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Summer 2006

This issue in pdf (best viewed at 75%)

Managing Menopause in Women with
an Inherited Risk of Breast Cancer

By Sue Friedman and Drea Thew

Presenter: Noah Kauff, MD, Clinical Genetics and Gynecology Services, Memorial Sloan-Kettering Cancer Center

Dr. Kauff discussed fi ndings from the much publicized Women’s Health Initiative (WHI) study on hormone replacement therapy (HRT) in post-menopausal women:

  • The WHI study was stopped early
    when participants who were taking
    HRT (estrogen plus progestin) had an
    increased incidence of breast cancer.
  • The HRT study group also had
    signifi cant increases in other diseases,
    such as coronary heart disease, stroke
    and pulmonary embolism.
  • The estrogen-only arm of the study
    (women with no uterus) showed no
    statistically signifi cant change in breast
    cancer or coronary heart disease over
    women on placebo.

Conclusions drawn from the study included:

  • HRT in naturally post-menopausal
    women should be used at the lowest
    dose for the shortest period of time to
    relieve symptoms.
  • HRT should not be given to asymptomatic
    women who are 60 or older to prevent
    chronic disease.

The WHI study focused on women of average breast cancer risk who went through natural menopause. Dr. Kauff emphasized that it is unclear whether the results apply to high-risk women in their 30s and 40s who experienced surgical menopause.

Dr. Kauff explained data from other studies regarding HRT including:

  • HRT safety is questionable for women
    with a history of hormone-receptor positive
    breast cancer
  • Good evidence shows HRT after ovarian
    cancer does not affect survival.
  • HRT may be reasonable for BRCA
    carriers who haven’t had breast cancer
    or whose breast cancer was hormonereceptor-
    negative after careful discussion
    of risks and benefi ts.
  • One study found a 60 percent reduction
    in breast cancer risk among BRCA1/2
    carriers who had oophorectomy, even
    when they also took short term HRT.

Dr. Kauff introduced some non-hormonal options for managing menopausal symptoms:

  • Selective serotonin reuptake inhibitors
    (SSRIs), commonly prescribed as antidepressants,
    effectively treat hot fl ashes
    in 60-70 percent of women and likely
    have no impact on breast cancer risk.
  • Non-medical interventions such as
    paced respirations and aerobic exercise
    can help mitigate menopausal symptoms.
  • Water-based lubricants and Vitamin Ebased
    moisturizers can improve vaginal
    dryness. If vaginal lubricants are ineffective,
    low-dose vaginal estrogen may help.
    Vaginal estrogens increase estrogen levels
    slightly and should be used only after
    weighing the benefi ts and the risks.

Menopause Resources

Several resources for managing menopause are shown below. See the FORCE
section on surgical menopause
for additional information and helpful links to related published studies.

Websites
Fertile Hope
A nonprofi t organization providing information and support for cancer patients whose medical treatments may affect their fertility.

Hyster Sisters
An online support site for women facing hysterectomy or gynecologic surgery.

North American Menopause Society
A scientific organization devoted to promoting women’s health and quality of life through an understanding of menopause.

Books
Dr. Susan Love’s Menopause and Hormone Book
by Susan Love

I’m Not in the Mood: What Every Woman Should Know About Improving Her
Libido
by Judith Reichman

Ovarian Cancer: Your Guide to Taking Control by Kristine Conner and Lauren
Langford

Restore Yourself: A Woman’s Guide to Reviving Her Sexual Desire and Passion
for Life
by James A. Simon, MD and Victoria Houston

Menopause the Musical

On the last day of the conference, attendees were treated to a lunch-time sing-a-long version of Menopause the Musical®. The live performance celebrates the mental and physical challenges of The Change through cleverly rewritten lyrics to 25 well-known Baby Boomer songs. Visit www.menopausethemusical.com for ticket information and details about performance locations and scheduling.

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