Hormone suppression after active treatment.

I'm mid-40s, pre-menopausal and was offered a choice: either tamoxifen or start zoladex injections during chemo to put me into menopause and then start exemestane a few months later - I started it before radiotherapy.

I had a long discussion about which was better for my long term outlook, which is the only thing I was interested in. They said that for people around my age, studies show that there is no difference in mortality rates between the two, but that zoladex plus exemestane reduces the risk of recurrence significantly more than tamoxifen (as in statistically significant in studies rather than massively!). So that is what I chose.

I asked about ovary removal and they said that it was an option but not at first - as it's permanent, they don't consider it until you've been on zoladex for 6-12 months to make sure you're OK with the side effects - there's no going back!

I'm 12 months into zoladex injections and haven't asked about ovary removal again - I figure as it's elective surgery, I probably wouldn't get it for a long time given how stretched the NHS is. My worry is hormones trying to fire back up when I stop zoladex in 5 years, though at my age that is unlikely! I couldn't go through the menopause twice.

Thank you so much for your feedback. I still have to have that conversation with my oncologist. How are you doing on your current regimen?! 

My experience of hormone therapy choices was similar to Beatthebreast's, though I made a different choice.

My oncologist floated the idea of zoladex + letrozole, with optional ovary removal later on. The other option she mentioned was tamoxifen on its own.

I looked it all up and agonised for ages, because as Beatthebreast says zoladex + AI gives you a better chance of being recurrence-free.

However - on balance I felt I just wasn't ready for menopause. I wouldn't cope well with heavy menopausal side effects at the moment (they were bad enough during chemo) and I worry about the effect an early menopause would have on my bone health. The additional benefit of zoladex + AI over tamoxifen was quoted to me as being a couple of %age points perhaps - not sure of a source for that. I felt that if I went that route, then zoladex would be providing all of the side effects but not really doing very much work. However, I've also chatted with people who find the effects of zoladex no big deal.

So, I've opted for tamoxifen on its own, and the side effects after 2 months have been noticeable but completely manageable.

It's such a personal decision. I found it really hard. I swung back and forth between them but I thought I could always ask to go down the menopause route in future if I change my mind. I'm late thirties, and I think if I'd been say 45 or so I'd have been much more likely to go the menopause route. At least that way you get it over with!

Hi. Thank you for your feedback. My major concern is recurrence and I feel if i choose tamoxifen over AI plus zoladex that is slightly more chances of having it back, I know it is only few percent but in my head - I made that decision. I wonder if there is any way they could establish how active your ovaries are to then choose the best treatment not just looking if you are pre or postmenopausal. I will have to ask my consultant. 

Absolutely - it does really come down to what are the most important factors for you. Recurrence and side effects being a big part of that.

Radge this is a good point on age. I was already experiencing some mild peri-menopause symptoms and mesopause probably only 5 years away. I also run pls do other strength things so bone loss didn't seem likely just now.

I started zoladex during chemo so I don't know whether the intensity of it was chemo on top or just menopause - I think it was chemo on top as everything worse just after each cycle. The worst thing for me was hot flushes and night sweats but they have significantly reduced and are very manageable now.

I figured I would need to go through menopause at some point so why not just get it out the way! As I say though, I already exercise to keep my heart and bones healthy, so I'm hoping this counteracts any issues with a slightly early menopause.

I am also on zoledronic acide every 6 months for 3 years, which helps keep bones healthy as well as helping to stop breast cancer coming back in your bones, I suspect you might be offered that as well (though not sure if you go down the tamoxifen route)

Hi @Goose39 

I was also 39 at diagnosis -  hormone positive. No genetic involvement.

I asked straight away if I could have my ovaries removed following treatment and both my consultant and oncologist fully supported me. I believe it was 6months after finishing Radiotherapy that I had them removed - I went in early and was home later the same day.
I started Tamoxifen during Radio. I was never given zoladex. I was given a bone scan which they will do every 3 years to monitor as nothing of concern. 
I honestly found the chemo induced menopause far worse than the medically induced or perhaps it just prepared me! 

Personally I couldn’t get my head around the continuation of treatment with injections, I just wanted out of the system if that makes sense and of course to lower the risk of recurrence. 
My symptoms include a small amount of weight gain and I do sweat a lot after any kind of exercise-  even just a gentle walk which I didn’t beforehand and is rather strange but other than that I feel really well. 

It is personal choice and definitely not an easy one to make.

Wishing you all the best with your decision and continued recovery 

Kelly xx 

I think once I m sat down with my consultant, options should be more clear to me. And I believe if one treatment is unbearable with side effects I can move on to the next one. Thank you for your feedback. Xx

Hi. I m glad you feel well after everything. I didn't notice many menopause symptoms during my chemo, my periods stopped, that is pretty much it. I kind of felt that getting rid of ovaries will tick few boxes like reduced recurrence and yes early menopause but then being on so many drugs after might feel like going through menopause for years before actually going through it naturally. My only concern is other health benefits of having ovaries. Like life is not hard enough wright now! Thank you so much for your feedback. Xx

Yes that is exactly right - lots of choices if you don't get on with something