Arimidex without ovary suppression in premenopausal woman?

Actually this is the medical oncologist's department (as Linda indicated), and in many cases you see this person after surgery and radiation are finished. I wonder if the rad onc was just assuming you are post-menopausal because of your age. The only way they would use arimidex for a premenopausal woman would be along with lupron or zoladex (monthly or bi-monthly injection) to suppress the ovaries. In some situations these are used instead of tamoxifen for a premenopausal woman. If you have no uterus and thus no menstrual periods, they can check your E2 (estradiol) and FSH (follicle stimulating hormone) levels to judge your status.

Hi Merymete, My MO explained it to me this way. You really HAVE to be absolutely for sure postmenopausal in order to do an AI without ovarian suppression (or an ooph'y). The idea is that if you start taking an AI, your pituitary gland will notice that something is not right and push the ovaries to make even more estrogen. A friend of mine was put on an AI without ovarian suppression because her MO assumed she was postmenopausal. Within a month or two her estradiol was very high.

Good luck!

I had a brief post about this on a different topic. My wife's MO put her on arimidex and she is only 40 years old. Had her regular monthly visits before chemo-therapy which just ended October 7th. As of right now she is not on any ovarian suppression drugs. Her MO is on vacation this week so we have an appointment with him the 25th of November. The pre-menopausal discussion will be happening then with him.

my question is, she is handling the arimidex very very well (no issues) if we were to push for her to stay on arimidex and get ovarian suppression shots (Lupron) how long can she stay on Lupron? Is there any guidance/studies on this? can she take arimidex and Lupron for the full 5 years? Then after the 5 years see if her ovaries wake back up? uuhhhhh don't know what to think, suggest to my wife. MO is against a oophy because of her age... and he says down the road she will need her ovaries to produce estrogen.. so in that case did I just answer my question.. she isn't post-menopausal b/c he believes her ovaries will kick back in-- thus she needs to be put on Lupron ASAP or taken off Arimidex correct

So a few minutes after I posted we got an email stating her charts had been updated. Upon going in and looking at her results from her last blood work that was done I saw the following:

Estradiol (which is the main estrogen produced in the ovaries) her level was 5pg/ml and post-menopausal levels should be 0-50 - so check she is within post-menopausal range

Then on her FSH (follick Stimulation hormone) she is 74.6 MIU/ML and post-menopausal range is 23.0-116.3

So I guess as long as her MO continues to do blood work to ensure her ovaries haven't started back up arimidex maybe the way to go. Then I would assume that if they do start up then maybe Lupron would be discussed.

I feel a lot better now about her MO's decision... and hopefully he will fortify that feeling when we meet with him on the 25th

Hi, Amstar. Did your wife's onc say he would add OS if her hormone levels start heading out of chemopause? There are several ways to go here. It is possible she would be prescribed some years on an aromatase inhibitor plus OS followed by some years on tamoxifen, or the other way around. Or just tamoxifen. The total years on endocrine therapy would most likely be five to ten.

Merymete. I agree that your FSH number is not high enough, and I think my onc would say the same, based on our discussions. So have you seen the medical oncologist now, and what did he/she recommend?

For both of you, the SOFT trial results should provide some guidance. It compared tamoxifen alone, tamoxifen with OS, and an aromatase inhibitor with OS for premenopausal bc patients. One other thing I learned from my reading is that the age at which your mother reached menopause can give a clue as to when you will reach menopause.

I would be very comfortable with that plan, Amstar. I assume the three-month visits will include a physical exam.

Merymete,

The hormone tests done last year showed that I was post menopausal. My estradial level was 12. My oncologist put me on Arimidex. But my recent hormone tests last month showed my estradial to be close to 150. My ob/gyn also noticed a 3 cm cyst on my right ovary and thickening of my uterus. So somehow my estradiol level increased during the last year which put me back to premenopause. The hormone tests should be done more frequently to see if you are still in post menopause. I believe Arimidex caused the cyst because I changed back to premenopause. I did total hysterectomy and ooph last week because my ob/gyn thought the cyst could actually be a tumor. It was a big cyst. I think my oncologist will put me back on Tamoxifen to prevent bone loss caused by Arimidex.