• 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.

@ Nathaniel -By not driving in every day there could be a $3,000 – $6,000 savings on fuel and wear and tear on a vehicle. There may even be a case that an employee could get by with 1 less vehicle, depending on the situation, saving even more per year. A

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Go Mayo Clinic for encouraging flexibility!!!

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Question: How does your group maintain the team concept between colleagues? Is your area involved with hoteling?

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I am a current Teleworker and love it! I love that Mayo is expanding Teleworking for other departments. I, however miss my co-workers and seeing them everyday, but there is so many benefits of being home. I would recommend it to anybody.

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This is a great way to save money on both ends, however, my area is not approved to work from home. Even after switching to an "in-cloud" system where everything is completed via Internet and is paper-less. I hope something is able to change so there is more flexibility!

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Hi Deb – What we have found to maintain the team concept is whatever is being done in the office we do it virtually as well. In addition we encourage the team to network when they have some down time through email, phone or IM. We do monthly staff meetings and those teleworking join in via the phone. We are not involved with hoteling, but do encourage staff to come into the office if there is an event planned and have a few work stations available to them. Hi Nathaniel – The PACs that are teleworking don't have printer access at home so that is where the savings comes in. Even here on campus we are working with all the offices to get them paperless and have made some great improvements over the past year. As others have mentioned above, the savings to the employee come from expenses they would have coming to work on campus. In addition there are other intangible benefits for the employee. This isn't necessarily something everyone wants to do, but for those that do it is a great option.

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If you or your area is considering Telework, you may find the following documents HR put together to be a helpful resource for you: Employee Telework Toolkit: http://mayoweb.mayo.edu/humanresources/documents/Employee_Telework_Toolkit.pdf Supervisor Telework Toolkit: http://mayoweb.mayo.edu/humanresources/documents/Supervisor_Telework_Toolkit.pdf

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From someone who works in a cube environment (for IT), I applaud this move toward working from home. I would not want to do so full time, given the collaborative nature of the work I do. However, many, many meetings are easily done via Lync and web-meetings. Simply put, the way cube "farms" are designed at Mayo – compared with many other tech companies – leads to a culture of working in a noisy environment, because we have to. I can no longer wear headphone to drown out conversations b/c I have developed tinnitus. Yet, why should I have to wear headphones to be able to concentrate, assuming others can even work with music without distraction? Further headphone, and in particular earbuds, have been proven to be bad for hearing/lead to hearing loss. Where I work there are no breakout rooms, e.g. open non-bookable rooms for teams to discuss work, often when a problem arises or for impromptu discussions. So many of these work related discussion are done in the work area where others are trying to concentrate. They have no choice, except booking a conference room, which are usually taken most the time. I urge you all, and especially Mayo leadership (especially especially IT leadership) to read: https://www.flexjobs.com/blog/post/new-study-increase-productivity-by-working-from-home/ Being a techie I cannot resist a Dilbert reference, but don't let the title fool you, it is spot on http://www.zdnet.com/blog/healthcare/dilbert-was-right-cube-farms-kill/1692 Telecommuting naturally solves many of these issues: it saves space & therefore money for Mayo, money for those that work from home (even part time since many can share offices/cubes with with one or more people), and leads to fewer people in small spaces that in turn reduces noise for those that don't telecommute. Perhaps most importantly increases both hours b/c time isn't spent commuting and productivity because you have a very quiet space allowing for long spans of concentration. If I have a 4 hour span of quiet, I can get quite a lot done.

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Is it ever possible to have medical secretaries telework? The majority of work is done via email and/or phone and we do not see patients. This would be great!

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There is a Yammer Group on Telework, so please join that group to share information and experiences.

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