Remove ovaries?

Helen,

I'm 45, and Aunt Flo still visits every month like the moon.  I also was strongly ER positive -- after I finished treatment, I assumed I should start thinking about having my ovaries removed, but both my gynecologist and my oncologist were strongly against this, because ovaries help protect your heart.  Even if they shut your ovaries down with Lupron injections (which we've also discussed), and even once you've gone through menopause, just having them in your body still seems to have the protective effect.

This is a particular concern for me, because I have a history of heart disease in my family.

So please talk with your doctors carefully about this, and ask them what your options are.  I'm curious that you're scheduled to stop taking Tamoxifen in December -- based on some large, well-respected studies that have been published in the last year, the standard of care is now tending toward 10 years on Tamoxifen, not 5.  My oncologist is recommending 10 years for nearly all his patients, unless they have particular risk factors.  

So maybe you don't need to stop taking Tamoxifen after all?

Just some issues to talk with your doctors about -- I always think it's good to get more than one opinion on these things, from your oncologist, your gynecologist, your surgeon -- whoever you like and trust.

Don't know if that helps?

Traci

Alexandra said:

My 2 cents

Hello Helen,

Because you had breast cancer in pre-menopausal age and especially because it was ER-positive, it is highly unlikely that it was hereditary. But not impossible.

If you haven't yet been tested for BRCA 1/2 I recommend getting tested.

If you're BRCA-negative, I think you should keep your ovaries and go through natural menopause for the reasons Traci brought up. Surgical menopause is acute and overnight brings new very unpleasant symptoms, even more so if you can't take HRT like I do.

But if like me you are BRCA-positive, get your ovaries and fallopian tubes surgically removed as soon as possible to reduce your risk of ovarian cancer.

Good luck with whatever you decide to do.

Alexandra

with your oncologist.  This is obviously both a medical and a personal decision.  Having your ovaries removed is surgery and the risk needs to be worth the benefit.  It sounds like your goal is to prevent estrogen production, not to prevent ovarian cancer?  Just want to say that even us old ladies without ovaries or being postmenopausal, are on hormone deprivation therapy (typically an aromotase inhibitor, but I'm actually on Tamoxifen).  Just because our ovaries are gone, or are there and not producing estrogen, doesn't mean we don't have any.  We do.  It comes from our fat cells and is converted to estradiol that acts like estrogen.  So removing your ovaries alone would probably not prevent the effects of estrogens and if any hungry cells are on standby, you will still be producing some fuel for them.  At age 48, you're nearing natural menopause and your ovaries will stop producing estrogen in relatively short order on their own.

It's such a Catch 22.  If you keep your ovaries, they're going to make estrogen for a few more years, and you could develop ovarian cancer.  And who knows whether they're going to or not?  Alexandra's suggestion of the BRCA testing is worthwhile discussing with your oncologist for sure.  And maybe even getting more than one opinion, because that's probably all it is (unless you have the BRCA gene) - a guess based on statistics.  Did you take Tamoxifen for 10 years?  I believe tht is the current recommendation from San Antonio.  If you only took it for 5, it would be worthwhile discussing that option vs. removing ovaries.  5 more years would probably get you through menopause. 

You must also still have your uterus since you're still having menstrual periods.  I've had both breast and uterine cancers, both were estrogen dependent.  Both were diagnosed 5 years AFTER menopause.  Not just ovaries to worry about . . . but the odds continue to diminish as the years go by.  Hope you're getting your uterine lining checked regularly while on Tamoxifen because it is known to cause uterine/endometrial cancer. 

Good luck with your quest.  I'm not sure that you will get a definite answer.  Just do plenty of research so you can ask really good questions when you discuss this with your oncologist.  You need to be satisfied that you make the right decision for you and not look back.

Suzanne 

I don't know if this will help, but my ovaries were removed when I was 47, during surgery for a rare gyne cancer that was ER+.  I went into surgically induced menopause then, but have done very well without any HRT, only having some hot flashes. I've combatted any potential cardiac risk from lack of estrogen with exercise and diet, which has worked well for me thus far. 

However, like someone else mentioned, our bodies can continue to make estrogen through other means, and 9 yrs later, I was diagnosed with ER+ Breast Cancer.  I started Anastrozole last March, and was told that with it or Tamoxifen, the guidelines now recommend being on one of those meds for 10 yrs.  The reason I was given is because estrogen can be sneaky, and in some cases, can hide in cells, popping to the surface again around the 5 yr mark. 

I also stay away from as many Soy products as I can, but since it is in just about everything, that's nearly impossible.  Soy creates a type of phytoestrogen that mimics human estrogen, as does Flax. Wish I'd known that 10 yrs ago! The isoflavones and lechithins are the worst, and should be avoided when possible, but when unavoidable, like when shopping for bread or tuna, my oncologist and dietician both said to choose the brands that have the most natural soy in them, with the least amount of soy products and/or by-products on the label. Good luck with your decision. After talking to your doctor, like Suzanne suggested, and maybe even a genetic counselor, you should make the decision that feels the best for you, and then not look back.