Oophorectomy v. Lupron/Zoladex

[DLL]

Hello, I'd appreciate any information in helping me make a decision. I am pre-menopausal (though still in chemopause.) My oncologist has always said that because I am HIGHLY ER+, I should have my ovaries removed if there is ever another reason to "go in there." (I am BRAC 1 & 2 negative.)

Now my gynecologist, taking into account my oncologist's statement about the ovaries, recommends removing the ovaries to shut off the estrogen, which is causing benign ovarian cysts, thick endometrial lining and polyps in the uterus. This would be a laproscopic day surgery -- three small incisions in the abdomen.

Even though it is just a day surgery, I'm a little nervous about going under general anesthesia -- I had tachycardia and extreme vomiting during my lumpectomy/SNB -- plus facing the other risks of a surgery. So I am thinking about whether I should push for chemical ovarian ablation instead (e.g., Lupron, Zoladex). I'd appreciate hearing from any of you who have weighed this decision or have information that might shed light on the best route. What are the pros and cons of oopherectomy v. Lupron / Zoladex? (Note that I am 48 so permanent loss of fertility is of no concern to me.)

P.S. I have just started tamox, but would switch to an AI after the estrogen is shut off either surgically or chemically.

Thank you!!!!

[Becky]

Hi

I don't know the pros and cons of an ooph versus chemical ablation because I just went ahead and got the ooph. I was 46 at the time and the operation is almost 4 yrs behind me. I was in chemopause when I made the decision but by the time I got the operation 6 wks later, I got my period back (twice and very regular). I was not concerned with fertility anymore either and, like you, I had a thickened uterine lining. Secondly, I was only moderately ER+ and PR neg so Tamoxifen usually doen't work very well with a pathology like that but an AI tends to work better (and they do work better than Tamoxifen in general). I really wanted to take an AI to give myself the best chance so I went ahead with it. It is a simple procedure and doesn't cause very much discomfort at all. Recuperation is a breeze.

Since you know you feel nausea afterwards (as I did) just make sure you tell the doctor and the nurses. I "came too" and felt alittle sick and they immediately put something in my IV drip and it was gone instantaneously. Someone else will be able to give you good information on Lupron or Zoladex. I didn't even want to consider the option since I also wanted the ovaries out because my paternal grandmother died of ovarian cancer and I didn't want to take any chances with getting that next

I had the ooph the way you described (laproscopically - and there is absolutely no telltail signs outwardly that I did).

[Shobha]

DLL - Thanks for starting this thread. Becky, thanks for the info on your experience with the surgery.

I too am considering ooph since I have developed a cyst in my ovaries. They tell me it is a simple cyst and will go away on its own but now the worry has set in. There will be another ultrasound in two months to review the cyst.

I am weakly ER+ (~10%), and so I was never given Tamoxifen. I have been regular with my periods within two months of the chemopause.

Did you or anyone here experience any crazy (literally ) side effects of ooph...

love,
shobha

[DLL]

Thank you, Becky! Very helpful.

Shobha, I do wonder if you can ease into menopause a tad more gradually (and easily??) with the drugs by slowly increasing the dosage, vs the suddenness of the oophorectomy? OR since I am now in chemopause, maybe I won't experience many/any additional symptoms after the ovaries are shut down??

[tricia keegan]

Like Becky, I also decided on the ooph without considering any meds to shut down the ovaries. I ahd taken tamox for eight weeks but the potential serious side effects bothered me and as I was highly hormone pos it was an easy decision.
The surgery was the easiest I ever had and recovery was quick also.
I've been fortunate in having none of the side effects normally feared with menopause, the first couple of months after the ooph hot flashes were a problem but these diminished with time.
I had the ooph in '06 and have no regrets and have been taking arimidex ever since.

[Cannon]

Same here - I insisted on the ooph same day as my double mast. I had had a hysterectomoy for large fibroid tumors 8 months before by bc dx - and had them leave in my ovaries. I was also brca negative, but wanted to be as aggresive as possible (stage 3 at dx) - and that meant no ovaries, and onto an aromatase inhibitor. I was in chemopause already - and sudden menopause sucked - but not as bad as cancer.

Rebecca

[Jackie07]

I talked to a gynecologist within my HMO Tuesday and he said they only do hysterectomy and oophorectomy for women who had the onset of breast cancer before 40. He said it will cost $5000.00 to do the testing to see if I am still .... (Can't really remember what he said, my brain automatically shut down when I heard the cost involved.)

