MHT post-BRCA diagnosis

Professor Martha Hickey

Deputy Head, Department of Obstetrics and Gynaecology, The University of Melbourne

Around one in 400 women carry pathogenic variants that are known to increase the risk of breast and ovarian cancer, most commonly the BRCA1 and BRCA2 pathogenic variant. These women have a lifetime risk of ovarian cancer of up to 44% (BRCA1) and a breast cancer risk of up to 70%. Screening for ovarian cancer does not reduce mortality and may cause harm. The only intervention shown to reduce morbidity and mortality from ovarian cancer risk risk-reducing salpingo-oophorectomy (RRSO). This procedure is recommended at age 35-40 years (BRCA1) or 40-45 years (BRCA2). In most cases this will induce surgical menopause. Relatively few studies have prospectively measured the effects of surgical menopause in this population. Evidence from surgical menopause in the general population may not be generalisable to this group. The existing evidence shows that vasomotor symptoms are common but are not more severe than those experienced at natural menopause. Mood and sleep disturbance and sexual dysfunction are also common in the first 12 months and may be persistent. Menopausal Hormone Therapy (MHT) appears safe for BRCA1/2 mutation carriers who do not have a personal history of breast cancer although there are few longitudinal studies. The optimum dose and duration of MHT is uncertain, but studies have consistently shown that MHT reduces but does not resolve symptoms after RRSO. Similarly, bone loss occurs despite MHT and bi-annual DXA is recommended after premenopausal RRSO.



Martha Hickey is Professor of Obstetrics and Gynaecology at the University of Melbourne and Director of the Gynaecology Research Centre at the Royal Women’s Hospital. She established the first Menopausal Symptoms after Cancer (MSAC) service in Western Australia and now leads this service for Victoria. She leads the WHAM (What Happens after Menopause?) study of non-cancer outcomes following risk-reducing salpingo-oophorectomy and has developed new resources for high-risk women and their healthcare providers about managing menopause.