Summer 2006
Contents
Ovarian Cancer Prevalence and Detection
Facing Our Risk of Cancer Empowered and Relaxed
Managing Menopause
(to search past issues of our newsletter)
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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