Ask the Nurse

I am 38 years old and BRCA 1 positive with a family history of premenopausal breast cancer. I’m done having children and my OB suggests having a hysterectomy and removing my tubes and ovaries. I’m very afraid of going through menopause. He suggested a low dose of Estrogen to start out. What would be the benefit (if any) of starting out on a natural hormone replacement vs estrogen? I hated taking birth control when I was younger because of the way it made me feel and I am concerned estrogen will be the same. Thank you!

I understand your concerns about undergoing early surgical menopause.

It is usually recommended to remove the ovaries and the tubes at age 40 for BRCA positive women. Removing the ovaries before age 40 is a bit early and hormone therapy may not mitigate all the risks of early menopause (under age 40).

Menopause after age 40 is normal, however surgical menopause with ovary removal not only removes all of a woman’s estrogen production but some of her testosterone levels. Many menopause experts recommend removal of uterus in order to:

  1. Fully remove Fallopian tubes to reduce cancer risk.
  2. Eliminate any vaginal bleeding issues with hormone therapy.
  3. Giving estrogen or estrogen +/- testosterone is easier and less risk and less long term expense than needing to also use a progesterone or a synthetic progestin to protect the endometrium/uterine lining.

Women under age 60-65 with hysterectomy, in general should be on estrogen therapy. Women with BRCA who take hormone therapy (HT) do NOT appear to increase their risk of breast cancer or other cancers. Estrogen therapy is good for the following:

In general, women with hysterectomy who use estrogen compared to women with hysterectomy who DO NOT USE estrogen live longer!

Rest assured that intolerance to high dose synthetic hormones in birth control agents - usually from the progestin component does NOT mean you will not be able to tolerate menopause hormone estrogen therapy, which is a much lower dose.

However, women with surgical menopause at age 40 need standard HT as opposed to very low doses of estrogen and some may need testosterone.

You may find it helpful to do one of the following:

  1. Join BRCA support group
  2. Seek out menopause specialist

Stay strong and healthy and seek out as much expert information as possible.

All My Best,
Speaking of Women’s Health Nurse

February 1, 2018 at 2:30am