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Update on Hormone Therapy for Previvors

January 12, 2017

by Alexandria Groves and Lisa Rezende, PhD

National guidelines recommend that women with mutations in BRCA have risk-reducing removal of their ovaries and tubes, (also known as salpingo-oophorectomy or RRSO) either between the ages of 35-40 or after they are done having children. RRSO greatly reduces the risk of ovarian, fallopian tube, and peritoneal cancer, but does so at the price of early menopause and its side effects, including memory changes, hot flashes, mood changes, vaginal dryness, decreased libido, sleep disturbance, weight gain, loss of bladder control, bone loss and heart disease. Finding treatments that improve the quality of life for mutation carriers who experience the effects of surgical menopause has been of great interest to the FORCE community for many years.

Dr. Susan Domcheck, MD, and Dr. Andrew Kaunitz, MD, current members of FORCE’s Advisory Board, recently published a “practice pearl” in Menopause: The Journal of The North American Menopause Society, focusing on the use of systemic hormone therapy (HT) in BRCA mutation carriers who have not had cancer. Systemic HT (sometimes referred to as hormone replacement therapy or HRT) involves hormones that enter the bloodstream through pills or patches, and circulates to reach every part of the body. Because menopause side effects can potentially be severe in young women undergoing RRSO, many experts consider the use of systemic HT for previvors until the normal age of menopause. However, some women and their health care providers are concerned that systemic HT will elevate their risk for breast cancer. This fear of increased cancer risk leads some previvors to refuse HT despite decreased quality of life after RRSO. Also of great concern are stories of previvors putting off having RRSO out of concern for the effects of surgical menopause. Some previvors report that their health care providers will not prescribe HT to treat their menopause symptoms.

Despite the fear of many women, Dr. Domcheck and Dr. Kaunitz believe that young surgically menopausal women should be offered systemic HT to help treat menopause symptoms. Though limited, data from three different observational studies concerning menopausal previvors with intact breasts and the effects of systemic HT show that the risk of breast cancer does not increase with the use of systemic HT. Drs. Domcheck and Kaunitz recommend that HT be considered for previvors from the start of early menopause and continue until at least the age of natural menopause. Importantly, they conclude the paper by noting Young previvors with or without intact breasts should not defer or avoid risk-reducing BSO because of concerns that subsequent use of systemic HT will elevate breast cancer risk.”

FORCE applauds this work by Dr. Domchek and Dr. Kaunitz. We hope that the publication will help women and their health care providers make informed decisions about managing both their cancer risk and their early menopause symptoms.

To learn more about hormone replacement therapy, please visit our menopause information pages here. It has multiple links for different FORCE sources, books, and other websites related to HT. You can also watch videos of Dr. Kaunitz giving a talk about the benefits and risks of HT for previvors and Dr. Domchek speaking on the Long-term Effects of Surgical Menopause from the Joining FORCEs Against Hereditary Cancer Conference in June of 2014.

Reference

Domcheck, S and Kaunitz, A. “Use of the systemic hormone therapy in BRCA mutation carriers.” Menopause: The Journal of The North American Menopause Society (2016) Vol. 23:1026-1027.

More information:

Kaunitz, AM. “Is menopausal hormone therapy safe when your patient carries a BRCA mutation?OBG Management (2015) Vol. 27, No. 8: 24026.

Additional FORCE Resources

FORCE Information: Menopause

FORCE XRAYS: Removing ovaries before age 50 may increase the risk of chronic conditions for some women

FORCE Information: Ovarian & Related Cancer Risk

FORCE Information: Surgical Removal of Ovaries & Fallopian Tubes

FORCE Videos: Long Term Consequences of Menopause:  Heart, Bone, Memory

FORCE Videos:  Menopause With and Without Hormones

FORCE Research Update:  How Women Manage Menopause Symptoms After Risk-reducing Removal of Ovaries and Fallopian Tubes

FORCE Research Update:  Decision Making on the Use of Hormones After Risk-reducing Removal of Ovaries and Fallopian Tubes

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