HRT Question

Hi
I'm a 43 year old female.   My sister died of ovarian cancer in 03. My first cousin is currently battling ovarian cancer My dr wants to take out my ovaries.    He put me on progestorone pills and I couldn't stand them. They made me very depressed and put about seven lbs on me.  My question is this: Is it better to take the HRT because of all the side effects or is it better just to take my chances. My ovaries have fibroid tumors on them now.  My sister was on HRT for years and she developed cancer.   I'm just so confused as to what to do.   THanks

[Annekathryn Goodman, M.D.]

Hi There,
Let me just summarize your issues to be sure that I understand them:
-You have a strong family history of ovarian cancer (sister, cousin)
-your doctor has recommended the surgical removal of your ovaries to protect you from developing ovarian cancer
-you have had an intolerance/side-effect to progesterone
-you wonder about taking hormone replacement therapy (HRT)

The current recommendation on risk reducing salpingo-oophorectomy (RRSO) includes:
-2 or more first degree family members with ovarian cancer
-a personal history of BRCA 1 or 2 mutation

Over the past 2-3 years, there has been a trend among medical oncologists who take care of premenopausal women with breast cancer to consider RRSO to reduce the estrogen level on the breast and reduce the risk of breast cancer recurrence.

With your family history, it is reasonable for you to consider RRSO. You could also consider genetic testing for BRCA 1 or 2. If that is something of interest to you, it may be helpful to ask your cousin if she could be tested. Only 10-20% of ovarian cancers are associated with the BRCA mutations. That means that in the majority of women with ovarian cancer, the gene mutations are not yet known and there is not yet a test for them.

As far as HRT, Estrogen replacement therapy is an option for women who are experiencing significant side-effects from the estrogen deficiency of menopause. for women who are not troubled by the symptoms of hot flashes and sleep disruption it is not necessary to take estrogen. Progesterone is only indicated for women who are through the menopause who still have their uterus. estrogen alone is associated with the stimulation of the lining of the uterus. progesterone prevents that stimulation.

I would suggest you first focus with your doctor on whether you want to pursue RRSO. If so , after surgery you and your doctor can see if you have troubling side-effects of menopause that need intervention.

best wishes