Tamoxifen or letrozole

[Magical_Moon]

Hi Em,
I had this type of blood test 15 years ago. It revealed that I was peri-menopausal, therefore, the consultant prescribed me HRT to control the symptoms and help prevent osteoporosis.
It is always difficult to decide which hormone therapy to take. Each type has its pros and cons. I started on Tamoxifen but it didn't agree with my body.
Are you able to keep reasonably active? I've read the risk of DVT and strokes is higher with Tamoxifen. Medical research has found that strokes are more common in tamoxifen users who have other risk factors for stroke (such as high blood pressure, overweight, sedentary lifestyle, etc.).
I can empathise with you having to make this difficult choice. It is not going to be easy when you are having to decide between chemically induced menopause or removing ovaries VS increased risk of DVT/stroke/uterine cancer.
Wishing you the very best.
M x

[emilysss]

Hi M

Thank you for the info - I didn't know they could do a bloodtest. Since I posted I have seen onc and she said she understood my concerns and I could go on Tamoxifen or Letrozole, although if I go on Letrozole I either have to have monthly injections to chemically induce menopause or have my ovaries removed. She seemed to think that was a fair enough option but it seems a bit drastic to me! Plus from what I have read Letrozole can be less effective when you are very overweight.

I'm still undecided, but leaning towards Tamoxifen I think.

Emxx

[Magical_Moon]

Hi Em,
I can understand your concerns about Tamoxifen especially as you have an axillary blood clot. Tamoxifen has been associated with DVT and also uterine cancer.
Although there's no definitive test to diagnose the menopause, a blood test is sometimes carried out to measure the level of the follicle-stimulating hormone (FSH). Your FSH levels will dramatically rise as your ovaries begin to shut down; these levels are checked via a blood test giving a good indication.
Considering you have an existing blood clot it would not be unreasonable to ask either your oncologist or BCN to arrange a blood test for you.
I understand that to be classed as post menopausal you must have had no periods for one year.
Hope you get a blood test to confirm yes or no.
Best wishes and good luck.
M x

[jiggyjoo]

Hi. Don't think its always the cost.  I started with Arimidex,had Dexa scan to check bone density.  I had osteoporosis in lower spine.  I was changed to Tamoxifen because it is supposed to be kinder to the bones. I am post-menopausal too.

[Judithvr6]

Well they stuck me on tamoxifen. I did wonder why, but didn't ask! Then thought it may well be cheaper.

Onc mentioned blood clots and asked if I am an active person. I replied that I need my rad treatment times arranged around pre booked Fri/Mon train travel to London to run the marathon on 26th April. She decided I was active.

I'm a little concerned about possible side effects on my running but can only give it a go for a while. BCN said not to start taking tamoxifen until radio starts (expecting that to be 20th April), I wonder if that was so side effects haven't had change to kick in before the 26 miles??

4 weeks of normality then it's back on the bc treadmill.

[emilysss]

Hi

Been reading through these threads as I am going to be starting hormone treatment soon, and like others I am already confused! 

I was pre-menopausal before chemo, but no periods after first couple of cycles. I am 47 so not sure when menopause would have started normally - does anyone know whether that comes into the treatment equation?

I'm very worried about Tamoxifen - I'm already very overweight and have an axilliary blood clot that I am currently prescribed Fragmin for.

Emxx

[Magical_Moon]

Hello Nenya,
I was diagnosed at 58. Post menopausal.
My original treatment plan was surgery, radiotherapy followed by hormone therapy (2 years Tamoxifen then 3 years Exemestane).
Took Tamoxifen for 4 months and had a terrible reaction to it so my oncologist switched me to Anastrozole.
I didn't like Tamoxifen at all. Body overheated permanently plus leg cramps. Never had leg cramps in my life so constantly worried about DVT.
I was told by my pharmacist that Anastrozole and Letrozole are more effective than Tamoxifen. When I did more research on the Internet, all the medical studies and statistics confirmed this.
Tamoxifen is a cheaper drug compared to AI's.
You will be referred for a DEXA scan if you are going to take Letrozole or Anastrozole and will be prescribed Calcium+D3 (Calceous) to protect your bones if considered necessary.
Good luck.
M x

[Nenya]

Hi Judith, I am 59 this year, but they still threw tamoxifen into the pot. Toss up between weight gain(weeble) and increased pressure on joints, or falling down n breaking something(clumsy me) and still having bone pain. One thing that has made me think though is risk of dvt with tam. Leaning strongly towards the letrozole and hoping they can fix bone thinning if it occurs. Let me know how you go on please x

[Judithvr6]

Hi.

I see onc tomorrow so my be asked to make a decision on what treatment too.

I'm 51 and post menopause so not expecting tamoxifen to be in the mix but any hormone treatment will be a whole new world to me.

(Having had bc 22 years ago much of this new one seems like deja vu.. Though things are done very very differently now).

Sorry I can't help.

J

[Nenya]

Thank you

[Sam_BCC]

Hi Nenya

Whilst you are waiting for the other users to reply with their knowledge you might find it helpful to talk things through with a member of staff on the BCC helpline.  Here you are able to share your concerns with someone who will offer you a listening ear as well as emotional support and practical information.  The number to call is 0808 800 6000 and lines are open weekdays 9 to 5pm and Saturday 10 to 2pm.

Best wishes Sam, BCC Facilitator 

[Nenya]

Argghhhhh looked at all the other threads about this problem, but still don't know what to do. Wish they just said 'take this'. I have been feeling so positive up to this point because I have not had to contribute anything, just been told to 'go here, have this done' and I have been fine. Now feeling a bit uncertain.