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Ask an Expert: Q&A

Ask An Expert: Q&A | For health professionals 25 Aug 2021
Hands up ask a question Ask an Expert 2

'Ask an Expert: Q&A' is a place for health professionals to ask our team of experts about cases seen in work and/or clinical practice.

Questions can cover a wide range of women’s health topics and will be answered by an expert in the multidisciplinary Jean Hailes health professional team. Read more about this series or learn how to ask a question here.

If you are not a health professional but have your own health question, visit our 'Ask Dr Jean' pages.

Answering your questions for this edition of 'Ask an Expert: Q&A' is Dr Sonia Davison, Jean Hailes endocrinologist and president of the Australasian Menopause Society.

Question 1

Can you give HRT [MHT] to women with a first-degree relative with breast cancer?

Jean Hailes endocrinologist Dr Sonia Davison

Answer

From Jean Hailes endocrinologist Dr Sonia Davison

An expert speaking on this topic at a previous World Congress on the Menopause in Vancouver discussed that a family history of breast cancer is not necessarily a reason to avoid hormone therapy use. The issue is one of risk. If there are other risk factors, such as dense breasts, or multiple close relatives with breast cancer, or BRCA1/2 gene mutations present (etc), breast cancer risk increases.

The Australasian Menopause Society has an information sheet dedicated to risks and benefits of MHT (menopausal hormone therapy), which details these risks further. There are also online tools for women to assess their overall breast cancer risk (even in the absence of MHT use).

The studies to date suggest that MHT regimens associated with the lowest risk of breast cancer contain progestogens that are close to endogenous progesterone (dydrogesterone and micronised progesterone).

Doctor with patient

Question 2

Is it safe to use vaginal oestrogen in a patient with past history of VTE?

Answer

From Jean Hailes endocrinologist Dr Sonia Davison

Past venous thromboembolism (VTE) is no contraindication to vaginal oestrogen use, as there is very little systemic hormone absorption. The pessary or cream are used nightly, vaginally, for 2 weeks, and then twice weekly thereafter.

Question 3

In a young woman who has had oophrectomy and colectomy for bowel cancer but no hysterectomy, will continuous combined transdermal MHT cause any bleeding?

Answer

From Jean Hailes endocrinologist Dr Sonia Davison

Whenever the uterus is present and hormone therapy is used, there is a risk of bleeding. Young women who have recently had periods are more likely to have bleeding when hormone therapy is introduced, even if the regimen is continuous combined MHT. It is also common to have bleeding within the first three months of hormone therapy use. If bleeding continues after three months of use, it is worthwhile changing to sequential progestogen use to plan for a regular withdrawal bleed.

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