Our Summary

This research paper investigates whether Hormone Replacement Therapy (HRT) is safe for women who have undergone a risk-reducing salpingo-oophorectomy (RRSO). RRSO is a procedure that women with high risk of developing ovarian cancer opt for, as it reduces their risk by 80-96%. However, this procedure can directly lead to menopause in women who haven’t reached it naturally yet. HRT can help manage the symptoms brought on by menopause, but there’s uncertainty about whether it’s safe in terms of increasing the risk of breast cancer.

The researchers looked at studies and national guidelines on the use of HRT after RRSO in women with specific genetic mutations (BRCA1 and BRCA2) that increase the risk of ovarian and breast cancers. They found that short-term use of HRT doesn’t seem to raise the risk of breast cancer or undo the protective effect of RRSO in women with these genetic mutations, who haven’t had a personal history of breast cancer.

The data suggest that estrogen-only HRT may be safer, but the best dosage and how long it should be used are still unclear and need more research.

In simpler terms, this study shows that using HRT for a short while after having surgery to prevent ovarian cancer seems safe and doesn’t increase the risk of breast cancer. But we still need to find out how much should be taken and for how long.

FAQs

  1. What is a risk-reducing salpingo-oophorectomy (RRSO) and why do some women opt for it?
  2. Can hormone replacement therapy (HRT) be safely used after RRSO without increasing the risk of breast cancer?
  3. What is the current understanding regarding the ideal dosage and duration of HRT use after RRSO?

Doctor’s Tip

A doctor might advise a patient undergoing salpingo-oophorectomy to discuss the use of hormone replacement therapy (HRT) with them to help manage menopausal symptoms. It is important to weigh the benefits of HRT in symptom relief against the potential risks, including an increased risk of breast cancer. It is recommended to use the lowest effective dose for the shortest duration possible. Close monitoring and regular follow-up with a healthcare provider is essential.

Suitable For

Patients who are at high risk for developing ovarian cancer, particularly those with BRCA1 and BRCA2 mutations, are typically recommended salpingo-oophorectomy. This procedure can reduce the risk of ovarian cancer by 80-96%. However, salpingo-oophorectomy leads to early onset of menopause in premenopausal women, which can be managed with hormone replacement therapy (HRT). It is important for these patients to discuss the risks and benefits of HRT with their healthcare provider to determine the best course of action for managing menopausal symptoms and reducing the risk of breast cancer.

Timeline

Before salpingo-oophorectomy:

  • Patient undergoes genetic testing to determine if they carry the BRCA1 or BRCA2 mutation
  • Patient discusses risk-reducing options with their healthcare provider
  • Patient decides to undergo salpingo-oophorectomy to reduce their risk of ovarian cancer
  • Patient may undergo counseling and preparation for surgery

After salpingo-oophorectomy:

  • Patient experiences immediate onset of menopause due to removal of ovaries
  • Patient may experience menopausal symptoms such as hot flashes, mood swings, and vaginal dryness
  • Patient may be prescribed hormone replacement therapy (HRT) to mitigate menopausal symptoms
  • Patient may undergo regular cancer screenings to monitor for any signs of breast cancer
  • Patient should follow national guidelines for the use of HRT following RRSO in BRCA1 and BRCA2 mutation carriers
  • Patient should continue to follow-up with their healthcare provider for long-term monitoring and support.

What to Ask Your Doctor

  1. How will salpingo-oophorectomy reduce my risk of developing ovarian cancer?
  2. What are the potential risks and complications of the surgery?
  3. Will the surgery lead to immediate onset of menopause?
  4. What are the possible symptoms of menopause that I may experience after the surgery?
  5. Is hormone replacement therapy recommended after salpingo-oophorectomy to manage menopausal symptoms?
  6. Are there any concerns about using hormone replacement therapy in terms of increasing the risk of breast cancer?
  7. How long should I consider using hormone replacement therapy after the surgery?
  8. Are there alternative methods to manage menopausal symptoms other than hormone replacement therapy?
  9. How often should I be monitored for any potential health risks after the surgery?
  10. Are there any lifestyle changes or preventive measures I should consider post-surgery to reduce my risk of developing cancer?

Reference

Authors: Vermeulen RFM, Korse CM, Kenter GG, Brood-van Zanten MMA, Beurden MV. Journal: Climacteric. 2019 Aug;22(4):352-360. doi: 10.1080/13697137.2019.1582622. Epub 2019 Mar 25. PMID: 30905183