[Laurel]

Kathaleen,

A total hysterectomy where the ovaries are removed along with the uterus will lessen the estrogen produced by your body (ovaries), but believe it or not our bodies will still produce estrogen even in our fat (dang!).

A.I.s are poorly tolerated by many and I can personally attest that they can give one a rough ride. I developed tendon pain secondary to fluid retention within the tendon which eventually got so bad that my knees swelled. Thank God I had reached my 3 years of A.I. therapy and opted with my Onc's full blessing to go back on Tamoxifen. Believe it or not I have no side effects from the Tamoxifen other than vaginal dryness and the standard dryness associated with menopause: dry eyes, skin, hair.....blablabla....This growin' old is NOT for the faint-of-heart, Ladies!

According to my Onc, the standard desire is to see us do 3 years of an A.I. if we can stand it, and then continue on Tamoxifen. How long exactly she was cagey about when I met with her a few weeks ago, but for now they new "standard" is another 5 years of anti-hormonal treatment. The benefit of continuing beyond 5 years is slim, so I told her I'd take it month by month dependent upon how I feel. There are associated risks with both Tamoxifen and A.I.s. The both can increase our risk for blood clots, elevated cholesterol, and osteoporosis. Tamoxifen is also associated with uterine cancer. My Onc. claims the associated uterine cancer is a mild form that is addressed by hysterectomy and rarely any post-surgical chemo.

My advise to you, for what it is worth, is to opt for the Tamoxifen until you reach menopause. Just know that once you achieve menopause you will probably be asked to do another 5 years of anti-hormonal therapy depending upon the research. Reduction in estrogen will cause vaginal atrophy (google it) which will put a damper on your sex life. I was 48 at diagnosis, and became menopausal during chemo, so my side effects are also those commonly experienced with menopause, just heightened by the anti-hormonals. I think your quality of life may be better on Tamoxifen.