Rethinking Menopausal Hormone Therapy After Risk-Reducing Salpingo-Oophorectomy in Women at High Risk for Breast Cancer

Women who inherit a germline mutation in a hereditary breast and ovarian cancer syndrome gene are recommended to have their fallopian tubes and ovaries removed 5–15 years before the age of natural menopause to prevent the development of ovarian or fallopian tube cancer. Early surgical menopause can lead to several acute and chronic health implications, and, although menopausal hormone therapy (MHT) remains the most effective way to mitigate these issues, use remains suboptimal. This is particularly discernible in populations who face extremely high lifetime risks of developing breast cancer, likely related to the misinformation surrounding its use on subsequent breast cancer risk. Here, we provide a summary of the literature on MHT use and breast cancer as it pertains to high-risk populations, notably BRCA1 and BRCA2 mutation carriers. We also introduce our intention to evaluate how newer formulations such as conjugated estrogen combined with the selective estrogen receptor modulator bazedoxifene may treat symptoms, maintain bone health, and potentially decrease breast cancer risk. Results would be transformative for menopause management in women with hereditary breast and ovarian cancer syndrome and inform guidelines on the safety of MHT in this unique population.