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Hormone Replacement

Women facing hereditary cancer have special considerations associated with early onset menopause and symptom management.

Is hormone therapy right for you?

It may seem contrary for high-risk women to receive hormones after removing their ovaries to lower their risk for breast cancer. However, overall, hormone levels resulting from hormone replacement medication is generally less than what the ovaries normally produce during the premenopausal years. Many experts agree that most women who are in surgical menopause before age 50, including those with BRCA mutations, are candidates for hormone therapy.

One study that examined short-term hormone therapy after oophorectomy in women with BRCA mutations indicated that prophylactic oophorectomy prior to age 50 substantially lowers the risk for breast cancer; risk reduction was similar in women who took hormones and women who did not take hormones post-oophorectomy.

Researchers from University of Pennsylvania reported that women who elected risk-reducing salpingo-oophorectomy (removal of ovaries and tubes) had a substantial decrease in breast cancer risk. In their study, hormone therapy after oophorectomy didn't significantly change breast cancer risk in the women. A follow-up study noted that women with BRCA mutations who used hormones reported better quality of life. 

For now, the long-term effects of hormone therapy after oophorectomy are unclear. While not every doctor will prescribe hormones to high-risk women after menopause, some physicians with special expertise in caring for menopausal women, including those who are BRCA mutation carriers, do prescribe hormone replacement therapy to such patients.

Many concerns about hormone therapy come from the Women’s Health Initiative, a large, randomized study of hormone replacement in post-menopausal women over age 50.  Women in this study took combined estrogen and progesterone, estrogen alone, or a placebo after menopause. It is important to remember that this study did not observe women with BRCA mutations, or premenopausal women who experienced surgical menopause. The study demonstrated that estrogen plus progesterone slightly increased the risk for breast cancer in older women who went through natural menopause. The study concluded, however, that estrogen alone does not raise the risk for breast cancer in this population. The study did not specifically consider women who underwent surgical menopause following risk-reducing oophorectomy, so its applicability to women in the high-risk population who undergo early menopause is uncertain.

It is important for women to discuss the risk of hormone replacement with their health care team to make informed decisions.

Updated 11/4/15

 

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