 years, versus 67.0 years in the postmenopausal group. Women with a premenopausal RRSO had an OR of 3.5 (95%CI 1.2;10.0) to have stress UI compared with age-matched women with a postmenopausal RRSO. The proportion of urge UI was similar between the two groups; 19.6% of the premenopausal RRSO group had urge UI compared with 22.7% in the postmenopausal RRSO group (p-value .48).

In the premenopausal group 23.6% had symptomatic UI compared with 18.9% in the postmenopausal group (p-value .31). After adjustment, women with a premenopausal RRSO had a borderine significantly increased risk of symptomatic UI according to the UDI-6 (OR 2.1 95%CI .93;4.78).

Conclusion More than 15 years after premenopausal RRSO, women more often experienced severe stress urinary incontinence compared with women who had undergone a postmenopausal RRSO.