Menopausal Symptom Management in Patients After Risk-Reducing Oophorectomy

Patients with BRCA1/2 mutations face difficult decisions on pursuing risk-reducing (and lifesaving) surgery, especially because of concerns about the safety of menopausal hormone therapy and breast cancer risk. However, observational data suggest that systemic menopausal hormone therapy does not elevate breast cancer risk among patients with pathogenic mutations with intact breasts who have undergone risk-reducing bilateral salpingo-oophorectomy (BSO) before age 45 years. Accordingly, such individuals should be considered for menopausal hormone therapy to improve quality of life and to decrease health risks associated with premature menopause. Given emerging data on the potential of estrogen-only therapy to reduce breast cancer risk, clinicians caring for women with BRCA1/2 mutations could consider offering hysterectomy along with BSO as part of risk-reducing surgery.