Estrogen replacement after ovary, uterus removal

DEAR DR. ROACH >>

My question concerns the benefits and risks of taking oral estrogen following removal of ovaries and uterus due to my concerns about ovarian cancer. I have recovered well from having this laparoscopic-robotic surgery. I am a healthy 69-year-old with a family history of ovarian cancer (mother) and breast cancer (mother and sister). The genetic testing ordered by my primary care doctor was negative for BRCA1 and 2 mutations. The specialist recommended removing the uterus at the same time since it would give me the option of taking oral estrogen, which could have many benefits. I have not decided on taking estrogen yet. I am concerned whether that would increase my risk of breast cancer and if there are other risks to consider.

— B.W.

DEAR READER >>

There are some risks and some benefits to taking estrogen, but no authorities recommend taking estrogen in order to prevent future problems. Estrogen should be considered as treatment for several conditions, probably the most common of which is the hot flashes of menopause.

An increased risk of breast cancer is clear among women taking combined estrogen and progestins; however, there seems to be little or no risk among women who take estrogen without a progestin (called “unopposed estrogen”), which is normally only prescribed to women who have undergone hysterectomy. One large study showed even a reduced risk of breast cancer.

Other risks include an increase in blood clots. The association between estrogen and heart disease remains uncertain, but it appears that women over 65 have a greater risk from heart disease than women within a few years of menopause (who may have a reduced risk of heart disease with unopposed estrogen). Estrogen reduces the risk of osteoporotic fractures and of colon cancer as well as diabetes risk.

DEAR DR. ROACH >> My sister gets flu shots without preservatives and has been unable to find out if any of the COVID shots available are preservativefree. What does your research say on this subject? She won’t get the shots until this is an option.

— L.B.T.

DEAR READER >> Neither the Pfizer nor the Moderna vaccine contain preservatives. I hope this reassures her. The new variants of the virus are much more easily transmissible. More than 99% of people admitted to the hospital with COVID-19 now are unvaccinated, as the vaccine offers very high protection.