Impact of concomitant hysterectomy on quality of life in BRCA carriers undergoing risk-reducing salpingo-oophorectomy.

To evaluate the association between concomitant hysterectomy at the time of risk-reducing salpingo-oophorectomy and patient-reported outcomes, including decision regret, health-related quality of life, and sexual function. National cross-sectional study using an anonymous, questionnaire-based survey. Carriers of the BRCA1/2 pathogenic variant who had previously undergone risk-reducing salpingo-oophorectomy with or without concomitant hysterectomy were eligible. Validated instruments were used, including the Decision Regret Scale, the EuroQol-5 Dimension questionnaire, and the Female Sexual Function Index. Participants were stratified according to hysterectomy status and postoperative use of hormone replacement therapy. Outcomes were compared using one-way analysis of variance and chi-square tests. A total of 178 women were included, of whom 46 had undergone risk-reducing salpingo-oophorectomy with concomitant hysterectomy and 132 had undergone risk-reducing salpingo-oophorectomy alone. Decision regret was low overall and did not differ by hysterectomy status or use of hormone replacement therapy. Health-related quality of life was largely preserved across groups, with lower scores on the EuroQol questionnaire and higher pain/discomfort reported primarily among women not receiving hormone replacement therapy. Sexual function scores were significantly higher among women receiving hormone replacement therapy across multiple domains of the Female Sexual Function Index. The most favorable outcomes in terms of quality of life and sexual function were observed among women who underwent hysterectomy and received postoperative hormone replacement therapy. Among BRCA1/2 mutation carriers who had undergone risk-reducing salpingo-oophorectomy, concomitant hysterectomy was not associated with increased decision regret or impaired patient-reported outcomes. Differences in quality of life and sexual function appear to be primarily related to the postoperative use of hormone replacement therapy rather than by hysterectomy itself, supporting an individualized, patient-centered approach to surgical decision-making and suggesting a key role for postoperative hormonal management.