Inadequate data makes it difficult to set realistic patient expectations after premenopausal risk-reducing salpingo-oophorectomy (RRSO). This study’s objectives were to characterize post-RRSO symptom profiles, track their evolution, and evaluate the impact of hormone therapy (HT). Premenopausal women from the randomized controlled trial (What Happens After Menopause?) WHAM participated in the study. Premenopausal women who had their ovaries removed (n = 99), RRSOs who used hormone therapy (n = 57), and RRSOs who did not use hormone therapy (n = 38) all participated in a prospective study of menopausal symptoms. Researchers used standardized questionnaires to assess symptoms (e.g., hot flashes, night sweats, low desire, vaginal dryness, poor sleep, anxiety/depression) pre- and post-surgery at 3, 6, and 12 months. Post-RRSO symptom profiles and the likelihood of profile changes were determined using latent transition analysis. Most Symptoms (81-87% non-HT; 36-41% HT; 7-9% comparisons), Few Symptoms (7-13% non-HT; 36-42% HT; 77-80% comparisons), and Sexual Symptoms (0% non-HT; 17%-27% HT; 14-15% comparisons) were the 3 symptom profiles discovered. After 12 months, only 2% of those who did not receive HT reported any improvement in their symptoms. At 3 months, the HT group had a 5-13% likelihood of improvement, a 6-14% chance of worsening, and a 12-32% chance of improvement, with a 4-25% chance of worsening. After RRSO before menopause, symptoms tend to cluster into individual profiles. By the 12-month mark, most people who don’t utilize HT will still be severely affected by their symptoms. However, HT users report significantly fewer symptoms and a much greater likelihood of improvement in comparison. These results have important implications for patient expectations and choices.