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Hormone therapy replacement in oncological high risk patients: is itpossible?


Obstetrics & Gynecology International Journal
Belardo María Alejandra,?1? Starvaggi Agustina?,3? Pilnik, Susana,?2? González Yamil Aura María,3? De Nardo Bárbara?3

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Abstract

Hormone replacement therapy (HRT) has been prescribed for women to avoid or decrease menopausal symptoms, in particular, the presence of hot flashes and night sweats, and to prevent other aging-related conditions, including osteoporosis and cardiovascular disease. Women with a pathogenic variant of BRCA1/2 have a higher lifetime risk of developing ovarian cancer (OC) and breast cancer (BC). It has been shown that risk-reducing salpingo oophorectomy (RRSO) is associated with an OC risk-reduction of approximately 80% and a BC risk-reduction of approximately 50%. Screening for ovarian cancer in high-risk women has not been shown to be reliable. RRSO is currently recommended between the ages of 35 and 40 for BRCA1 mutation carriers and between 40 and 45 for BRCA2 mutation carriers. Despite the well-established reduction in cancer risk, oophorectomy induces surgical menopause and its associated risks. The abrupt decline in circulating sex hormones causes menopausal symptoms, such as vasomotor symptoms, loss of libido, as well as being associated with a decline in cardiac and bone health, and overall bad quality of life among others issues. Many of the side effects can be ameliorated by HRT, but for women with a personal history of breast cancer, exogenous hormones are contraindicated. Although HRT after surgical menopause is prescribed to BRCA mutation carriers without a personal history of breast cancer, the impact on breast cancer risk remains unclear. In this review we discuss a detailed analysis of the updated literature related to the use of HRT in women who undergo RRSO.

Keywords

BRCA 1 mutation, BRCA 2 mutation, Risk reducing salpingo oophorectomy, Menopausal symptoms, Replacement hormone therapy, Hot flashes, Vasomotor symptoms, Osteoporosis, Ovarian cancer, Breast cancer, Cardiovascular, Bilateral salpingo oophorectomy, Estrogen alone, Estrogen plus progesterone, Interval salpingectomy with delayed oophorectomy

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