Menopausal status and choosing therapies

AlaskaAngel · 07-31-2012, 01:12 PM

I am posting the info about a very current review that clearly points out that menopausal status is not very well determined by providers.

The point is that accurate menopausal status has a LOT to do with whether to take aromatase inhibitors or tamoxifen, as well as to do with whether or not favorable conditions are present for cancer.

The common basis used by OB-Gyns and others is 12 months without periods. This is not truly accurately definitive, even though that is often not made clear to patients, who hear that rule of thumb and apply it to themselves when making choices about therapies.

Studies have demonstrated that some women are not fully menopausal even up to age 70 or more, whether or not they are still having periods.

www.ncbi.nlm.nih.gov/pubmed/22...

Jackie07 · 08-04-2012, 01:09 AM

That probably explains why even after a prophylactic hysterectomy/oophorectomy (removal of uterus and ovaries) at 50 and having had chemopause since late 2003, my oncologist still gives me Tamoxifen...

Becky · 08-04-2012, 05:08 AM

Removal of the ovaries is the most perfect menopause you can attain. When you get the ovaries removed, you are postmenopausal. There is no question.

Jackie07 · 08-04-2012, 01:59 PM

But that doesn't mean there's no Estrogen being produced in our body...

“Some estrogens are also produced in smaller amounts by other tissues such as the liver, adrenal glands, and the breasts. These secondary sources of estrogens are especially important in postmenopausal women. Fat cells produce estrogen as well.^[8]”

^{Estrogen (Biosynthesis) http://en.wikipedia.org/wiki/Estrogen>>}

Genetics probably play a role - I've never been overweight in my life (the brain tumor[s] have impacted my satiety center and I tend not to feel 'hungry'). My breasts are gone, ovaries are gone, so the estrogen must have come from liver and adrenal glands...

Becky · 08-04-2012, 02:12 PM

Aromatase inhibitors stop the production of estrogen in these organs. They just cannot stop estrogen production in functioning ovaries.

AlaskaAngel · 08-13-2012, 02:03 PM

We tend to lean toward believing chemotherapy is the "most effective" treatment for breast cancer, but for those who are least menopausal, chemotherapy may only provide temporary or limited protection from ovarian influence. It may be that removal of the ovaries would actually provide at least some patients with more protection from recurrence than chemotherapy. Naturally, the younger one is, the more difficult it is to accept full menopausal status (in terms of planned pregnancies, as well as a more fulfilling sexuality for a longer length of life). In addition, menopausal symptoms and status is only one SE of chemotherapy and the host of drugs used in support of chemotherapy.

This too raises the question again about whether combining removal of the ovaries with trastuzumab may actually be fully protective against recurrence for certain breast cancer patients, rather than combining it with chemotherapy.

If the stem cell info from Fred Hutch study holds up, then it would be even more reason to avoid the chemo and substitute ovarian removal.