• By Liza Torborg

Tuesday Q and A: Hormone replacement therapy may protect against health risks

September 9, 2014

woman holding hormone replacement medicationDEAR MAYO CLINIC: I am 42 years old and have a BRCA1 gene mutation. I’ll have a prophylactic oophorectomy later this year. I have had a prophylactic mastectomy as well, and am considering hormone replacement therapy. How soon after surgery would I need to start taking hormones? What are the risks if I decide against hormone replacement?

ANSWER: For a woman carrying a BRCA mutation without a personal history of cancer, hormone replacement therapy, or HT, is usually recommended from the time your ovaries are removed until you turn 50. Beyond that age, the risks of continuing HT for a BRCA mutation carrier are not fully known. So HT is usually stopped around age 50. Going without any hormone therapy after prophylactic oophorectomy may increase the likelihood of some significant health risks, including problems that could affect your bones, heart and brain.

A mutation in the BRCA1 gene significantly raises your risk of breast and ovarian cancer. Surgery done in an effort to prevent cancer by removing the breasts, called prophylactic mastectomy, and removing the ovaries, called prophylactic oophorectomy, often can dramatically lower those cancer risks.

The surgeries, however, pose their own health risks. Because your ovaries make most of your body’s estrogen — one of the hormones that regulates your menstrual cycles — removing your ovaries triggers menopause. That means after your surgery, you are likely to have menopause symptoms, such as hot flashes, night sweats and vaginal dryness.

When menopause happens before age 50, which is considered the average age for it, research suggests the risk goes up for bone thinning, heart disease, parkinsonism, anxiety, depression and dementia. After your ovaries are removed, HT during your 40s may provide some protection against these health risks.

Hormone replacement therapy involves taking medications containing female hormones to replace the ones your body no longer makes after menopause. Estrogen typically is prescribed along with the hormone progesterone or a medication similar to progesterone called progestin. This is because estrogen alone, when not balanced by progesterone, can stimulate growth of the uterine lining, increasing the risk of uterine cancer. If you have your uterus removed, you won’t need progesterone.

To get the best protective effect, you will likely need systemic HT. That means the hormones are delivered to your entire body. Along with reducing your risk for heart, bone and brain problems, systemic HT often effectively decreases hot flashes, night sweats and vaginal symptoms of menopause. Hormone replacement therapy comes in a variety of forms, including pills, skin patches, gels, creams, sprays and a vaginal ring. Talk to your doctor about which is best for you.

It is important to note that if you have already had breast cancer, HT is not appropriate for you at any age. That’s because HT can increase the risk that certain kinds of breast cancer could come back.

Research is currently underway to see if surgically removing only the fallopian tubes, a procedure called salpingectomy, could be a viable alternative to prophylactic oophorectomy for women who have a BRCA gene mutation. Studies have found that a relatively high percentage of ovarian cancers begin in the fallopian tubes. Removing the fallopian tubes before cancer begins may be an effective way to prevent ovarian cancer while avoiding the side effects of ovary removal. This is still under investigation and is not standard care at this time. However, talk to your surgeon about your options before you have surgery.

Hormone replacement therapy can be a complicated topic. It is important that you fully understand the risks and benefits in your situation before you move forward. Talk with your doctor about his or her recommendations based on your medical history, as well as your individual circumstances. Ask questions and get the information you need to feel comfortable making a well-informed decision. Myra Wick, M.D., Ph.D., Obstetrics and Gynecology, and Mary Marnach, M.D., Women’s Health Clinic, Mayo Clinic, Rochester, Minn.

This is a great opportunity if you live in an area with access to Mayo-approved high-speed internet. Unfortunately, there are areas, especially in southeastern Minnesota, where that access is difficult if not impossible to obtain due to speed requirements set forth by Mayo.

COMMENT

This is great. I'm so happy to hear that Mayo Rochester is stepping up. This is along time coming great Work LeTesha. You are going to find you have happy employees & a happy employee always works better 🙂 What great service we are giving to our patients. I love to hear the split shift idea & Sally gets 70 minutes of her time back. Such a win win for all….

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I think this is a great opportunity for employees & Mayo Clinic!! The six points on deciding if telework is right for your unit are great, but I have heard of departments telling employees that working from home is a privilege and if they want to work from home they need to buy/supply their own equipment (monitors, docking stations, etc.). That does not seem right.

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I know how it saves on space, but how does it save on paper or toner–or equipment maintenance costs? The PAC still has to print the same things–and if they don't need to print them, then neither do the PACs working on campus, so that seems like the real issue. Telecommuting is a great option for many, but I still think that some of that cost savings ought to go back to the employee who's making it possible, to offset the costs of working from home (space dedicated, increased heat/electricity used, possibly investments in furniture to make the workspace suitable, possibly upgraded internet access). If Mayo saves $32k/yr, they could definitely apportion out $10k of that to the involved teleworkers as a small bonus, and still come out ahead. And then it wouldn't be just because of shifting costs to the employee.

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How do you ensure protected patient information when you work from home? I would think it might be easy to leave a screen up when family members are around. Just curious.

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@Nathaniel, the teleworker is seeing a savings as well. Transportation costs, clothing costs and even food expense, Mayo can't be furnishing home offices, what if they leave/retire from Mayo after a few years?

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This is a great step forward as this concept has been in use by major companies for 10+ years now and has been proven to increase employee satisfaction and retention along with the lower costs and green initiative savings by not physically commuting. Kudos! I'm certain there are other non-patient care areas that could benefit from this way of working smarter.

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I have been teleworking, at least part time, for 7 years now due to health issues. Back when I first started this, it was percieved negatively, so it is good to see this coming into vogue. I no longer have a Mayo Office at all, and I use the same computer systems at home that I used to have in my office in Rochester. I gladly pay for heat, electricity, and internet and still feel I am saving time and money over gas and vehicle maintenance if I were still able to work onsite. I love the idea of mentoring others and have passed that on to my Supervisors. Thank you Mayo!

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Lori – to protect PHI the telework equipment is designed not to store any information locally on that equipment. Also teleworkers must work in a room that isn't a main through traffic area, such as a room with a door that can be closed during work hours or use a room divider if they don't have a room with a door. In addition all employees must follow the institutional policy for confidentiality. To date we have had no PHI concerns or violations.

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Telework is a great thing! Because of it, I didn't have to find a new job when I moved to California. 🙂

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How do you find out about applying for this position?

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This is great!! After communting for 12 years…I would love to have the option of telecommunting especially in the winter!!!

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I have been teleworking for 11 months and it is the best career move I have made! The savings alone for me and my family per month is around $300.00. I have seen my production increase as well with being home. I am very thankful to Mayo and my Department for allowing me this position!

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Are there or will there be any new positions available? What are the specific job requirements?

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