HRT/Oophorectomy & Strokes

In my continuing crusade to inform women about the value of their ovaries, I saw this article in a UK newspaper online yesterday.

HRT shown to increase risk of strokes:

A study released by the University of Nottingham using a base of 40,000 women and found that women on HRT had a 29% greater risk of strokes.

This comes in the same week that I saw the results on HysterSisters.com of their annual survey, which includes a base of respondents of a little less than 6,000.

The most startling thing of course is that half of the women who'd had hysterectomies also had oophorectomies (I think that's about 2,580 of the respondents since not all had hysterectomies at the time they took the survey).
79% said that they had moderate to high intensity of menopause symptoms (and let's consider all those symptoms that aren't "felt" like osteopororis and arterial damage).

42% of women who went on HRT were not satisfied with the forumlation

62% who changed formulation reported better results, but 11% still didn't have their mix right.

What disturbs me so much is that I still see ladies in their forties being told that their doctors prefer to remove their ovaries at that time to reduce their risk of ovarian cancer - or worse, because they don't need them anymore. I, of course, and doing my best to help show them the most recent information. The American College of Gynecology and Obstetrics abandoned the prophylactic removal of ovaries for women over forty-five back in the nineties.

One of the ladies on the board pointed to an excellent article (PDF file) called - Rationale for Ovarian Conservation by Donna Shoupe MD. Any woman considering any gynecological surgery should read that article. The article is five years old and seems to have made very little dent from what I've seen on the hystersisters boards. For every woman who asks for advice on the topic, I'm guessing there are five that blindly follow their doctor's counsel.

Posted by Elizabeth M. on January 9, 2005 9:35 AM

ihad an oophorectomy three yrs ago at age 35. i have stopped taking hrt because of worries re breast cancer, etc and the thought of a very long usage. any alternatives to ease the menopausal symtons?

1. Posted by teresa brown on May 10, 2006

You should really talk to your doctor. There are some very serious health reprecussions for surgical menopause.

There are endocrinologists that specialize in menopause.

Take care.

2. Posted by Lizzie on May 11, 2006

uJo60x

3. Posted by Ijhipram on July 14, 2009

uJo60x

4. Posted by Ijhipram on July 14, 2009

Six months ago due to maternal terminal ovarian cancer and BRCA 1&2 gene mutations I chose to have my ovaries and uterus removed. It is the best thing I have ever done and I've never felt better. I was in excruciating pain every month for 2-3 weeks per month. I finally know what it feels like to live pain free.

Hormone Replacement Therapy and Life Expectancy After Prophylactic Oophorectomy in Women With BRCA1/2 Mutations: A Decision Analysis
Katrina Armstrong, J. Sanford Schwartz, Thomas Randall, Stephen C. Rubin, Barbara Weber
From the Department of Medicine, Center for Clinical Epidemiology and Biostatistics, and Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine; Leonard Davis Institute of Health Economics, University of Pennsylvania; Abramson Family Cancer Research Institute, University of Pennsylvania Cancer Center, Philadelphia, PA.

Address reprint requests to Katrina Armstrong, MD, MSCE, University of Pennsylvania, 423 Guardian Dr, 1204 Blockley Hall, Philadelphia PA 19104-6021; e-mail: karmstro@mail.med.upenn.edu

PURPOSE: The decision about prophylactic oophorectomy is difficult for many premenopausal women with BRCA1/2 mutations because of concerns and controversy about the use of hormone replacement therapy (HRT) after oophorectomy.

PATIENTS AND METHODS: A Markov decision analytic model used the most current epidemiologic data to assess the expected outcomes of prophylactic oophorectomy with or without HRT (to age 50 years or for life) in cohorts of women with BRCA1/2 mutations. Sensitivity analyses were conducted to assess the impact of alternative assumptions about effects of HRT, effects of prophylactic oophorectomy, and risks of cancer associated with BRCA1/2 mutations.

RESULTS: In our model, prophylactic oophorectomy lengthened life expectancy in women with BRCA1/2 mutations, irrespective of whether HRT was used after oophorectomy. This gain ranged from 3.34 to 4.65 years, depending on age at oophorectomy. Use of HRT after oophorectomy was associated with relatively small changes in life expectancy (+0.17 to -0.34 years) when HRT was stopped at age 50, but larger decrements in life expectancy if HRT was continued for life (-0.79 to -1.09 years). HRT was associated with a gain in life expectancy of between 0.39 and 0.79 years for mutation carriers undergoing both prophylactic mastectomy and oophorectomy.

CONCLUSION: On the basis of the results of this decision analysis, we recommend that women with BRCA1/2 mutations undergo prophylactic oophorectomy after completion of childbearing, decide about short-term HRT after oophorectomy based largely on quality-of-life issues rather than life expectancy, and, if using HRT, consider discontinuing treatment at the time of expected natural menopause, approximately age 50 years.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

5. Posted by Alicia on September 7, 2009

HRT/Oophorectomy & Strokes

Post a comment

Recent Entries