Femara Questions

[WolverineFan]

Hello,

My onc just put me on Femara, and as I was going through the material from the drug manufacture, it talks about Femara being used after someone has taken Tamoxifin and that Femara is safe for an individual to take up to 24 months.

I have never been on Tamoxifin (just recently finished chemo), and my onc is saying I need to take Femara for 5 years.

I am curious if anyone else has been given this same regiment.

Thanks in advance for sharing your experience!

Hayley

[Cannon]

Hi Hayley,

Yes, I started on Femara w/o tamoxifen first. In fact, one of the reasons I had my ovaries removed was so I could take an aromatase inhibitor (AI)as they have shown to be better for Her+ than tamoxifen. As far as I know, you need to be post-menopausal (or ovaries in suspension) to take an AI. I started with Arimidex, my joints hurt so much I wanted to cry, the Femara is so much better for me. I also take Glucosamine and Chondroitin, which I believe helps with the joints and achiness.

Best,
Rebecca

[BonnieR]

I am on the 5 year plan. No Tamoxifen.

[WolverineFan]

Thank you ladies for responding. According to my blood work, the chemo put my body in a post menopausal status. However, because of my age, she said there is a chance that my body could revert back, and if I have any spotting I need to stop the Femara and begin something else. Thanks again for responding.

Hayley

[Becky]

Hi Wolverine

I had to respond via your last post as I was just like you and you look premenopausal age in your picture.

I was 45 when I ended everything and lost my period during chemo. My onc did bloodwork (LH and FSH but not estradiol) and I was postmenopausal. I started Arimidex and got my period back within weeks (as Femara and Arimidex are used to "cure" infertility in some countries). Also, since I did not get my estradiol checked, I might have been on the edge of reverting back anyway. My second opinion onc at Sloan Kettering said "don't do this without checking the hormone levels every month". She said she had seen plenty of women come out of it - even though I was clearly on the older side as the general rule is if you are 40 or over, consider that chemo will put you in menopause for good. That didn't happen to me. If you don't get your blood work done often enough, you may be unprotected for several months. This is why I had my ovaries removed.

If you are still on Herceptin, Tamoxifen does protect you well. It is Tamoxifen alone that might be questionable.

As you know, you should discuss this with your doctor but you might be too young to take an AI without ovarian suppression.

[WolverineFan]

Becky,

Thank you for responding. I am one who asks lots of questions to my onc, but I have to tell you, I apparently didn't know what questions to ask her regarding this after reading your post. In my last chemo treatment, she told me that they were going to run some blood work to see if I was post or premenopausal. When I went in earlier this week to have my Herceptin treatment, she told me I was clearly "post" menopausal. When I asked what my bloodwork showed, she told me I was at 108 and anything above 23 was considered to be post menopausal. I had no idea that there were various blood tests to look at hormone levels, so I really do appreciate your post. I turned 40 in June, so it will be very interesting to see what happens. It is my understanding that I will continue to have bloodwork every three weeks when I get Herceptin, but I am not sure they will be running the LH, FSH or estradiol tests in addition to the CBC.

Thanks again for your post. I learn so much from people on this website.

Hayley
(aka Wolverine Fan)

[Becky]

Hi Hayley

Email your onc so that your next bloodwork they test your estradiol levels (and continue to do so) as levels 30 and below are clearly postmenopausal. Unlike me, you are highly hormone positive (I am 50% ER+ but PR negative). I had my ovaries removed because by that time I was 46 and clearly it wouldn't be an issue (plus my paternal grandmother died of ovarian cancer which isn't as curable as bc). You would not have to be so drastic as Tamoxifen/Herceptin is a good combo and you have time to decide other options prior to Herceptin being done (that is IF you do not stay postmenopausal which you might). I had a Herceptin buddy who was 33 and she stayed postmenopausal. I felt bad reverting back then getting the oophorectomy because she didn't have children and wanted to give it a try when she was done with treatment in a couple of years. Weird as I was clearly done with child bearing and get my period back and she, being so young, goes postmenopausal and wants a baby in the future. So it goes - you may end up postmenopausal for good. I just wanted to let you know that you can get bloodwork to make sure you are as Femara will not be effective if you become premenopausal again.

Have a great Halloween with those cute children!

[WolverineFan]

Thank you Becky!! You provided me with some great information. I sincerely appreciate it. Hope you had a great Halloween. We just got back from trick or treating and had a blast!!

Thanks again,

Hayley

[Unregistered]

Hi Hayley,

I was diagnosed at 44, and stopped having my periods during chemo. But when my onc subsequently put me on Femara, she prescribed that I have Zoladex injections every month to shut my ovaries down. Apparently, just because one stops menstruating doesn't mean that one definitely is post-menopausal. I am now 47, and recently asked about stopping the Zoladex, figuring I should not need it any more. She said she would not feel comfortable with taking that risk.

My onc is at UCSF. I have seen lectures that she gives for other oncs on the internet, and one point she mentions as a common mistake is that she frequently seems women who have metastatic disease and are getting Femara (or other AIs) and who are not yet truly post-menopausal. (As Becky mentioned, in those scenarios Femara can actually increase estrogen production.) Dr. Rugo would then prescribe Zoladex or Lupron injections, and this helped reverse disease progression.

Good luck with this!

Best,


Jill

[WolverineFan]

Jill,

Great information. Thank you so much for your post. This is why I love this site so much! Thank you all for responding!!

[Mgarr]

Hayley

I won't weigh in on the Femara(ER/PR-) question but will just share my own experience as I was 39 when I began treatment and my menstruation ceased for almost 3 years. I have now been back to a regular cycle, so Jill and Becky have great advice like always :)

Best of luck.

Mary

[WolverineFan]

Mary,

Thanks so much for sharing. I appreciate your input. Also, I see you are from the great state of Michigan. That is where I was born and raised, hence the Wolverine Fan name for my user id, despite the fact that I graduated from the University of Oklahoma. My mom and siblings all still live in Michigan, and I will be traveling home for Thanksgiving and looking so forward to it.

Thanks for weighing in.

Hayley

[flynny]

Hi Haley and Becky, I am not on Femara, but I do take tamoxifen and I am very glad I read this post. I have not had my period since last April/May and my doc at Dana Farber said I probably won't get it back. However, I have heard from some people (like yourself Becky) that after 3 or 4 years it comes back. I have never asked or it has not been discussed about levels. This definitely makes me think to ask that question when I see her in Jan. As you can see I'm very low ER+ so she thought the tam would be helpful. Any input would be great. Thank you.

[WolverineFan]

Hey Sarah,

After reading your history, we are much in the same boat (two tumors, one DCIS and one invasive). My onc, while I like her a lot, is not one for telling me lots of information, and I am one who likes to have lots of information. I read so much about all of this, but it didn't even dawn on me to ask the question as to what tests can be done to determine status of menopause, because I thought it was simply one test done on bloodwork. This is why I love this site so much, because I've found I can learn so much more from others than what I can from my onc.

Good luck and keep us posted.

Hayley