Chemo-induced menapause, what drug to take?

Hi
I am 42 years old and ER/PR/HER2 positive.
I finished chemo last June.
I am on Tomaxifen, because I was premenapause before chemo. The chemo put me into menapause. wondering if anyone has experienced this ??
I was on herceptin but my MUGA scan went from 51% to 36%, so now I am on heart medication and hopefully my heart will get back to normal so I can go back on herceptin.
Thanks
Bonnie T

[michele u]

bonnie,
I'm 41 and i was premenapausal at dx also. I'm er/pr neg, so can't take tamoxifen. If you are wondering about hotflashes and what take, Effexor is a good choice. It is a antidepressant, but works good for hotflashes. I take 75 mgs and when i'm having hotflashes i take 150mg for about a week. I had my ovaries removed at dx, just because i didn't want it to ever spread there. If you have any other question, i'm a nurse also.

Many of us learned about menopause early! I had always skipped those chapters in "womens" books. Figured I had a good 10 years at least. But chemo sent me there early. I found that Remifemin (sp) helped me a lot, mainly with night sweats. You should check out Dr. Susan Love's website, www.susanlovemd.com. She has a lot of information on menopause, as well as breast cancer.

Love and light,

Lisa

If you are her2 positive by FISH and not receiving concurrent herceptin , taking tamoxifen may actually be worse than not taking it. At a conference in Laguna Niguel in July Dr. Carlos Arteaga expressed his opinion that aromatase inhibitors may not work in her2neu amplified patients not concurrently on Herceptin, but at least they, unlike tamoxifen, did not have a potential to make it worse. His talk was not published, but perhaps your oncologist can communicate with Dr. Arteaga regarding whether you could be switched to an aromatase inhibitor until you get back on the Herceptin, as it at least is just not as effective rather thanpossibly paradoxically resulting in tumor growth stimulation.

Most of this is from basic research rather than clinical studies, but as, to the extent of the biochemistry of her2neu breast cancer is understood, tamoxifen alone in a her2neu by FISH positive patient was in his opinion not only not effective, but contraindicated, it would make sense for your oncologist to check this out with him.

At ASCO, I was told that Nancy Davidson, MD gave a talk regarding that all chemo-induced menopause is not permanent, and perhaps it was not yet time to change the recommendation that patients be given an AI rather than tamoxifen if the patient is not "naturally-postmenopausal"-- but it is not clear to me whether she separated out her2neu hormonally positive patients from the rest. Dr. Stephanie Jeffreys of Stanford presented a paper in Molde Norway where she stated that contrary to previous thinking, she has found in her laboratory studies that the majority of her2neu positive patients are also hormone receptor positive (it has been written for many years that only 10% of her2neu positive patients were hormone receptor positive) and that there may be three different groups of these her2 and hormone receptor positive patients, each with a different prognosis.
This has only been published as an abstract.
Until these groups are separated out and their prognosis and best treatment methods studied, we are looking at recommendations of how to treat all the "fruit salad" but some of breast cancer patients are" peaches", some "plums". some "apples"and some "oranges'. In ten years perhaps multigene arrays will tell oncologist how to treat each subgroup of breast cancer patients.
You did not say if you were er+ and pr+ and how strongly.
Again, noone knows the answer, but it is theorized that being on Herceptin may be able to negate the untoward growth stimulatory effect of Tamoxifen and may make aromatase inhibitors effective in her2amplified patients, according to Dr. Arteaga.

Let's hope you get to get back on!

Good luck, Lani