Zoladex & letrozole combination in Pre Menopausal


does anyone know how effective the above is, i have been taken off Tamoxifen as i have a blood clot in arm from picc line & Onc has tonight suggested that i have the above, he says it is as good as the Tamoxifen, am worried as can only find info relating to post menopausal woman.


Hi Sarah,

Here’s the link to BCC’s publication regarding Zoladex


And the publication on Letrozole


The staff on the helpline may be able to help you more though with your question if you would like to give them a call.

Take care,
Jo, Facilitator

Hi - I was taken off tamoxifen when it stopped working and put onto zoladex and letrozole. I was peri-menopausal and the zolodex “makes” one post-menopausal so that the letrozole can work to best effect. My onc said it was actually better than tamoxifen though whilst it works, tamoxifen is the standard - and a good treatment…

Hi Sarah,

I’ve just stopped taking tamoxifen as I have recently been diagnosed with a local recurrence and therefore appear to be tamoxifen resistant. The oncologist has recommended monthly injections of zoladex alongside the daily intake of letrozole.

I haven’t started taking the letrozole yet but I’m expecting it to be prescribed at my next consultation in mid November, when they will have assessed my menopausal status/test results etc.

I share your worries but my understanding, and hope (!) is that they will look to perform an oophorectomy once my hormones have stabilised. I’m not particularly looking forward to the prospect of further surgery or being permanently menopausal (I feel as if I have been cheated of my best years - I was 37 at original diagnosis and am now ‘only’ 41) but the only other alternative is to refuse any additional treatment, which, at this stage, I’m not willing to do.

Has your onc discussed the possibility of an oophorectomy with you at all? How do you think you would feel about further surgery?



Thank you both for getting back to me, Haxted my Onc also said that some feel this combination is as good if not better.

Naz, am 41 too, i only finished treatment in July & had been taking Tamoxifen for 2 months when they discovered clot in arm & as Tamoxifen increases risk of clots they had to take me off it, it was only because of insisting seeing Onc today that they have come up with this proposal as i explained that i felt very nervous having delay in treatment for Bc.

I had periods all the way through chemo then they stopped briefly while on Tamoxifen but came back as soon as i stopped it, have to go to hospital tomorrow for implant so may well ask about ovaries.


Hi Naz, Sarah,

Whilst I cannot comment on Zoladex/Letrozole combi, I did have an oophorectomy in July. I am 42 and it felt the right thing to do as my BC was very oestrogen receptive.
All in all it was an easy procedure for me (laparoscopic). SE’s are manageable, I had imagined it to be worse.
PM me if you want further info.



I am pre-menopausal (37) too and just started last week on Zoladex and Femara because, like Naz, it seems the tamoxifen was not effective and I had a recurrence.

I would be very interested to hear how soon you found the side effects from the Zoladex kicking in and what extra side effects you think are attributable to the Femara rather than the Zoladex, if it is possible to distinguish. So far I am just feeling tired but no other effects, granted it has just been a week.

I think I have read somewhere too that this combination is as good than just Tamoxifen - at any rate I don’t think it is worse in terms of cancer treatment, it just works very differently. My understanding is that it is not the first line of treatment because early menopause carries other risks eg to bone density, and therefore to be avoided if possible, so they use Tamoxifen instead in premenopausal women.

Naz - what did they say to you in the end about when to start the Femara?


Hi Claire,

I’ve pm’d you.

Catch up everyone again later.


Hi Claire,

I had Zoladex on Friday & am going to start letrazole next Friday so that i can see what sort of Se’s if any that i may get instead of them being muddled together.


Hi Claire, Sarah, Naz, and Nikki -

I’m 44 and pre-menopausal also. I tried tamoxifen twice, but was taken off because it made my heart race and palpitate. I’m supposed to start zoladex injections and letrozole next week. My oncologist thought having an oophorectomy was too drastic, considering my oncotype score was a 9.

I would love info on side effects and/or any advice you have to offer!

Thank you … I hope you’re all doing well!

Hi, I am 42, I have been on zoladex since July, tomoxifen didnt work so have just started letrozole. So far hot sweats at night and during the day too.

Good evening - I’ve been to see my Ocologist for a review today as I have been off Tamoxifen for 6 weeks. He has suggested taking Zoladex injections (1 x month) and Letrozole daily. I’m 45 and have been on Tamoxifen for over 18 months with severe headaches. Since coming off the Tamoxifen the headaches have eased. Is there anyone is the same position as myself - just a little wary of the injection/tablet combo, Many thanks