Oophorectomy and Al vs. Tamoxifen

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pataj
pataj Member Posts: 2
edited June 2014 in IDC (Invasive Ductal Carcinoma)


I have a history of ovarian cyst and had an ovary removed at 28. At 38 had a hysterectomy which left behind one ovary, cervix and very small flap of uterus above the cervix. Have had issues with endometriosis as well. At 42 I still has a very slight period and am not considered menopausal. Just went through bilateral mastectomy for IDC. No radiation....very wide margins.....no chemo recommended. Oncologist was quick, maybe too quick, to recommend Tamoxifen! has anyone had experience with oophorectomy? Just seems to make more sense....less side effects....

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  • FairyDogMother
    FairyDogMother Member Posts: 253
    edited November 2013


    Pataj, I'm 36 years old and my oncology surgeron and oncologist both recommend an oophorectomy. I will be getting one after chemotherapy don't know if it will before radiation. Even if when I get my oophorectomy I still have to take estrogen blockers. I just won't be taking Tamoxifen. You might want to ask your doctors about the other hormonal drug you will be taking.

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  • Moderators
    Moderators Member Posts: 25,912
    edited November 2013


    pataj, welcome to Breastcancer.org! We're sorry you have to be here, but glad you found us!


    There are two articles on our Ask The Expert section that you may find interesting to read. They're called Hysterectomy instead of tamoxifen? and Why get an oophorectomy?


    We hope this helps!


    The Mods

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  • mdg
    mdg Member Posts: 3,571
    edited November 2013

    I was 45 at dx and still had periods.  I did chemo and the periods stopped.  I went on tamoxifen.  My gyno discovered an ovarian cyst on me and it would not go away.  I had an oophorectomy earlier this year.  I am still on tamoxifen.  Regardless of the oophorectomy my doctors are keeping me on tamoxifen.  Now that I am for sure post menopausal they wanted to switch me to an AI but my dexa scan revealed severe osteopenia so I will stay on tamoxifen.  Did your doctor indicate you would not have to do any oral medication if you do an oophorectomy?  It is my understanding that most people stay on oral meds regardless of oophorectomy.  Just curious what your doctor said....


     

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited November 2013


    pataj - several things - oophorectomy is not without side effects. Surgical menopause is a sudden change for the body, and the long term side effects of being without estrogen starting from a pre-menopausal age are potentially impactful. The reason pre-menopausal women are put on Tamoxifen is that it does allow estrogen to circulate and continue to do the positive things it does. The drug blocks the hormone receptors on breast cells to protect from recurrence, or a new primary estrogen driven cancer. Estrogen has protective qualities for bone and heart health, which is why Tamoxifen is prescribed for pre-menopausal women. I had a total hyst/ooph at 45 and went from a healthy cholesterol level in the 150s to 260, without bad eating habits or weight gain. I was put on a statin to try to get my cholesterol under control - I have just recently just discontinued it after being on it for several years. I also developed osteopenia very quickly. My osteopenia worsened measurably after chemo and six months of an aromatase inhibitor. I am now on Prolia injections and they have improved my bone health, but again I am having to treat a side effect of surgery and drugs with another drug, which has potentially negative side effects of its own. I had, and continue to have, brutal hot flashes that have caused issues with sleep and general comfort. The flashes have not dissipated in the 12 years since the hyst/ooph, chemo and Femara have not improved them, or worsened them - I have multiple throughout the day and night, and they are severe enough that other people can tell that I am having them, and they interfere with my ability to sleep and function. Should you decide to go ahead with an oophorectomy, discuss whether your doctor plans on an aromatase inhibitor to suppress your remaining estrogen and fully understand the side effects from that class of drugs, have a baseline DEXA scan if you have not already, and have your cholesterol checked at regular intervals.

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  • pataj
    pataj Member Posts: 2
    edited November 2013


    I have an appointment with my GYN. Oncologist is really not willing to discuss any alternatives to Tamoxifen. I get that it is pretty much standard proceedure at this point and the OncaDX came back with a 92% survival rate with the 5 years of tamoxifen....but if you can improve those odds....I guess it just scary that you really do not know if the drug is working or not until you have another estrogen receptor cancer appear!! Thanks for everyone's input!

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  • 4sewwhat
    4sewwhat Member Posts: 2,093
    edited December 2013


    Bump!!

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  • stephaniegee
    stephaniegee Member Posts: 81
    edited December 2013


    I'm confused, does having an oophorectomy cancel out Tamoxifen or would Tamoxifen still need to be taken?


    It is my understanding that even with the removal of breasts and ovaries the cancer can return and can come back in the bones, liver, etc. Does Tamoxifen help prevent this, or is only useful at blocking the cancer from returning to breasts?


    Do you know what I mean?? Not sure if I'm explaining it right...

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  • edwards750
    edwards750 Member Posts: 3,761
    edited December 2013

    I don't know for sure stephaniegee; maybe someone else does but we all know that cancer can recur in the lungs, bones, liver, etc., so removal of the ovaries will eliminate the fear of OC but you are right but what about the other areas? I am post-menopausal and was initially taking Arimidex but when I developed osteoporosis my dr switched me to Tamoxifen. I had no real issues with Arimidex but Tamoxifen has a number of side effects. None of them are unmanageable but they are still uncomfortable...hot flashes, weight gain, hard to concentrate, etc. Obviously the "good" outweighs the bad but some days I would love to toss them out the window. I think your question should be directed to your Oncologist. Diane

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  • rgiuff
    rgiuff Member Posts: 1,094
    edited December 2013

    I would think that if you are premenopausal,  and can keep your ovaries, you will be better off. Tamoxifen does have its side effects,  but they are reversible once discontinued. And the side effects have to be more tolerable than the effects of surgical menopause!  Removing ovaries slashes levels of not only estrogen, but other important hormones as well, which could have major impact on sex life, cardiovascular system, bones, skin, sleep, joint comfort etc.  And having gone through natural menopause recently, with all the above areas affected, I would prefer to have remained premenopausal for much longer! And you would still need to take tamoxifen or an AI, to block the small amts of estrogen made in adrenal glands and fat cells.  This could feed the cancer cells, whether they are in the breasts or circulating around the body potentially getting to bones, liver etc. Research well all the potential side effects of this surgery as it is irreversible. If you can just take tamoxifen,  you will block estrogen from getting into cancer cells, but still have it getting to parts of your body that benefit from it. 

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