Hormone replacement therapy in healthy BRCA1 and 2 mutation carriers after risk-reducing salpingo-oophorectomy: A 5 Ws and 2 Hs practitioner toolkit

: The management of menopausal symptoms in healthy women carrying BRCA1 or BRCA2 mutations is clinically challenging, particularly in those undergoing risk-reducing salpingo-oophorectomy. This preventive surgery is recommended because it lowers the risk of ovarian cancer, halves the risk of breast cancer and decreases the risk of all-cause mortality; nevertheless, it induces premature menopause, which does have health consequences. Given the negative impact of premature surgical menopause on BRCA1 and 2 mutation carriers' health and quality of life, this population could greatly benefit from hormone replacement therapy. However, its use in this context remains limited, mainly due to patients' and physicians' concerns about its oncological safety. Current evidence suggests that a short course of hormone replacement therapy does not increase breast cancer risk in BRCA mutation carriers after risk-reducing salpingo-oophorectomy. Therefore it can be proposed to BRCA mutation carriers until the age of natural menopause. This review represents a guide to daily practice by answering questions - the 5 Ws (why, when, who, what and where) and 2 Hs (how and how much) - to help physicians in their counselling on hormone replacement therapy and its prescription for this special population.