Had chemo, double MX, Rads and now on tamoxifen, what next?

Hi, Annie.  Welcome to the club no one wants to belong to.  My situation is/was similar to yours.  I was 49 when diagnosed and after 2nd chemo, no more periods.  I then had surgery and after recovery from surgery, I was given a blood test for Estradiol which showed a level low enough to be commensurate with menopause.  I was then given the AI over Tamoxifen.  Have you been given the Estradiol blood test yet?  I would definitely ask for that.

You are correct about the study above.  AI's work differently than Tamoxifen.  AI's block the production of estrogen in the aromatase process in the body's fat cells.  Tamoxifen blocks the estrogen receptors on any cancer cells.  Therefore Tamoxifen can block estrogen that's coming from it's usual source--the ovaries--as well as that produced in the aromatase process.  AI's won't work for pre-menopausal women because they won't block estrogen from the ovaries.

I remember that two years ago, my onc was thinking about 2 years on Tamox and then 3 on an AI, but I believe that thought process is superceded now by the study you quote and others.  

My onc did not seem to think my menopause was impermanent.  My OB/GYN said, however, that ovaries can sometimes start producing again in a woman's early 50's.  I got her to remove mine.  However, it took me about a year to get into this OB/GYN and get lined up for the procedure.  It's not something that the onc's endorse much anymore.  I wanted to go to that level of precaution, and I do feel a difference in that I am finally getting some hot flashes that I did not have before, yet I was supposedly in menopause from about October 2011.

Hope this helps.  

Annie, I turned 48 a few weeks before my BMX. I was not yet in menopause. My doc was one of the docs running the big trial of tamox vs AI. He recommended removing my ovaries to put me in menopause for good, so I could go straight on the AI. There are downsides to the ooph, but in my case we figured the plusses outweighed that downside. I would definitely discuss this option with your onc.

The reason you can't use the AI if you still produce estrogen in the ovaries is that the AI does not block this estrogen going to the cancer cells. Tamoxifen is the only drug that does that. Once your ovaries are gone or have shut down, the estrogen in your body is the result of testosterone (produced in your adrenal glands) being converted to estrogen. The AI blocks this conversion.

Also, it is standard guide line not to do routine scans etc. However, my doc does a full blood panel before each visit to make sure my overall health is holding steady and to watch for too much calcium in the blood stream (can signal bone mets) or unusual liver function. He also does tumor markers, although they are unreliable. In addition, he gives me a chest X-ray and a liver ultrasound once a year as part of routine follow-up. All these are fairly low-invasion methods.

Annie: My doctors (both Gynecologist and ONC) said the average age of menopause should be around 51-52,  also in most of the cases the daughters should get into menopause at the same age as moms.