Hysterectomised women’s perceptions and experiences of the risks and benefits of opportunistic salpingectomy: A qualitative interview study

Background Opportunistic salpingectomy performed during benign hysterectomy to reduce ovarian cancer risk has uncertain long-term effects on ovarian function, potentially resulting in earlier menopause. As opportunistic salpingectomy is performed as a preventive intervention without a medical indication, it is essential that the decision to undergo the procedure be made through a shared decision-making process. This study explores women’s perceptions and experiences of opportunistic salpingectomy, factors influencing their decision to participate in a randomised trial, and the lasting impact of the procedure. Methods A qualitative interview study with focus group discussions was conducted with women who had undergone hysterectomy with or without opportunistic salpingectomy 2–7 years prior. Women were recruited from the HOPPSA (Hysterectomy and OPPortunistic SAlpingectomy) cohort through purposive sampling. HOPPSA is a randomised controlled trial in which women aged < 55 years undergoing benign hysterectomy were randomised to hysterectomy with or without opportunistic salpingectomy. Focus group discussions guided by a semi-structured format were recorded digitally, transcribed verbatim, and analysed using qualitative manifest and latent content analysis. Results Twenty women (mean age 45.8 years, range 28–53 years) with varying indications for hysterectomy participated in this study. Fifteen were randomised in HOPPSA, whereas five declined randomisation but joined the follow-up. The analysis identified three categories: Decision on whether to participate in the randomised trial, Deciding on opportunistic salpingectomy, and Health after surgery. Participation in HOPPSA stemmed from a desire to contribute to research or acceptance to let chance decide on tubal removal, though some participants later expressed regret. Limited information from healthcare personnel on the risks and benefits of opportunistic salpingectomy hindered shared decision-making. After surgery, women noted an inadequate focus on health during menopause. Conclusions Decision-making regarding opportunistic salpingectomy is complex and influenced by health illiteracy, personal priorities, and trust in healthcare. Findings highlight the need for personalised consultations on the preventive procedure and long-term support during the transition to menopause. When clinical evidence on risks and benefits is limited, such as for opportunistic salpingectomy, shared decision-making is crucial.