Back out of menopause age 47 - help!

When I saw my surgeon back in November he said that I wouldn’t come out of my chemo-induced menopause as I am 47. I’ve had regular blood tests, and the one in March showed a complete change. My oestrogen level has shot up to normal range and the FSH and LH are heading rapidly downwards (the opposite from menopause).

So what to do now? My cancer was 8/8 ER+ and 8/8 PR+. So should I now opt for ovary removal? Luckily i refused the switch from tamoxifen to an aromatase inhibitor.

The thing is I’ve been feeling so much better the last month or so. I don’t know if that’s because of the change in hormone level or a coincidence. My kidney function has also improved as that had not been quite right since chemo.

Any thoughts gratefully received!
Elinda x

How about Zoladex? I’m on Tamoxifen and Zoladex because I was not yet post-menopausal at diagnosis. I’ve settled on to them OK apart from disturbed sleep patterns, and even that’s improving now after a few months. I don’t get any of the other SEs that are quoted in the literature.

Hi CC

don’t really want to go down that route. I had lots of those types of treatments for endometriosis and I always felt so grotty. Plus my mum didn’t go into menopause until late fifties so could be another ten years.

Did they feel that you should have something other than tamoxifen or was it optional?

I was offered Zoladex + Tamoxifen as being the next best thing to chemo. Since the benefit of chemo was small for me I decided against that. I could have chosen to have just Tamoxifen but went for the extra benefit of the Zoladex. I’ve been taking both for around 6 months now and doing OK. I thought Zoladex was sometimes used to help with endometriosis?

Yes it is. I had radical surgery for the endometriosis back in 2009 so fortunately don’t have any endo symptoms anymore.

Although I’ve not specifically had zoladex in the past all the other endo treatment I’ve had has made me feel terrible that’s why I’m not keen to try zoladex.

I don’t know what age you are but if I follow my mum’s pattern it would mean being on zoladex for about 10 years so not sure if that’s even an option.

I don’t know how long you can stay on Zoladex. I started it when 51 and likely to have it for a couple of years after which they will do a blood test to see if I’ve gone into menopause. If not I stay on Zoladex a bit longer and test again, if menopausal I switch to aromatase inhibitors.
The listed SEs for Zoladex sound horrendous but as I said, I haven’t had any except the sleep problems. But a lot of others posting on here have had a horrible time with the SEs, but that’s mostly the much younger women. It seems to hit them like a truck.
My GP suggested I try the monthly version of Zoladex to start with, see how I got on with it, then go on the 3 monthly version if it’s OK, which is what I’ve done.

Hi elinda45
I was told that I would be menopausal after having Zoladex and Tamoxifen for my primary - when I was 41. However, after the 2 years of Zoladex (that was the usual practice) my periods did unfortunately return and obviously the hike in hormones that also comes with them. I have since developed bone mets and I am sure the extra hormones were a (big) contributory factor to this. I am strongly ER and PR +ve (as you are) but luckily my BC is very slow moving and a low grade. I had no sign of any spread or recurrence whilst on Zoladex but both were diagnosed a year or 2 after stopping Zoladex. So I would say if you have any fears at all about BC returning (and I guess everyone of us does) you should lower your risk as much as possible. Since having chemo for my mets a blood test still didn’t show me as being menopausal so I had Zoladex again for a few months until I had my ovaries ablated - I really didn’t want those pesky hormones :slight_smile: It was a decision I don’t regret and certainly didn’t have the dilemma of not wanting to lose my fertility or wanting to add to my family so it was easy for me to take. In terms of side effects I suffered really badly on Zoladex but I was younger by 5 years and since having my ovaries ablated I can honestly say my 2nd menopause has been a doddle!
Good Luck with your decision
Nicky

Thanks Nicky, that’s certainly given me something to think about.

I suppose the question is how urgently do I need to see someone to discuss? I have an appointment in May with my breast surgeon and my GP suggested a blood test later this month to check again before that appointment. My last one was at end of March.
As everyone assumed I’d stay in menopause no-one has discussed what I should do if ovaries started functioning again.

Hi Elinda

Interesting post as I am considering ovarian ablation as I am ER8 and have a family history with bc/ovarian bc. My treatment for primary bc finished in Feb and I agreed with Onc to start the ovarian discussion at the point when treatment finished (too much to cope with and all that).

I am 42 now and every doctor I have asked (breast surgeon, onc and his registrars) about chemo induced menopause has given different views: They don’t know if my ovaries will start to produce again. They may, they may not.

Whilst my onc did say ‘there are no guarantees’ ovarian ablation will improve your chances, he did support my case based on strong er+ coupled with family history.
I have done my research since and also have spoken to a friend consultant gynacologist in the Netherlands who said he performs oophorectomies for pre-monopausal women with primary bc at the time of the their breast op (offered to each pre-menop. woman, though it remains elective whether they have it or not). He also suggested to do it sooner rather than later, i.e. don’t wait until the ovaries are producing again.

I am interested to hear that your oestrogen level is tested via blood tests. How regular is that done and who initiates this for you?

I am waiting for my referral to see gynacologist to ask my questions and get it over and done with. I am particularly interested whether I’d stay on TAM - have you asked this question?

Hope this helps.
Nikki x

Hi Nikki

Tricky isn’t it?

I’ve rung the helpline and spoken to the most wonderful person who has calmed me down. My blood tests are basically now showing me as peri-menopausal. The question is whether they’ll stay like that or whether ovaries etc will start fully functioning again.

I’m seeing my surgeon in 3 weeks and will have another blood test done before I go. I have to say i’ve been feeling soooo much better this week and think it could at least in part be down to the hormones. No hot flushes for 5 days which means 5 days of being able to sleep through the night - bliss!

I’m on tamoxifen but not keen to have zoladex unless they think it’s essential.

My blood tests are done every three months by my GP. I have these checked: oestradiol (oestrogen), lutenising hormone (LH) and follicle stimulating hormone (FSH) to make up a hormone profile.
These tests are very straightforward.

This was done at the suggesetion of my gynaecologist. I’ve had a hysterectomy so obviously wouldn’t have any indicator like periods.

With regard to tamoxifen, I am planning to stay on this for 5 years whether I’m post menopausal or not. The reason is that I already have some joint problems and my Onc thinks that would be best as aromatase inhibitor is likely to make that much worse. There is then the option to go onto an aromatase inhibitor afterwards.

It’s so difficult all this decision making. It’s a constant weigh up between quality of life and the threat of cancer. Horrible!

Be grateful if you let me know how you get on and what you decide.
Elinda x

Hi Elinda

Great you’ve had a few good nights! It’s quite alarming though that you can instantly tell there’s a change in your hormone levels. I have just bought a chillow pillow to help with the night sweats…

Yes - it’s tricky making a decision. It’s permanent, can’t reverse it. Like you I am not keen on Zoladex after hearing and reading about the SE’s (I can just about live with Tam SE’s).

I’ll keep you posted when have my appointment etc. Let’s compare notes on this.

Take care - Nikki x