Topic: removal of ovaries vs lupron

Nov 13, 2012 07:54AM voraciousreader wrote:

Eileen... I am sorry to hear about your recurrence. At 53, I was premenopausal at diagnosis and agreed to Lupron injections for two years. These last few months my menopausal status is being checked and I appear to be menopausal. I too, worry about the abrupt depletion of estrogen since heart disease runs rampant in my family. Since I menstruated longer than most women, the decision to do ovarian suppression was a little easier for me. I wonder at age 48 now, based on your family history, at what age would you normally approach menopause? Perhaps your body at 48 is closer to menopause and a few months or a year of O/S might not be as much of a further cardiac risk, since you already had an estrogen loss from your previous chemo. Furthermore, everyone varies when it comes to menopause symptoms. What's not to say that you are feeling well now with your regular periods and in a year, as you approach natural menopause, you feel awful again. Likewise, you might surprise yourself and move smoothly into menopause!

Deciding whether to do O/S is not an easy one. But with two premenopausal breast cancer diagnoses, I would carefully review my risks vs. benefits of treatment while considering quality of life. Good luck!

Nov 13, 2012 10:07AM - edited Nov 13, 2012 10:16AM by LtotheK

Hi everyone,

I'm interested in this post as my period seems to have returned after 2 years and 2 months in chemopause.  That's me, always reinventing the wheel.

To the point about oophrectomy or suppression, the latest studies indicate that higher circulating estrogen is linked to a higher risk of recurrence (I believe just in ER+ patients).  I am currently on Tamoxifen, and I am SO grateful for the stuff.  Edited to add: I also know from some studies that Tamoxifen may have trouble blocking all estrogen in patients with higher circulating estrogen, it's mechanism is very complex.

These are extremely complicated choices. I already have osteoporosis in my spine thanks to a combination of granny and chemotherapy.  I'm doing better with exercise and Fosamax, but someone wrote in here that diet and lifestyle can combat the effects of ooph or Lupron.  That's not entirely true, a lot of things have to be weighed.

I've also looked at heart and bone health in relation to overall survival stats with women who had BC.  Thing is, osteoporosis is also a deadly disease (my granny died from it).  We always trade one problem for another, and it's important to assess the overall risk of return.  For me, if the ooph only raises my chances a few percentage points, I don't think it's worth the bone health issues.  This will also be a challenge for me in the future if I am switched to an AI.

Lupron is a widely used drug for ovarian suppression with women who've had cancer.  University of Chicago has a big study going on ovarian suppression + AI.  I don't think the jury is out on long term SEs right now, and it's important to remember our docs balance a lot of this information against our risk.  I used to defy my oncologist, and I still bring a lot of studies to her desk. It has been interesting, though--in the long run, she's been consistently correct about a lot of my questions.  Bring the studies to your appt.

Edited to add: Eileen, my heart goes out to you.  I think one of the scariest things about all these treatments is, they simply don't know which ones of us they are actually working for.  You are very young, make sure to get three, not two opinions on your next treatment.  We are thinking of you!!!

Nov 13, 2012 02:26PM voraciousreader wrote:

I chose ovarian suppression rather than chemo for two reasons. Based on the Oncotype DX score of 15, the risks of chemo outweighed the benefit AND chemo is not as potent on Grade 1 tumors as it is on Grade 2 and 3 tumors. I also have Zometa infusions every 6 months for 3 years. The only issues that I had with the Lupron and Tamoxifen were gynocological but are manageable. Furthermore, some of my gyno issues preceded my diagnosis, so I can't entirely blame my treatment on my gyno woes. Just makes my treatment a little complicated.

Aug 15, 2018 09:43AM Ashirgir wrote:

and how are you doing now? Did you take the ovaries out? Or chose the Lupron route

Oct 3, 2019 06:33AM Brilee76 wrote:

I've decided to go the oophrectomy route. I'm 43 and a grandma. I've been on Lupron for almost 4 months and have read about the SEs with Lupron. I've always been leary of taking anything for an extended period of time due to SEs. I don't have the known mutation on BRCA2 but my mother and I do have an unknown mutation on the BRCA2 gene and we've both had breast cancer. Since the known mutation increases your risk for ovarian cancer and I was going to have to have the LEEP procedure done anyway I felt the hysterectomy with oophrectomy just made sense. I'm currently undergoing chemo so my oophrectomy has been postponed and the Lupron shots continue. I took Tamoxifen for a short time before my mastectomies. My oncologist will be starting me on Letrozole when it's safe to do so as she feels there are better results with Letrozole than Tamoxifen. She says I have to be postmenopausal to take the Letrozole.

May 12, 2020 09:51PM jmren wrote:

Hi Sarah - My situation is a bit different, as I was diagnosed at 43. My ovaries tried to restart, but permanent menopause was always the goal since I was double positive they didn't want that to happen. I did the ovarian suppression for two years. When I was presented with the choice of the oophrectomy I went ahead because:

1 - money. The surgery was covered completely (I had it at the end of the calendar year), but the suppression meds were maxing out my out of pocket each year and financially three more years would have been really tough.

2 - pain from injections. I would sometimes have substantial bruising and pain with the injections so it was nice be be done with those.

3 - reduced number of doctor visits and blood work. Again, this was mostly financial and not a huge issue but the thought of cutting my doctor visits per year in half was a nice thought too.

4 - had already decided on no children. Since I had to make the decision on not having kids at the beginning of my treatment two/three years earlier, the oophrectomy wasn't going to change that outcome for me.

The procedure went really well and I needed less than a week off work for recovery. I haven't regretted the decision once. I will share that I was surprised at how emotional I got around the time of the surgery...I think it was part of the grieving process (again) and just a strange loss related to womanhood or something. I hope that helps you in your processing.

Blessings - JM