Since I've had two full-round of chemo in the past 6 years, I am hoping that everything is indeed shut down.

5-19 rev. : I told my oncologist about the [genetic] testing fee and he ordered the test for me so I won't get charged for it.

[Lien]

I'm on Zoladex and have been since the end of 2004. It's a drag, but I tolerate the shots well. Had a strong period for two weeks and then it stopped. I did get hot flashes and I feel my ability to multitask and concentrate has diminished. My skin is ageing, but it probably would have anyway. My biggest complaint is, that I have no libido left. That's putting a strain on my marriage, even though we decided on doing this together. Also, the lining of the vagina is getting thin, which causes discomfort. All these things may happen with an Ooph as well, but I don't know about that. The Zoladex have to be repeated every three months, and they can be painful. Not big deal painful, but the needle is big and you need a doc who knows how to do it. I had to teach mine, and now the shots are not so bad.

I am hesitant to take biphosphonates because I already have trouble with my jaw, but you need to check for osteoporosis. I'd make sure they do a baseline Dexa scan before deciding on either solution. An AI might make your bones weaker as well. My boneloss seems to have gone very fast during the first two years, and has tapered off now. I'm borderline osteopenic. I try to exercise to keep my bones in good shape.

Some docs prescribe the once a month shots of Zoladex. That's a real hassle. I'm glad I'm on a 3 month schedule.

Hope this helps

Jacqueline

[DLL]

Thanks, Jacqueline! I followed your advice, and I am going in for a baseline bone density DexaScan today. I met with my oncologist yesterday to discuss the ooph vs. Lupron routes, and she encouraged the ooph route, particularly with the (laparoscopic) ooph being just a quick day surgery and given that I have no need for my ovaries. She thought the side effects from stopping estrogen via the ooph are a bit easier to control than the side effects of Lupron.

Did any of you who had an oophorectomy (but left the uterus) have any irregular bleeding after you recovered? I have a friend who is a gyno surgeon (who practices in a different part of the country, so I can't use her) who mentioned that irregular bleading can be a consequence of having the ovaries out without also taking the uterus or at least doing endometrial ablation. My gyn surgeon is willing to take out the uterus, also, which would double the recovery time from 3/4 days to a week. But I've got a disabled child to take care of, so I like the shorter recovery time (and, yes, less extensive surgery.) Advice appreciated!!

(PS, I went to the hystersister site to research this, but got scared away by all the horror stories. I'm hoping that all those who had good experiences with oophs or hysts just don't have any need to post there...)

[Becky]

I had no ooph problems but I had vaginal bleeding only because I had a simultaneous D&C. The D&C was so the gyne could do a full biopsy since I had the thickened uterine lining (which I mentioned before).

I have had no vaginal bleeding since about 3-4 days after the ooph (which was only due to the D&C)

[DLL]

Thank you, Becky!!! I am having a D&C also for the same reason. Glad to hear you had no bleeding problems from the ooph. Best to you!! Deb

[tricia keegan]

I had no bleeding whatsoever although did'nt need the D&C either.
I've been fortunate in terms of side effects and hope you will be too

[Marily]

HI, I remained pre- menopausal after my chemo. We tried Lupron and it just did not work..(once they gave me a double dose ouch) We finally did the oophorectomy and it was easy and with no problems after. We did discuss removing everything and My surgeon said he would do a good look and if the uterus was ok the removal would continue with the scope. If there looked to be a problem then he would switch to abdominal Hysterectomy He feels one should not cut up things if there is a question of cancer and therefor would have to change to abdominal lap. to remove the uterus intact. We continue bone scans and so far I have been fine with replacements with vitamin D and Calcitrate twice daily. I too am on the watch for severe bone loss. I also was on tamox. and was told to get off it, by a Dr at an ASCO convention. So with surgical menopause I went on Aromasin. Do have some ot flashes and have noticed loss of sexual feelings. I am highly estrogen and progesterone pos so this was essential for me. Good luck in your choices... You are considering the right way and asking good questions.

hugs

[DLL]

Hi, all. Thanks for advice and comments. For those checking this thread later and wondering about the operation itself, I want to report that the laparoscopic oophorectomy was an easy day surgery, no complications, minimal pain (tenderness, not sharp) for a couple of days that was easily controlled, QUICK recovery. Back at work 4 days later. NO REGRETS!!

[Becky]

Great news DLL. It's an easy operation.

[Cannon]

So glad it went well!