Should you take HRT after ovarian cancer?

Q: I had a hysterectomy and oophorectomy in 1993 because of ovarian cancer. At that time I was taken off hormone replacement therapy (I had been on it for two years due to an early menopause at age 37). About 1½ years later, my doctor suggested resuming HRT, and about ½ year after that I developed a recurrence. My doctor feels that it was not related. I am not on HRT, at my request, but I’m very confused about my best treatment option. I am at risk for osteoporosis. Your opinion and any suggestions would be greatly appreciated.

A: I am sorry to hear of all that you have been through. I agree with your doctor that the recurrence was unlikely to be related to the estrogen replacement therapy, but I certainly can understand your reluctance to go back on it. I trust you are doing all the good conservative preventive measures for osteoporosis – getting in at least 1,500 mg of calcium a day, 400 units of vitamin D and lots of exercise, and of course, not smoking.

There are other medical options for osteoporosis protection. Fosamax, or alendronate, in the 5-mg daily dose, is approved for prevention (the 10-mg daily dose is for treatment of established osteoporosis). Evista, or raloxifene, might also be a very good drug for you. It acts in certain tissues in the body like estrogen, so that it protects against osteoporosis, and gives you a favorable lipid profile But in other tissues such as the breast, it acts like an estrogen blocker, so that it actually lowers the risk of getting breast cancer. Unfortunately, there is no data available about women with previous ovarian cancer, but since raloxifene blocks estrogen’s action at the uterus too, I would think it should be safe for you.

Of course, we don’t have a lot of data on the effects of natural substances such as soy and flaxseed on ovarian tissue. They contain the phytoestrogens, isoflavones and lignanes, and do have some protective effects on bones. Some women find them helpful for symptom relief as well.

If vaginal dryness is a problem, you would certainly be a candidate for something like the Estring, a soft rubber ring coated with estrogen placed in the vagina and left there for three months at a time. It very slowly releases estrogen to the vagina, and has been shown to produce no elevation at all of blood estrogen levels – its effect is totally local.

Fortunately, in this country we are beginning to address the needs of cancer survivors, and we need to pay attention to issues like osteoporosis prevention in younger women.

What you have in your mind?