Gynaecological oncology: HRT after risk-reducing oophorectomy: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Gynaecological oncology: HRT after risk-reducing oophorectomy

Sample item

A 40-year-old BRCA2 carrier without breast cancer has risk-reducing salpingo-oophorectomy with her uterus preserved and has severe vasomotor symptoms. What is the advice?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Hormone therapy is acceptable until about the age of natural menopause, with a progestogen for endometrial protection

Surgical menopause at a young age raises the risk of osteoporosis and cardiovascular disease, and in BRCA carriers without breast cancer hormone therapy up to about age 51 does not appear to negate the breast cancer protection from oophorectomy. A progestogen is added when the uterus is present. Women with previous breast cancer are managed differently.

Option by option

  • A. No treatment is possible

    Effective treatment exists.

  • B. Hormone therapy is absolutely contraindicated

    It is not absolutely contraindicated in unaffected carriers.

  • C. Hormone therapy is acceptable until about the age of natural menopause, with a progestogen for endometrial protection (correct)

    Correct. Replacement until natural menopause age with progestogen cover is acceptable.

  • D. Unopposed oestrogen is recommended with an intact uterus

    Unopposed oestrogen with an intact uterus causes hyperplasia and cancer.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is C, Hormone therapy is acceptable until about the age of natural menopause, with a progestogen for endometrial protection. Surgical menopause at a young age raises the risk of osteoporosis and cardiovascular disease, and in BRCA carriers without breast cancer hormone therapy up to about age 51 does not appear to negate the breast cancer protection from oophorectomy.

Why is "No treatment is possible" not the answer?

Effective treatment exists.

Why is "Hormone therapy is absolutely contraindicated" not the answer?

It is not absolutely contraindicated in unaffected carriers.

Why is "Unopposed oestrogen is recommended with an intact uterus" not the answer?

Unopposed oestrogen with an intact uterus causes hyperplasia and cancer.

What concept does this question test?

It tests Gynaecological oncology: HRT after risk-reducing oophorectomy in OBG. A progestogen is added when the uterus is present. Women with previous breast cancer are managed differently.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gynaecological oncology: HRT after risk-reducing oophorectomy?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.