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Hormone replacement therapy in BRCA mutation carriers: how shall we do no harm?


Women with a BRCA mutation have an increased risk of developing breast and ovarian cancer. Bilateral salpingo-oophorectomy is the only effective strategy to reduce this risk. Risk-reducing bilateral salpingo-oophorectomy (RRSO) is recommended between the ages of 35 and 40 for women carriers of BRCA1 and between the ages of 40 and 45 for women carriers of BRCA1 and BRCA2 mutations. Most women undergo this procedure prior to their natural menopause subsequently developing an anticipated lack of hormones. This condition affects the quality of life and longevity, while it is more pronounced in women carrying a BRCA1 mutation compared to BRCA2 because they are likely to have surgery earlier. Hormone replacement therapy (HRT) is the only strategy able to significantly compensate for the loss of ovarian hormone production and counteract menopausal symptoms. There is strong evidence that short-term HRT use does not increase the risk of breast cancer among women with a BRCA1 mutation. Few data are available on BRCA2 mutation carriers. Therefore, BRCA mutation carriers require careful counseling about the outcomes of their RRSO, including menopausal symptoms and/or the fear associated with HRT use.

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Risk-reducing bilateral salpingo-oophorectomy


Hormone replacement therapy


Hazard ratio


Confidence interval


Breast cancer


Risk-reducing salpingo-oophorectomy


National Comprehensive Cancer Network


Women’s Health Initiative


European Society of Human Reproduction and Embryology


Million Women Study


Endometrial cancer


Ovarian cancer


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Correspondence to Miriam Dellino.

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The manuscript had ethical approval. The Ethical Review Board was obtained from the Ethics Committee of the Policlinico Bari, Italy, who approved the study protocol.

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Loizzi, V., Dellino, M., Cerbone, M. et al. Hormone replacement therapy in BRCA mutation carriers: how shall we do no harm?. Hormones 22, 19–23 (2023).

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  • BRCA
  • HRT
  • RRSO