What does this research mean for the field?

Despite clear safety recommendations, over one-third of surgically menopausal BRCA mutation carriers do not use systemic menopausal hormone therapy, primarily due to cancer risk concerns, and pre-surgical counseling on menopausal symptoms is inconsistently delivered. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research seeks to evaluate the usage of menopausal hormone therapy and counseling practices among BRCA mutation carriers post-surgery.

May 30, 2026

Menopausal hormone therapy use and counseling patterns among surgically menopausal BRCA mutation carriers.

Key Points

This research seeks to evaluate the usage of menopausal hormone therapy and counseling practices among BRCA mutation carriers post-surgery.
Cross-sectional web-based survey conducted with BRCAm who underwent RRSO before age 60.
Assessed menopausal symptoms and psychosocial distress using established scales.
Utilized univariate and bivariate analyses for data evaluation.
73.78% of participants used some form of hormone therapy; 64.4% reported systemic hormone therapy use.
70% cited cancer risk as a reason for not using MHT.
Systemic MHT users had significantly lower menopause rating scale scores than non-users.

Abstract

e12736 Background: Risk-reducing salpingo-oophorectomy (RRSO) for BRCA mutation carriers (BRCAm) is recommended by age 35–40, resulting in premature iatrogenic surgical menopause. Menopausal hormone therapy (MHT) is safe and effective in BRCAm without a personal history of breast cancer, but use remains variable despite clear recommendations. We aim to assess the prevalence of systemic MHT, provider counseling patterns, patient attitudes, and patient-reported outcomes among BRCAm following surgical menopause. Methods: We conducted a cross-sectional, web-based survey of patients recruited through a national BRCA network. Eligible participants were BRCAm and underwent RRSO to prevent or treat ovarian cancer before age 60. Individuals with a personal history of breast cancer were excluded. Menopausal symptom severity was assessed using the Menopause Rating Scale (MRS), and psychosocial distress was measured using the NCCN Distress Thermometer. Univariate and bivariate analyses (Chi-square for categorical variables; t-test/ANOVA for continuous) assessed the relationships between MHT and outcomes of interest. Results: Of 396 completed surveys, 259 respondents met eligibility criteria. The median age at surgical menopause was 41.6 years. Seven (2.7%) reported having their ovaries removed to treat ovarian cancer. Most identified as white (94.21%) and non-Hispanic (88%) and most were insured (94.2%), at least college-educated (71.43%), earning > 100,000 per year (65.64%), and receiving medical care in urban or suburban areas (91.12%). Most were married (79.5%), followed by single (8.1%), divorced (5.0%), long-term partner (3.1%), and widowed (1.9%). 197 (73.78%) reported using some type of local or systemic hormone therapy, with 64.4% reporting systemic use. The majority (59.2%) also reported using non-hormonal alternative treatment. Reasons for MHT non-use included concern for cancer risk (70%), personal cancer history (2.8%), and other health problems (2.8%). Participants receiving systemic MHT had significantly lower MRS scores compared with non-users, while distress scores were similar between groups; 20.85% percent of women reported that menopausal symptoms were not discussed prior to RRSO. Conclusions: Among surgically menopausal BRCAm, 35.6% are not using MHT, and guideline-concordant counseling is inconsistently delivered. These findings highlight the need for improved provider and patient education and development of evidence-based, patient-facing interventions to reduce inappropriate non-use of systemic MHT and mitigate the long-term health consequences of estrogen deprivation.

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