Afraid about incomplete ovarian suppression

stephilosphy00

Hi ladies, I am very struggling with this now and my onc is not able to give me answer yet!

I have been on Lupron for 1.5 years and Aromasin for 8 months. My estradiol was 17 when I started Aromasin, now it is 21 (checked the day Lupron was due)! I know Lupron is working but my E2 level is definitely not low enough! Am I in menopause now? I have seen many places online E2 < 28-32 can be considered postmenopausal or it has to be under 10? I am just afraid I am under incomplete ovarian suppression and AI is not working well for me now.

I am only 31, just got married and have no plan for baby. Should I consider oophorectomy to be in real menopause so I can keep being on AI?

Thank you so much! I am not able to find answer anywhere else, hopefully anyone could give me some advice! Thank you very much!

NettaGER

Your estradiol level is indeed too high. One can reach values below 5, if the combination of chemical ovarial ablation and AI is working properly. What does your MO say? There are other active ingredients available, maybe something else is working better. I get Trenantone and Letrozole and reach values below 5 at the end of the 12 week cycle, even though I am heavily overweight.

stephilosphy00

Thank you for your reply! I haven't seen my doctor yet, I just got the result back. I have taken Aromasin for 8 months, I am scared it is not working for all this time since my estradiol is not low enough (15-20), any thoughts? I do have a lot of SEs from Aromasin.

Cpeachymom

steph- I am on Lupron plus Tamoxifen because I was told there is a chance of “breakthrough” estrogen even with the Lupron. You’re correct, the AIs can’t handle the extra estrogen. This could also be a possibility for you? At least it puts off the decision of oophorectomy while giving you protection

Piggy99

This is something you need to thoroughly discuss with your doctor. The oophorectomy decision is a lot trickier in your case, being early stage, than in the case of someone with stage IV.

You still have a pretty good chance of living to an old age, and removal of ovaries more than a decade before you would be expected to enter normal menopause carries its own risks, beyond the obvious infertility consequences (osteoporosis, higher risk of cognitive impairment, etc).

Tamoxifen with ovarian suppression is also an effective therapy for reducing recurrence, and your doctor should be able to help you weigh the risk of recurrence against the risk of entering permanent menopause at 31. It's a tough decision, for sure.

stephilosphy00

Thank you for all your replies! I met another pre-menopausal women who is on Zoladex + Arimidex for more than 3 years. She said her Estradiol level is always about 20, while her doctor never thinks there is a problem. She gets treatment at MD Anderson. I am very confused why there is no straight answer about that.

Rambros

I had the same worries myself so I had the surgery after a year on shots, but I was 37 and done having kids. That would have been a harder decision if I was younger or thought there was any chance I’d want another biological baby.

Maybe ask your doctor to test the estrogen level mid way through a shot cycle (perhaps the estrogen level only creeps up to 21 in the last day or 2 before you get the next shot)? Or find the names of expert doctors on the issue (the names listed in research articles) and email them

stephilosphy00

Hi Rambros, thank you for the idea! I already message my onc to ask for another hormone test midway next month!

stephilosphy00

I just wonder why there are no clear research on it!

stephilosphy00

Onc will let me go back to Tamoxifen plus Lupron after my upcoming reconstruction next week, she agreed I shouldn't take the risk of that extra estrogen.

stephilosphy00

Did a sensitive estradiol test st Labcorp earlier this week which came back at 2.6pg/ml! Big relief!

FarAwayToo

steph, are you staying on Aromasin then?

stephilosphy00

My estradiol level has been under 5 pg/ml since my onc ordered the sensitive Estradiol test (LS/MS/MS) instead of the regular one. Yes, I have been on Aromasin and monthly Lupron shot since July 2017, I actually started Lupron when I was diagnosed back in late 2016.