Testing hormone levels: Before | During | After treatment

JohnSmith · August 2014

I had a couple simple questions for Premenapausal women whose cancer is Hormone receptor positive and require Tamoxifen and/or AIs and are undergoing ovarian suppression.

1. Did you get your hormone levels tested BEFORE starting treatment to get a baseline number?

2. After Hormone Therapy begins, how often are your hormone levels tested?
- once a month, every few months, etc?

Rosiesride · August 2014

hey john...I am finishing up rads next week and my MO wanted hormone levels checked before deciding what meds to go on. I am 54 and had not been in menopause at the start of chemo back in February. Just had my levels checked a few days ago...waiting for results and will have appointment with MO soon to start the hormone therapy...whatever it will be! Not sure how often levels are checked. Rosie

JohnSmith · August 2014

Sounds good. Please let me know what you find out.

SpecialK · August 2014

johnsmith - AI drugs are only prescribed for those firmly in menopause (known prior to dx or those who have had a hysterectomy/oophorectomy), or to those pre-menopausal women who are receiving ovarian suppression meds like Lupron. Tamoxifen is pretty much prescribed for those who were/are pre-menopausal prior to treatment, but can also be used by post-menopausal women who cannot take AI drugs for tolerance or co-morbidity reasons. Hormone levels are not usually checked on those taking AI drugs, to my knowledge, as the assumption behind prescribing this class of drugs is that you have very little circulating estrogen by virtue of being post-menopausal. Aromatase inhibitors suppress the mechanism of androgen conversion to estrogen so I am not sure if traditional hormone level testing can ascertain circulating estrogen levels. Hormone level testing seems to be done primarily for those whose menopausal status is in question. Doing any hormone level testing for women taking Tamoxifen would be pointless as the drug allows circulating estrogen. The point behind giving this drug to pre-meno women is to allow circulating estrogen to do the positive things it does (benefit heart and bones) while blocking the receptors on breast cells. Tamoxifen is not metabolized by some individuals, so can be ineffective, and there is a metabolizing test - linked below - but there is some question about the accuracy and reliability of the test.

http://emedicine.medscape.com/article/1762071-overview

lekker · August 2014

JohnSmith - I assume you're asking about this as a way to see if endocrine therapy is working in a given individual. Unfortunately, even if you found out that circulating estrogen levels were at zero, cancer cells are constantly mutating and might've found another way to thrive even in the absence of estrogen. There are many cell signalling pathways in cancer and only a few are currently known and targeted (ER, HER2, mTOR, etc) and many more are being studied. I'm not a scientist, but it seems that cancer, much like HIV and the "triple cocktail" treatment, needs to be shut down from multiple angles at once. Sorry that I went off track from your original question, just wanted to give some background.

JohnSmith · August 2014

Yup, sounds like the direction for my wife is ovarian suppression with hormone therapy. Initially
on Tamoxifen for a couple months, until the suppression kicks in, then
to an AI for 5 years (perhaps another 5 years... data from the next
phase of the SOFT & TEXT clinical trial will tell if it's warranted... Probably though).

I recall reading a post about someone's estrogen levels spiking up after taking meds (perhaps it was from Tamoxifen - don't recall the thread now). To me that sounded counter intuitive to have levels spiking for HR+ BC since it's fueled by hormones, thus one of the reasons for my question.

Thanks

lekker · August 2014

I remember my MO saying that AI's can shift premenopausal ovaries into overdrive even with OS. It's the body's way of trying to maintain balance. I don't know how common that reaction is, but I got the feeling that it was pretty rare and a woman would show symptoms of too much estrogen (as opposed to the expected SE's of estrogen deprivation). Let us know what you find out. Even though I had an ooph, I elected to stay on tamoxifen for a while to protect bones and heart.

Testing hormone levels: Before | During | After treatment

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