Dealing with premature menopause in women at high-risk for hereditary genital and breast cancer

Risk-reducing salpingo-oophorectomy is the mainstay of ovarian cancer prevention in BRCA mutation carriers. However, premature menopause exerts many short and long-term consequences on the individual health that are preventable with a tailored approach. Even though our level of knowledge on BRCA1 and -2 mutation carriers is still in its infancy, the basic principles governing the management of menopausal symptomatology and the prevention of diseases should be applied, including the use of hormone replacement therapy (HRT), approximately until the age of 50. Indeed, short-term HRT significantly ameliorate quality of life and symptoms associated to vulvo-vaginal atrophy, without displaying an adverse effect on oncologic outcomes in BRCA1 and BRCA2 mutation carriers without a personal history of breast cancer. Premature menopause affects significantly also bone health, cardiovascular parameters and cognition. A standard of care is required in order to identify those women at higher risk of developing chronic conditions at midlife and beyond. Appropriate counseling on both hormonal and non-hormonal treatments is an essential part of a shared decision on the most effective management of women at high-risk for hereditary genital and breast cancer.