I'm so confused! Tamoxifen vs Arimidex vs Oophorectomy

Hello! I had oophorectomy in January at 41 years old. I was diagnosed 2 years ago at 39. My ER was also high at 91-100% (the lab doesn't give exact number for some reason). I did a year and half on Tamoxifen as my oncologist at the time didn't think I needed ooph due to low Oncotype of 12. That oncologist moved and my new oncologist thought it could provide a small benefit being that at my age I probably still had another 10+ years of menstruation based on my mom's menopause age of 52. I went ahead with it because I wanted to feel like I did everything possible to see my kids grow up, especially since I didn't have chemo. The way I figured it, I would be going through menopause eventually, this was just coming sooner than expected. The surgery itself was quite simple and was just sore a few days. I did switch to arimidex in April. I do have hot flashes, mostly at night and I have some joint pain in both ankles but nowhere else. So I'm actually not sure if it's the arimidex or maybe I'm starting to have arthritis because my ankles are achy and stiff in the mornings and after sitting a long time. I'll talk to my onc about that at my next appointment. I also get migraines and always got menstrual migraines about 2-3 days before my period like clockwork. I was afraid such a hormonal shift would make them even worse, but I"m happy to say that didn't happen. Now the only time I get them is with other triggers like not enough sleep or dehydration but that doesn't happen very often. So there's the one bright spot in this! I also had a DEXA scan after I started Arimidex to get a baseline bone density test since it is known to decrease bone density. Well, quite a surprise I had osteopenia in my lower back and hips (numbers very close to osteoperosis) and my femoral neck has full blown osteoporosis. So I had my first zometa infusion for that in May and will have another in November. Overall, I'm glad I did it because my personality is very risk adverse and I didn't want to wonder about if I should have done it.

You already know that Tamoxifen is for pre-menopausal women and an aromatase inhibitor (there are three) is for post-menopausal women, right? Since you're not yet in menopause, you can either go with the Tamoxifen or have chemically- or surgically-induced menopause and go with an AI. Either way the goal is to get rid of the estrogen in your body.

Others who have been faced with the decision will weigh in. (No decision for me--I was already post-menopausal.)

Did your MO give an opinion on which option they would recommend over the other, or is completely choose your own adventure here??

I was diagnosed two and a half years ago at age 49. I was still getting regular periods at that time. I was 95 per cent ER positive also and high PR as well. My Oncotype was a 3 but I did chemo because of some positive nodes. My MO had said from beginning he wanted to shut my ovaries down and have me go right to AI's. I had done some research and I was in full agreement with him. I remember someone pointing me in the direction of the SOFT trial which I read and it said ovarian suppression with AI's has a better track record than tamoxifen. I went with every percentage I could get. I did four months of Zoladex shots while I started anastrozole with the intention of getting an oopherectomy as soon as I could. I had the ooph and it was an easy surgery and recovery. I don't miss my periods at all and actually feel more balanced and even as far as moods without the crazy monthly hormone fluctuations. I was very clear on what I wanted to do and have no regrets. Best of luck with your decision.

Hi Mocame,

I am three years out from a post-mastectomy local recurrence, ER 99%, PR 84%, Ki-67 3, Grade 3 (weird, but not a typo). I was 50 and pre-menopausal, and also a migraine sufferer - though not as frequently as you are and with well-documented triggers, so no preventative medication.

I have been treating with monthly Lupron injections and Arimidex. This has not been without side effects - mostly joint pain and some weight gain despite very high activity levels. The surprising side effect for me was the migraines stopped entirely. I have stress-tested myself on this with known triggers and have had a grand total of one migraine since starting treatment.

Your mileage may vary - it was pretty clear hormone fluctuation was a factor in my case because they hit me hardest postpartum. But it is possible ovarian suppression may have a positive effect on the migraines for you and open up some options. Your neurologist may have some thoughts.

I haven’t taken the step of having the oophorectomy: I figured that option was always open and Lupron was a smaller commitment. But for my risk level and proximity to menopause, the AI was an easy choice for me.

We are all different, but this was my experience. Good luck on your choice and healthiestwishes,

Yuuki

Hi there. I was diagnosed last year, age 49, pre-menopausal, and 100% ER and PR positive. Just a couple of months after starting Tamoxifen, it was discovered that I needed to have a hysterectomy. Yay another surgery six months after a BMX! Anyway, this meant I had the option of having an oophorectomy at the same time as the hysterectomy. My cancer was not very aggressive with an oncotype score of 9, so my MO said it was entirely up to me if I had my ovaries removed or not. She said it would've been an entirely different discussion if my oncotype score was in the 20+ range. My decision in the end was to keep my ovaries. I figured with my overall low risk of recurrence plus taking Tamoxifen, that I was already doing more than enough and I didn't need to put myself through a hard menopause on top of everything else.

Hope this helps.

Hi, I finished Chemo and radiation for stage 2 bc in July. I have been on Anastrozole the past 2 months and getting my Zoladex shots monthly. I am due to get an Oopherectomy Wednesday. I figured why suppress the ovaries when I could just remove them. I wasn't planning on any more kids and I've been having menopause symptoms since treatment started in January. I felt like an Oompherectomy was the way to go. I just hope the menopause symptoms don't get worse.

I had ooph/hyst at age 50; It was not difficult for me. DX'd with BC at 58. I would recommend getting a DEXA bone density test if you have not already. AI's can cause bone loss, whereas Tamoxifen does not. Had I know when I had my Ooph yrs ago that removing ovaries, thereby lowering Estrogen, also causes bone loss, I would've monitored my bones more closely. When I was DX'd, I found out I have osteoporosis and osteopenia, so I took Tamoxifen instead of an AI. Best wishes!