Meanings of menopause: Reflections on risk-reducing bilateral salpingo-oophorectomy among women with a BRCA1 or BRCA2 mutation and intact ovaries

Women with a BRCA1/2 mutation may consider surgical removal of healthy ovaries for reduction of ovarian cancer risk. A significant proportion of BRCA1/2 mutation carriers decline risk-reducing bilateral salpingo-oophorectomy (RR-BSO) because of ambivalence about the onset of surgical menopause. This study focuses on the connection between meanings of menopause and indecision about RR-BSO among women with a BRCA1/2 mutation and intact ovaries. Using interpretative phenomenological analysis, the investigator conducted in-depth interviews with 14 BRCA1/2 carriers considering RR-BSO. Study results showed that participants had complex relationships to menopause informed by four themes: (1) fear of the unknown menopausal experience, (2) separation of self from body, (3) transformation of sense of health, and (4) transformation of personal agency. The results suggest that exploring women's fluid and contradictory attitudes about menopause enhances understanding of indecision. These findings support the need for a detailed assessment of women's perceptions of menopause during counseling about RR-BSO.Key words. BRCA1 BRCA2 risk-reducing oophorectomy surgical menopause indecision interpretative phenomenological analysis genetic counseling.