BAD peri-meno symptoms--adding HT to the mix??

Anonymous

BAD peri-meno symptoms--adding HT to the mix??

beasgirl

Hi all. I'm in a decision-making stage. I have a history of bc, 10 years ago did left mastectomy, chemo, herceptin. New DCIS in R breast, have had 2 excisions, and now looking at radiation and HT. The cancer was stage 0, I forget the grade, but it was small, about 1 cm. There is a history of early bc in my family but no BRCA.

I'm 50. For at least 5 years, I've been struggling with bad perimenopausal symptoms, especially hormonal migraines and depression. Since my onc nixed HRT, I finally landed on a combination of lyrica (pregabalin), wellbutrin (bupropion), and effexor (venlafaxine) that seems to work pretty well. Anybody who's gone through struggles with finding the right meds for depression etc. will understand what a long and tough process this is.

Now I'm looking at tamoxifen, which not only causes migraine, depression, etc., but can't be taken with wellbutrin; or some kind of AI, which I think isn't so effective for perimenopausal women, unless you shut down or remove your ovaries, which ALSO has awful menopausal symptoms.

Just wondering if anybody has had similar struggles and what your approach has been. Happy to hear all stories, positive or negative--I just really have no idea where to go with this. I'm going back to school for clinical mental health counseling, and I'm about to start an internship--finally felt like I was getting my shit together--I SO don't want to spend another 5 years dealing with horrible hormonal symptoms.

GreenHarbor

Hi beasgirl from a fellow MA resident! I hit menopause at 48 or so. I had hot flashes that I treated with Estroven (contains black cohosh, which has a plant estrogen in it). When I was diagnosed with breast cancer at age 52, I had tostop taking that. I started on anastrazole 3ish weeks post op. The hot flashes increased in severity and frequency, and started waking me up at night, which in turn aggravated my pre-existing insomnia. My oncologist started me on 37.5 mg of Effexor. This almost immediately eased the hot flashes. Within a couple of weeks, my anxiety (what I would describe as intermittent and fairly low grade, with occasional situational spikes) was MUCH better. My husband and boss both noticed the difference. My oncologist had me start on the anastrazole as she felt it was the most effective AI. Other than the hot flashes, I have drier skin and some mild hair thinning. I have osteopenia, which I'm treating with increased calcium intake and weight bearing exercise. I think it's impossible to predict who will experience side effects and how bad they'll be. I'm on another thread with women who started AIs and tamoxifen over the winter. Many of them started at a partial dose, working gradually up to a full dose over time, with the thought that a gradual increase would allow the body to adjust. I started at a full dose right away, but you may want to consider that. Once I finished radiation treatments and the accompanying fatigue, I joined a gym (first time in my life!). I find the exercise helps me have more energy and feel better. I would be candid with your oncologist about your concerns, and also with your mental health clinician. Good luck with whatever you decide!

AliceBastable

I'm taking Tamoxifen (started late December) and I haven't gotten any headaches, nor have my moods changed. It affects everyone differently (some, not at all), and you can't know until you try it. I think there are threads here about takingTamoxifen and anti-depressants, and which ones work best with it.

tmonster85

I've been on tamoxifen for about 1/1/2 years. I feel like it may be causing bone/joint pain. I also have fibromyalsia and that causes a lot of nerve pain. I was on Lyrica for the fibro prior to my cancer treatment, my oncologist said Lyrica decreased the tamoxifens effectiveness. My research disagrees with this. Is anyone on here on both? Also is anyone experiences the bone/joint pain and think its the tamoxifen. Also, I was not given a bone density scan prior to the start of tamoxifen. My research shows they should have done a baseline and then do one at least every 2 years.

Beesie

"or some kind of AI, which I think isn't so effective for perimenopausal women, unless you shut down or remove your ovaries"

Just want to make the point that AIs are only given to women who are in menopause, either naturally or as a result of ovarian suppression or ovary removal. So if you are in perimenopause but not yet menopasual, you will not have the option to take an AI unless you shut down or remove your ovaries.

That said, to AliceBastable's point, everyone reacts differently to anti-hormone drugs. Some people experience many side effects affecting quality of life, some people experience just a few manageable side effects, and some people barely notice that they are on the meds. Until you try it, you won't know how you are affected.

I hesitate to even mention this, but if you were to have a right breast MX, you will effectively have had a bilateral and anti-hormonal therapy will not be required. Your first diagnosis was ER-/PR-, so no anti-hormonals there, and your second diagnosis is DCIS, for which anti-hormonals are not required after a MX (because DCIS does not metastasize and after a MX, the risk of a local recurrence is so low). So that is another option.

Rah2464

tmonster please do get a bone density scan asap. While Tamoxifen taken post-menopausally can help with bone density retention, it can be a completely different story if you are pre. I was pre and I lost a lot of bone mass in two years. As to the bone/joint pain all antihormonals can cause that but I do experience it with Tamoxifen primarily in my shins and feet for some reason.