How do you counsel premenopausal women with BRCA1 or BRCA2 mutations on the need for bilateral oopherectomy?

I typically mirror the NCCN guidelines in this area. For those with BRCA 1 mutations, I recommend RRBSO between age 35-40 after completion of childbearing. Because those with BRCA2 mutations typically have onset of ovarian cancer later, it is reasonable to delay until age 40-45.

Counseling needs to include discussion of quality of life, menopausal symptom management, breast cancer risk reduction, etc. At this time, there is no evidence to support the effectiveness of risk reducing salpingectomy ...

It is reasonable to consider BSO late 30's for BRCA1 and early 40's for BRCA2 germline mutations.