treatment options - ovaries removed versus tamoxifen

I am just finishing up on chemo and they say I will go on tamoxifen. I am considering taking out my ovaries and or removal of remaining breast instead of taking tamoxifen. I am concerned with the side effects (bone ache, weight gain and the endometrial carcinoma, blood clots). I am premenopause 46 yrs old and had a mastectomy of one breast. I am just finihing chemo (cyclo, duc, and taxol) and managed to not gain any weight during this time. I lost 8 lbs threw it by working out when I could. Being on the taxol I get alot of joint pain in hips and knees. I also have hot flashes and am not having my period during this time (last 4 mts). The onoclogist are resistent on removing my ovaries is the feeling I am getting. What options are there besides tamoxifen to stop estrogen?

I think different doctors have different ideas. I asked about ovary removal (I was 44 at dx, 46 now) but was discouraged by my doctors. I think there are other considerations to take into account, though I can’t remember what now. I was premenopausal before dx, but the chemo seemed to put me into the menopause. I haven’t had a period since about 3/4 way through chemo.

I don’t have problems with tamoxifen. You have to remember that it is only usualy those who are having problems who post on here. If all is fine you don’t bother. I have not put on any weight (been on it since Oct 07), yes I have hot flushes, but I would have those anyway going through the menopause, and the joint stiffness I got rid of by changing the brand of tamoxifen I was taking. I will be on tamoxifen for another year or so before swapping to an AI for two or three years. Removal of ovaries is permanent. I’m not saying don’t do it, but make sure you have all available information. You could always try tamoxifen first, and if it doesn’t suit you then go down the surgical route.

I agree with Roadrunner. Your body still makes oestrogen in the fat cells even after ovary removal. Tamoxifen is designed to inhibit the action of the hormone on breast cancer cellsso it can act on growth in other parts of the body. Getting everything removed does not guarantee no recurrance and Tamoxifen can be used to treat secondaries anyway, so you could end up taking it if you were unlucky enough not to get clear of cancer in the long run.

Things that help to lower oestrogen are reportedly keeping weight under control,exercise, being careful with alcohol - there is advice on this website re diet etc.

It sounds to me like you are so worried about a recurrance that you don’t want to take any chancesand so are prepared to have really drastic surgery. Maybe you are also angry with your body (like I am with mine). The truth is you need to accept that there will be some risk whatever happens but that Tamox will reduce that risk significantly - not that i love it by any measure but the more I learn the more I feel that drastic surgery is not preferable.

Reports keep saying that cure rates are high and hopefully you will be one of those people whose encounter with cancer ends here.

If I was you, I would go with your Onc’s opinion because when all is said and done they deal with more cancer than we do. Surgery can cause other problems, I know a woman who has damage to her bowel as a result of a necessary full hysterectomy so it isn’t a no risk strategy.

Good luck in whatever you decide.

Jane x

You don’t need to have a hysterectomy in order to have your ovaries removed. An oopherectomy - or to give it its full title - a bilateral salpingo oopherectomy is done as a day procedure through keyhole surgery.
My recovery was virtually immediate and discomfort was less than my periods used to be.

I had my ovaries removed at the same time as I had my axillary clearance. I was 43. I am very pleased I did because my cancer is strongly ER+ and I feel I struck an immediate blow against it right at the beginning of treatment.

It also obviously made me post menopausal which enables me to take Arimidex. Tamoxifen carries significant risks of endometrial cancer and blood clots. Arimidex doesn’t - although bone depletion is its major problem.
Arimidex is currently outstripping Tamoxifen in preventing recurrence - just Google up ATAC trial to see info on this.

Going into immediate surgical menopause is not easy - you will still get plenty of hot flushes etc. But menopause is part of the female condition - we all have to deal with it sooner or later so we just have to get through it somehow.

Even if you have your ovaries removed it is still advisable to take aromatase inhibitors like Arimidex to knock out any remaining oestrogen being produced by fat and other organs.

Ovary removal is unfashionable at the moment. That doesn’t mean it is ineffective. I don’t regret having mine out at all. And I can’t describe the joy of not having periods any more!

Good luck.

grrr i typed a response and it hasn’t entered…why is that…lol

Ok this is my third time typing this out…lol

Thank you for your replies, I appreciate them.

I have my last chemo treatment of AC–Taxol this month. I am frustrated with the side effects. AC i suffered constipation (8days w/o a bowel movement) Tried stool softeners senokot S and lactulose, suppositories, enema with no success then resorted to oral laxative to finally work. My internal organs with the stool compacted suffered as well and I worked threw it. Taxol I am suffering joint pain and ache with mild constipation. My point is I have not been with out side effects, these are the worse ones I had… so I want to educate myself on the available options of treatment to stop estrogen receptors. I am willing to try tamoxifen to see how I respond but want a plan B in place.

My biggest fear is gaining weight, endometrial cancer and blood clots. I work hard at maintaining my weight threw watching what I eat and working out with weights. Weight always has affected my self esteem as well as my health and energy levels, always has.

I find the onoc here comes to chemo review meetings w/o my file and does not have the time to educate me. I have to correct him on what type size of tumor yada yada. So I seek out the information and educate myself the best I can.

I just want to know what other drugs are available to stop the estrogen receptors so I can review them as well.

Hi,

I had my ovaries out in feb this year but i still have to take tamoxifen. Having your ovaries removed will reduce your hormone levels but you may still have to take tamoxifen or another hormone blocker. I dont suffer to bad with the side effects of tamoxifen just flushes i havent gained weight and if your fairly active the chances of blood clots is greatly reduced.

Take Care

Leslee x