Dr. Roach: Assessing estrogen replacement after ovary and uterus removal

Keith Roach
To Your Health

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.

Dr. Keith Roach

B.W.

Dear B.W.: 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: I have a question about routine bloodwork – including D and magnesium levels – that is usually part of a yearly physical. In the morning I take a multivitamin and calcium supplement with D3 and magnesium. Should I stop taking any or all of these a few days before fasting bloodwork to get an accurate reading?

S.M.

Dear S.M.: Most people don’t need to take magnesium and calcium supplements, but if your doctor has recommended it, then you absolutely do want to take it when you get your blood levels checked. Your doctor wants to know whether the doses you are taking are getting you into the desired level. The same is true with blood pressure and diabetes medicines: The goal isn’t (usually) to see whether you still have the condition, it’s to be sure the doses are correct.

Unless your doctor tells you differently, you should come in for blood tests taking your medication the same way you always do.

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 preservative-free. What does your research say on this subject? She won’t get the shots until this is an option.

L.B.T.

Dear L.B.T.: 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.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.