Hormone Replacement Therapy Safety for BRCA Carriers with Premature Surgical Menopause
Safety and Recommendations
- The American College of Obstetricians and Gynecologists recommends that hormone replacement therapy (HRT) is safe for BRCA mutation carriers who have undergone risk-reducing bilateral salpingo-oophorectomy (RRSO) and have no personal history of breast cancer, and should be continued until the age of natural menopause (around 50-51 years) 1, 2
- HRT should be continued until at least age 51 (average age of natural menopause) to minimize long-term health consequences of premature menopause 2
- The National Comprehensive Cancer Network recommends that HRT is contraindicated in BRCA mutation carriers with a personal history of breast cancer 1
Benefits of HRT After Premature Surgical Menopause
- HRT minimizes long-term consequences of early menopause, including increased risks of osteoporosis and bone loss 1, 2
- HRT provides relief from immediate menopausal symptoms such as vasomotor symptoms (hot flashes) 1, 2
Formulation Considerations
- The North American Menopause Society recommends that for women without hysterectomy, estrogen must be used with progestogen to protect against endometrial cancer 2
- The lowest effective dose of HRT should be used to minimize potential risks 1
Important Considerations and Caveats
- Regular assessment of bone health is recommended for women who underwent RRSO while premenopausal 1
- Supportive measures should include resistance and weight-bearing exercise, smoking cessation and reduced alcohol intake, vitamin D and calcium supplements, and vaginal moisturizers and lubricants for all women following risk-reducing surgery 1