In the case of breast cancer, studies suggest that estrogen does not increase risk of breast cancer when used in surgical menopause, even among those who are BRCA1 or BRCA2 carriers provided they do not have a personal history of cancer. In those in surgical menopause who have a Factor V Leiden mutation (which increases risks for blood clots), the long-term protective effects of hormone therapy may often outweigh the risks posed by the use of hormones.

Nevertheless, if you are concerned about using estrogen due to a family history of estrogen-dependent cancers, blood clots, or other risks, it is wise to discuss this with your doctor to make sure that you are carefully dosed and monitored to avoid adverse effects of hormones in surgical menopause. Alternative medications can also be used in some extreme cases (e.g., in patients with current estrogen-positive cancers).”

Estrogen therapy is the most effective way to prevent all of the symptoms and risks associated with surgical menopause. However, for those who absolutely cannot take estrogens, there are some alternative therapies available:

  • For hot flashes and other vasomotor symptoms, paroxetine is FDA approved, and other drug approaches may be effective (other SNRI/SSRI antidepressant drugs, clonidine, and gapabentin)
  • For depression, desvenlafaxine is the only medication that has been shown to be effective in large trials in menopausal depression, although other antidepressant medications and cognitive behavioral therapy may also be effective.
  • For vaginal dryness and atrophy, effective alternatives include low-dose vaginal estrogen cream, prasterone, and ospemifene; additional helpful approaches include vaginal lubricants, moisturizers, and laser therapy.

For osteoporosis, effective alternatives include biphosphenate medications and selective estrogen receptor modulators such as raloxifene, tamoxifen, or bazedoxifene+estrogen.

Visit www.iapmd.org/surgery for lots of evidence-based information and resources for those considering, going through or recovering from surgery for PMDD/PME.

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