Hormone therapy advice please! Tamoxifen or Letrozole?

I don't  know how much help this will be as I'm  very post menopausal (75) but given the choice of anastrozole (similar to letrozole I think) or tamoxifen as I'm  at low risk of recurrence.. As a golden oldie I have another healtb issue or 2!! Oncologist said I was less likely to have joint pain with tamoxifen but there was the issue of it causing blood clots in a small no. of people. I'm  on anticoagulants anyway so ok for me she said.

Tamoxifen after the menopause tends to strengthen bones so don't  know in your case. I have a bad habit of falling over so tbought sounded a "good thing". I know you have to be checked for osteoporosis before starting aromatase inhibitors and may need other support treatment.

Although I was glad to have choices, decision making is never easy. I had no probs with menopause all those years ago apart from getting hot and unnecessary sometimes.

My decision was driven by my other conditions really. In the end although good to be involved ,it's  the oncologist who has the knowledge,training and experience to guide you

I'm sure you'll  get more advice from the younger ones!

Thanks! Any advice appreciated. I think the oncologist is worried I'm trying to think too far ahead but I really want to feel like I know what I'm taking. Xxxxx

The list of SE’s are indeed frightening/ worrying. Here we do see a lot of women who have struggles with both. There are those whose bodies come to terms with them - with support . And those people who never have a days worry don’t inhabit here as 
I am -63, post menopausal and was HER2 +

Letrozole has been my onco’s choice of med. 

Now almost 2 years from starting my symptoms have lessened . I try to keep fit. Have dropped wine. That has meant far fewer hot flushes consequently much better sleep. Have vitamin D supplement and antihistamine . The last 2 to sort out SE’s prescribed by onco

At the end of the day it’s your body and your decision to make

Just hope a glimpse of my experience will help you make a good decision

Leolady56

Hiya,

Letrozole does not switch off your ovaries. If you want to take letrozole you would need an injection called zoladex, usually given every 4 weeks to stop your ovaries making oestrogen if you are peri menopausal. Or you could have your ovaries removed. 

Cwtches,

Gay xxx

Hi Flowerhappy, I had Womb and breast cancer at dame time. Both hormonal receptive. I was on tamoxifen before my full hysterectomy which put me sttaight into menopause at 49 and straight onto letrozole as i have no ovaries and because I still had the breast cancer .

Letrozole for me is horrendous! The joint pain is incredibly painful. I'm on a 3 mth holiday from letrozole due to its side effects. I luckily didn't suffer much from going into menopause. If I could take tamoxifen over Letrozole I would but I can't .

Hi

How old are you ? and have you had chemotherapy ? I was 51 when diagnosed and had a period just before my chemo started , then put on Tamoxifen after the chemo finished . I have never had a period since (that was three years ago) Six months after starting tamoxifen I had a blood test to confirm where I was in the menopause cycle and my oncologist was concerned my ovaries were trying to kick start , long story I have stayed on Tamoxifen since then but came off in September this year for surgery so was tested again to see if I am yet in the menopause , I have now had two of these tests which are inconclusive and will discuss at my oncologist appointment in January.

Tamoxifen can be taken whether you are pre or postemopausal but Letrozole or one of the other AI drugs are only effective if you are post menopausal or have with zolasez. My oncologists view as that as guidelines are now for 10 years of medication it is not really such a rush to move from one to the other. 

I asked about how old you are as if you are 50ish it is unlikely that when you finish 10 years of medication you will start the menopause , taking Tamoxifen does not halt the menopause it is just that the symptoms are there in abundance particularly after having chemo. There are so many factors to take into effect that it is really impossible to see what may happen in the future.

I would also view with caution side effects , they don’t happen to everyone and in some cases the symptoms show that the medication is doing it’s job, however unpleasant this seems at the time , most people with cancer will not join these forums so you don’t always get a balanced view of how many suffer - my mum had Tamoxifen and had no problems at all but would also never come on a forum. 

Best of wishes with whatever road you go down

jo x

Wow thanks for all the detail.. I really appreciate your time spent answering! I'm 47 so yes in ten years time I would definitely have gone through the menopause anyway! My oncologist is going to talk it through in more detail as there are possible clinical trials too but I wanted to try to be as informed as possible before I go to her. I find I keep having to make big decisions in too much of a hurry... some which have been the wrong ones for me. Thanks, Jess xxxxx

Thanks, this is really really helpful. I'm sorry you have terrible joint pain.. it sounds awful. Good advice to be thinking about. Xxx

Hey, I’m on letrozole coming up to a year....

It is difficult to separate what gives you symptoms! I have been through chemo, radiotherapy and now have ovary suppression, Zoledronic acid every 6 months and Letrozole! My main issues are sore joints (feet, ankles, elbows and fingers), aching muscles when I have been busy, sore feet when I haven’t moved for a while....But it doesn’t stop me doing anything! It is troublesome but not life changing....I don’t take any pain relief but I do take some joint supplements. I feel I have aged 20 years....and hobble a bit when I stand up....but I’m here, keeping busy and trying to move on.

I also often feel tired....no idea if that’s drugs or just life!

Hi Flowerhappy,  if you look at my profile you will see that I refused a debulking operation for ovarian cancer, When on wait and see time I was prescribed Letrozole by my oncologist. First review was last week and my tumour (high grade serous, stage 4) has shrunk by one cm! Team are pleased it is working for my type of cancer. However the worst side effect for me is the joint pain. When I wake up my arm sockets are very painful and my hands are curved like claws and painful. Unable to open bottles or lift teapot etc. It is a bit like what I assume RA to be like. After I move about the pain lessens a bit, I also take painkillers for joint pain (flarin),can be bought over the counter, although I still cannot make my hand into a fist. However I think it is bearable and worth the price of tumour shrinkage. I intend to take up weight lifting exercises to strengthen by bones and walk a  bit more. My Oncologist thinks I should continue taking it if I can manage and I trust his judgement. I am well past the menopause and I know we are all affected differently so it may not suit you. Re the hot flushes I carry a small battery fan with me. I have no other side effects. apart from the usual ones of having cancer! Will be reviewed again in March

Just wanted to share my experience with you if it is any help. I hope you find the right treatment for you and you can tolerate it, it is amazing what we can manage when we have Hobson's choice lol !

Wishing you happy and peace free Christmas and better health for 2020.

Love Pat xx