Lupron shot vs. oophorectomy
Hi all,
I've been getting a Lupron shot every four weeks to suppress ovarian function so that I can be on Ibrance and Letrozole. Isn't medically induced menopause so much fun??
My MO said that it was my choice whether I wanted to continue to get this shot every four weeks forever, or to have my ovaries removed. I'm not sure where I'm leaning on this. The surgery is an outpatient laparoscopic procedure, so it doesn't seem like it would be bad. The shot isn't so bad either, but having to go get it every four weeks (and plan around that) may get annoying.
I guess I just wanted to hear from those of you who've made a decision on this, and whether it ended up being the right one.
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I’m curious, too.
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I had mine done last April because I was fed up with the every 4 weeks thing of the giant needle - hated the general planning limitations, hated the waiting around in day patients for the (overworked) nurses to get to me for one stupid shot, hated the wobbly legs it gave me for a day or two. Onc agreed to it when my BRCA test came back positive for BRCA1 - it made it very easy to convince the insurance company at that point!
Super easy surgery of about an hour or so and i went home the same day. Maybe a week of recovery and resting at home and then another few weeks of gradual recovery. There was some pulling sensation in the lower abdomen for most of that time, and I would feel a need to brace it with my arm when getting out of bed/a chair for a week or so, but it wasn't pain just a general feeling of oddness. 10/10 would do again! I had some tiny scars but I guess they went away when they did the DIEP.
The only issue, though, is with timing. Surgery on Ibrance can be challenging due to the hits it can take on your blood counts and the margin of safety they need for neutrophil counts for surgery. I believe I needed to stop a week before and still had to do WBC promoting injections to get my counts up high enough. So it was planned around my week off with an extra week off somewhere in there. I was prepared to take the risk, though I did progress later last summer (but who knows if missing that time was really the cause, im guessing not as I was starting to bump up against the median PFS time)
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I have had Lupron shots for 5 years now-- 2017 with MBC diagnosis and pre-menopausal at the age of 47 back then. My MO mentioned an oophorectomy early on, but I did not want surgery. I guess I should have done it, maybe. Hindsight is 20/20, you know. Who knew I would still be getting Lupron shots 5 years into the future.
Finally, this year we changed me to every 3 month Lupron shots, per my request. I researched the 3 month version and read that studies show it is just as effective as the monthly version for MBC patients needing to suppress the ovaries for hormone positive cancer. That is some better for scheduling,, and for less butt shots too.
I am now 52 years old. I wonder when I can stop the shots altogether. My Mom went thru menopause at 54. When would I have naturally went thru menopause?? I don't know if there is any blood tests for the docs to do to see if I am close to menopause. Since I get the shots to suppress the ovaries, would the blood tests be accurate?? So, I guess I will continue the shots indefinitely. I still do not want surgery, and could I even do surgery with low counts on Lynparza (like Sondra's situation). Would a GYN want to do surgery on an MBC patient 5 years in??
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Sondraf, thank you! This is so helpful. I think that I'm leaning towards having the surgery now. My MO did say that they would schedule it on my week off of Ibrance, and so far she has said that my blood counts have looked good, so hopefully I won't need to have an additional week off.
Candy-678, my MO said that the shot would be forever; I would guess that there's no way to tell if you've gone through menopause when you're on the shot. Every three months does seem much better than monthly for the shot.
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My MO tested my hormones levels (I'm on monthly lupron shots also) right before I received my last lupron shot. Literally right before, as in I went to the lab for bloodwork and then to the clinic for the shot, she felt doing the tests on the very last day before I got the next shot would give her accurate readings. She says the results came back that I am still not in menopause and we will continue with the shots, argh! Oh well. The tests were for estradiol and FSH.
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Diagnosed at 54 and was still menstruating at that point. Didn't receive lupron, but did get the gosserelin shots until a couple of years ago and my oncologist thought it would be fine to stop. Now I am considering how I would feel if the mets showed up in my ovaries. So, I think I might have made another decision if I had to do my treatment(s) all over again. But the shots were easy, and the least of my worries, since I had to come in every month for labs and office visits with my oncologist, anyway.
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I think if you are older/on the cusp of menopause then perhaps it isn't worth it, or its debatable. I just hated hated hated the scheduling aspect (especially how things are scheduled here - it was never a quick in and out, always the sitting and waiting eternally in the chemo wards) and then the BRCA thing really tipped it over the edge. I had a tough time with low counts on Ibrance that I am not experiencing on Lynparza at all, so if your counts are routinely in the 1-2 range then you should be good to go no problem.
Forgot to mention that the real pain from this surgery is from the abdominal gas they use to pump you up to get in there with the equipment. They warned me and boy they weren't kidding! I went for a walk the night I got home to start getting that gas out of me and it was truly painful. It leaves via the right shoulder so you will take ibuprofen/tylenol to manage that. Takes about a week or two for that to finally dissipate, but yeah, stretchy pants are your friend for a month!
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I was diagnosed de novo at 49, still with regular cycles. My MO recommended BSO, then I tested positive for BRCA 1 mutation which sealed the deal. I had 1 Lupron shot, then started 5 months of chemo, which kept things shut down, then had total hysterectomy and BSO before I started on Kisqali. Surgery was no big deal. I work part time and took 3 weeks off, but I honestly could have gone back after 2. I was on the fence, but am glad I did it
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I was also diagnosed de novo, at 44. I was having regular cycles and no signs of menopause or even peri menopause. It could be more than 10 years until I would go into menopause naturally. I think in my case, having the surgery makes sense. I am negative for the BRCA mutations, however
Sondraf, thanks for the tip about the stretchy pants!
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li77 - did you end up having the oophorectomy? I’m in a similar boat. Diagnosed de novo at 41, premenopausal. I have been getting monthly Lupron, switched to a 3 month Lupron in May but went back to monthly in August as my PET in August showed mix results after 15 months of everything decreasing. The main change in that time was the 3 month Lupron depot and a reduction from 100mg Ibrance to 75mg with multiple stops and delays on the first two cycles on 75mg.
I’m BRCA negative but my paternal grandmother died of metastatic ovarian cancer. My MO says it’s a personal choice and is impartial on what I’d like to do.
Part of me wants to have the oophorectomy, but part of me wonders if I should avoid surgery. I’ve never had surgery for anything ever before.
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Sunshinedaydream, yes, I just had the oophorectomy on Monday. It's been a super easy recovery; I'm not even taking the prescribed pain medication. I also have never had any surgery besides a c-section 10 years ago, so this is my first time being put under anesthesia. I had the surgery on what would have been day 1 of my Ibrance cycle, and my MO is having me wait to start until after my 2 week post-op appointment, so I'll have a 3 week break from Ibrance. I'm still on 125mg, and my wbc keep going down, so hopefully this break will give them time to recover. The surgery was just couple of days of discomfort (some soreness and gas pressure) but not bad at all, and then it's one less thing to worry about. I'd totally recommend it!
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li77 - thanks for the update. Wishing you a continued easy recovery and enjoy your break from Ibrance. I’m definitely leaning towards the surgery and have a consult on Sep 1
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