A new study from the Royal Women’s Hospital shows that women who have surgery to lower their ovarian cancer risk often experience sudden changes linked to early menopause.
These changes can impact sexual wellbeing, bone health, sleep, and mood. Unfortunately, many of these women are not prepared and don’t receive the support they need.
The WHAM study (What Happens After Menopause?) is a multicentre, prospective cohort trial. It enrolled 104 pre-menopausal women who had risk-reducing bilateral salpingo-oophorectomy (RRSO) and 102 age-matched controls. These participants came from centres in Australia and the United States. All participants were at high inherited risk of ovarian cancer; such as the BRCA1 or BRCA2 gene variants.
The study tracked participants for 24 months. The findings have appeared in over 12 international peer-reviewed publications; including the British Journal of Obstetrics and Gynaecology. Key findings at the two-year point include:
- Sexual function: There were big drops in sexual activity, desire, and satisfaction. These declines continued even with menopausal hormone therapy.
- Vasomotor symptoms, like hot flushes and night sweats, are reduced by menopausal hormone therapy but still persisted for some. The study was the first to show that vasomotor symptoms peak by three months after surgery and do not get worse over the next two years. Most women described their hot flushed as ‘mild’.
- Sleep and mood: Temporary declines shortly after surgery, largely recovered over two years.
- Bone health: There was significant bone density loss. Menopausal hormone therapy helped protect against it, but it didn’t stop it completely.
- Cognition and cardiometabolic health: The good news was that no major negative changes were observed within the 2-year follow-up.
- Menopausal hormone therapy usage: Only 6 out of 10 women used it. Barriers included fear of risks and not getting specialist advice.
Professor Martha Hickey is the Head of Menopause Services at the Women’s and is the lead researcher of the WHAM study. She said many women felt let down by the health system.
“These women are making an important and brave choice to reduce their ovarian cancer risk,” she said. "Many have to deal with sudden surgical menopause without enough support.”
Prof. Hickey explained that around ten percent of women have premature or early menopause. Reasons can include chemotherapy, radiation, or the surgical removal of ovaries. Surgical menopause happens suddenly, unlike natural menopause, which is gradual.
To fill this gap, the Women’s offers a dedicated Menopausal Symptoms after Cancer (MSAC) Clinic. This clinic also offers expert care for women facing early or surgical menopause to reduce their cancer risk. The clinic provides personalised symptom management, advice on menopausal hormone therapy, and ongoing support for bone and heart health.
Prof. Hickey said the study highlights the need for ongoing, personalised care instead of just one post-op appointment.
“Surgical menopause isn’t the same as natural menopause,” she said. “To optimise physical and mental health for these women, we need to provide evidence-based care during midlife and beyond.”
With new funding secured, the WHAM study will keep going. The next major check-in is planned for the 10-year mark.
Read the full WHAM study in BJOG (July 2025): https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.18304