From cancer prevention to survivorship: Comprehensive menopause management after risk‐reducing salpingo‐oophorectomy

Abstract Risk‐reducing salpingo‐oophorectomy (RRSO) is the cornerstone of ovarian cancer prevention for women with hereditary cancer predisposition syndromes. When performed before natural menopause, however, RRSO induces immediate surgical menopause, with vasomotor symptoms, sexual dysfunction, accelerated bone loss, and potential long‐term cardiometabolic consequences. For eligible women, menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms and prevents estrogen‐deficiency bone loss. MHT should not be prescribed solely to prevent cardiovascular disease, and cardiometabolic risk requires standard preventive care. Concerns about breast cancer risk nevertheless limit its use. Recent observational evidence in BRCA1/2 pathogenic variant carriers found that estrogen‐only MHT was associated with a lower breast cancer incidence in one prospective matched analysis, whereas combined estrogen–progestogen therapy was not statistically associated with increased risk; residual confounding and limited treatment duration preclude causal conclusions. For women with a personal history of hormone receptor–positive breast cancer, systemic MHT remains generally contraindicated, and non‐hormonal options, including neurokinin receptor antagonists, selected antidepressants, gabapentin, and cognitive behavioral therapy, can reduce symptom burden. Genitourinary syndrome of menopause and sexual dysfunction require proactive, multidimensional management. This narrative review synthesizes international guidance, cohort studies, trials, and systematic reviews to provide a practical framework for preoperative counseling and long‐term survivorship care after risk‐reducing gynecologic surgery.