From the Research
Hormone replacement therapy (HRT) is generally considered safe for women with a history of stage 0 ductal carcinoma in situ (DCIS) who have undergone bilateral mastectomy, as the risk of breast cancer recurrence related to hormone exposure is significantly reduced. Since the breast tissue has been completely removed, the primary concern of HRT increasing the risk of breast cancer recurrence is mitigated. However, it's essential to consider the potential risks associated with HRT, including increased chance of blood clots, stroke, and possibly ovarian cancer, as noted in studies such as 1 and 2.
When deciding on HRT for these patients, the following factors should be considered:
- Menopausal symptoms and their impact on quality of life
- The patient's age and time since menopause
- Other health factors, including risk of osteoporosis, cardiovascular disease, and cognitive decline
- The type of HRT regimen, with options including estrogen-only therapy for women without a uterus or combined estrogen-progestin therapy for those with an intact uterus to prevent endometrial hyperplasia
Standard HRT regimens can be used, including:
- Estrogen-only therapy (such as oral estradiol 0.5-1mg daily or transdermal estradiol 0.025-0.05mg patches) for women without a uterus
- Combined estrogen-progestin therapy (adding medroxyprogesterone acetate 2.5mg daily or micronized progesterone 100-200mg daily) for those with an intact uterus
Treatment should be individualized, with the lowest effective dose used for the shortest duration needed, as suggested by studies such as 3 and 4. Regular follow-up with healthcare providers is essential to monitor the patient's response to HRT and adjust the treatment plan as necessary. The decision to use HRT should balance symptom relief against potential risks, considering the patient's overall health and well-being.