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Menopause: Tos and BRCA mutation, mitral valve regurgitation, sleep disorders


1. I am 50 years old and have been in surgical menopause for 7 years due to the BRCA mutation. Can I have hormone therapy?

The topic is very delicate and the subject of studies. Second Alessandra Graziottindirector of the H. San Raffaele Resnati Center for Gynecology and Medical Sexology in Milan, “although recent studies indicate that HRT does not appear to compromise the protective effect of salpingo-oophorectomy on the breast, it is necessary that the indication and type of treatment are jointly evaluated by the trusted oncologist and the gynecologist expert in hormonal therapies so that the decision is well thought out and personalized for the individual woman, of whom the risks and benefits of each option must be well assessed”.

In particular: estrogen itself does not appear to increase the risk of breast cancer in women carrying the BRCA1 mutation who have undergone salpingo-oophorectomy; the safety of progesterone, essential for the protection of the endometrium, requires further checks. On the other hand, when the woman is also subjected to hysterectomy the indication of progesterone disappears, and with it the potential risk for the breast.

In summary, says Graziottin: researchers remain cautious in consideration of both the high baseline risk in BRCA1 and/or BRCA2 carriers, and the absence (for now) of controlled studies that have definitively evaluated the role of hormone replacement therapies in this group of patients. Each decision must therefore be personalized.


2. Mitral regurgitation: does menopause have anything to do with it?

The specialists at Humanitas Gavazzeni explain that the pathologies affecting the mitral valve are, in most cases, caused by the wear and tear of the valves which can be generated with the passing of age. But this degenerative disease can affect young people, also due to rheumatic fevers bacterial infections, or endocarditis, which affect the tissue that lines the cavities and valves of the heart. Furthermore, the mitral valve can be damaged following pathologies of the left ventricle as a consequence of myocardial infarction (ischemic mitral valve) and, although in rare cases, it can have a congenital origin, following a defect, that is, present from birth.


3. Sleep disorders in premenopause: what to do?In the period preceding menopause, when after the age of 40, the body prepares for the end of the fertile age, about a third of women complain of frequent episodes of insomnia. In addition, you begin to feel other symptoms, such as hot flashes, sweating, weight gain, anxiety, and depression. And the perimenopause. Vincenzo Tullo, neurologist and head of the Headache Clinic at Humanitas, explains that insomnia can be linked to anxiety and depression caused by hormonal alterations, with a drop in estrogen, typical of this period. Among the nutraceutical substances most used to combat insomnia and any other symptoms typical of the premenopause period (and also menopause), there is SOYBEAN with its compounds called isoflavones, flax seeds, and alfalfa. Dr. Tullo recommends following a diet rich in fresh fruit and vegetables, preferring cruciferous vegetables (such as, for example, cabbage and turnip greens), because they are rich in antioxidant substances that help the metabolism. Furthermore, attention must be paid to the quantity and quality of food, avoiding large portions, fatty foods, fried foods, excess red meat, cheeses, sauces, and canned foods.

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