Tamoxifen and menstruation

Is it possible to get a second opinion from a gyn onc? I had irregular periods on T, but I think regular periods are fine because it allows the uterine lining to slough off. I did speak to a gyn onc and he said if the uterus is proven benign by a D&C there is no reason to remove it. After a year of TVU's biopsies and incredibly heavy periods I opted for a D&C with an ooph. Honestly uterine cancer is pretty rare and generally the treatment is a hyster. Ovarian cancer is a whole other issue. Have you tested negative for the BRCA genes? If so your risk for ovarian cancer is low as well. However your onc might suggest ovary removal or suppression if your BC is estrogen positive. I definitely would not rush into anything until you have discussed with your onc.

Hi Faye -

I am 43 and have been on tamoxifen for 18 months - and had mostly regular periods that entire time. There have been a few stretches of two months without a period, but my OB/GYn and my oncologist both said that as long as I was menstruating somewhat regularly, there was no need for concern, but that tamoxifen can make periods irregular for some women, and stop it entirely in other women (mostly those close to natural menopause, is my understanding).

My Ob/Gyn, who is herself on tamoxifen after BC, said no additional cervical screening was necessary as long as I was having semi-normal periods (as the above post points out, she said that the monthly shedding of the endometrium is a good thing and protective against cancerous changes in the lining - which is why it's mostly postmenopausal women at higher risk for endometrial cancer, not premenopausal.

A hysterectomy does have significant side effects - especially if you're pre-menopausal and when accompanied by an oophorectomy, and I would be concerned about a doctor who said otherwise -- though your doc might very well be right about your early age of diagnosis suggesting high risk, but I would also look for a second opinion. Look for information on the SOFT trial - where ovarian suppression plus tamoxifen, or an AI or tamoxifen alone were compared for recurrence rates. http://www.nejm.org/doi/full/10.1056/NEJMoa1412379...

Did you have chemo initially? The study showed that women who needed chemo initially fared better with ovarian suppression + hormonal drugs than those who just received tamoxifen, but among women who didn't need chemo initially, there was no difference.

From the discussion "Patients who receive a diagnosis of hormone-receptor–positive breast cancer when they are younger than 35 years of age are a subgroup considered to be at higher risk for adverse outcomes than are older premenopausal women, on the basis of retrospective analyses of data from IBCSG and U.S. Intergroup trials.17,18 The results observed in this subgroup in SOFT add to the evidence that ovarian suppression plays an important role in younger premenopausal patients.13-15 Among the women younger than 35 years of age, breast cancer recurred within 5 years in approximately one third of the patients assigned to receive tamoxifen alone but in one sixth of those assigned to receive exemestane plus ovarian suppression.

Any benefit from ovarian suppression must be weighed against the adverse effects. Adding ovarian suppression to tamoxifen resulted in increased adverse events — most notably, menopausal symptoms, depression, and adverse events with possible long-term health implications such as hypertension, diabetes, and osteoporosis. When exemestane is combined with ovarian suppression, adverse sexual, musculoskeletal, and bone-density effects are more frequent than with tamoxifen plus ovarian suppression.10"

Faye, I think you should find a new GYN, one who understands tamoxifen and cancer and works closely with your MO. Can you get a referral from your MO? Who does he/she recommend? Try to get a couple names and then pick the one you like best.

In my case, I started tamox @ 46 and had my periods for awhile and then they became irregular when I was around 48. My MO said that tamox does not cause you to stop having your periods and that my missed periods were due to my being in "peri-menopause." I took a break from tamox and my periods came back like clockwork for awhile and then stopped. When I asked my MO about that, she said that tamox won't stop you from ovulating but sometimes it interferes with the "signaling." (to tell your endometrial lining to slough off?) So an irregular experience but FYI.

I agree with others--the decision to have a a hysterectomy and remove your ovaries should not be taken lightly. I chose to remove one ovary in 2014 because I had a cyst that was "probably not cancer." (but didn't look like any of the 5-6 types of known benign cysts either) We did watchful waiting for 9 months and it didn't go away so we removed it (there were a couple weird things going on.) At that time, I considered removing both ovaries but did not want to go through the surgical menopause. Then my mom was Dx'd with ovarian cancer, so I wanted the other ovary out. I was on the shelf about removing my uterus as well and got many opinions. My MO thought the risk of endometrial cancer wasn't that high and that there is an increased risk for prolapse. My regular Gyno and an Gyno-Oncologist recommended removing the uterus, in part, because I'd already had one surgery in that area. (2 surgeries in the same area is better than 3). I chose to do the full hysterectomy, and it was the right decision for me, but you should think about the pros/cons before doing it.