Returns of Menstural Cycles

[Rupali]

Hi all,
I am 30 years old. Was diagnosed 11/04 with STage 3A BC. Her2+++, weekly ER+ PR +. Had a 9cm tumor . Mastectomy done in 12/05 and then 11/22 nodes positive.
Had 4 rounds of AC and 4 Taxol dose dense, 33 Rads, started Herceptin 05/2005. Have been on Herceptin since.
Started Tamoxifen in 06/2005.
Started Vitamin E 10/2005 together with some other supplements.
Today I got some staining and had some pains like periods yesterday. I will like to know did someone else who was premenopausal get periods back and what cold be the implication of this.

Please respond

Regards,
Rupali

[Rupali]

Someone please respond if u had a return of menstural periods while on tamoxifen

[saleboat]

Hi Rupali. I just had my period return after ending chemo on Sept. 23 and being without my period since the end of July. I started tamox on Oct 17. Tamox is not supposed to stop your periods, as far as I know.

Jen

[Rupali]

HI Jen,

Thanks for responding. So did your periods return when you were on Tamoxifen.
Did your onc say that Tamoxifen is not supposed to stop your periods. As I understood that if periods return while on Tamoxifen then they will look at more cruel methods to suppress ovaries estrogen production capacity.
Please respond.
Regards,
Rupali

[Cynthia]

I was 43 at time of diagnosis and was pre-menopausal. My periods stopped with chemo but started back up again about 4 months after chemo ended. I was strongly ER+ (90%); Her2+++; and 4 nodes pos. I was told that aromatase inhibitors are better than Tamoxifen for Her2+ gals but that you have to be post-menopausal for it to work. So when my periods came back I took Zoladex for a couple of months to suppress my ovaries so I could still take Arimidex. Since I knew I didn't want any more kids and since I didn't like the Zoladex shots that are given in the belly once a month, I had my ovaries removed in March of this year (which was a truly no big deal surgery for me). I enjoy knowing that I am now truly post-menopausal and that I am getting the best protection from Arimidex that is possible for me.

I know you are quite a bit younger and that this may not be an attractive option for you but I hope this helps.

Stay well.

Cynthia

[Rupali]

Hi ,
Thanks Cynthia for your reply.
I am a little confused is that could it be Vitamin E that could cause my periods to come back. I started Vitamin E 800 IU and that stopped my hot flashes and then suddenly the periods came.
Regards,
Saurabh

[saleboat]

Hi Rupali,

My periods did return after 6 weeks on Tamoxifin. Because the studies comparing the use of ovary shut-down for pre-meno women with early stage disease vs. the current standard of care (Tamox only), my Onc has NOT considered this an option for me. We have talked about it a bit and given that Tamox is not as effective for Her2 disease, I'm not sure that I'm happy with her conclusion. BUT, there are many pre-meno women who do have their ovaries shut-down thru shots or removed in order to ensure that they are post-meno.

Not sure that this helps. I'm not worrying about the return of my period. I suppose there is reason to worry, but frankly, I'm sick of worrying. Maybe I'll take it up again after the holidays.

Jen

[Cynthia]

Saurabh,

Whether or not your periods came back because of the vitamin E will probably never be known. However, I understand that while chemo puts many women in permanent menopause, others start menstruating again sometime after chemo is done. I also understand that the younger you are when you go through chemo, the greater the chance you will get your periods again. Since you are only 30, you probably have young ovaries that want to keep on doing their thing, which means, in part, that they produce a lot of estrogen which causes you to cycle. (Please bear in mind that I didn't take vitamin E and my periods returned, and I have 15 years on you, so sometimes these things just happen.) The real issue in my mind is what you want to do about the high levels of estrogen that your body is producing now given that you are ER+. Since AI's may be better for Her 2+ women than what you are now taking, you may want to talk with your doctor about pursuing an AI (though that requires you to get your ovaries to stop working -- either chemically or by surgery). The other downside to that is your age in that I understand a woman in her thirties who has to have her ovaries shut down can experience some really awful hot flashes, etc. Bottom line, you may want to consult with a few oncologists who are really up on hormonal therapies to see what may be the best approach for you.

I do wish you the very best.

Cynthia

[Rupali]

Hi Cynthia,

That was my husband typing for me and his name is Saurabh and accidentally he finished the note with his name.
Anyway, I met my local oncologist an hour back and she said this always happens with young women on Tamoxifen and this is a sign that the ovaries are still active.
She will talk to my other oncologist who is actually an oncologist in MGH, Boston and also happens to be one of the leading researchers in fields of AI's and Hormone therapy.
She thought that there might be a chnace that they might have to put me on LUPRON once every 3 months together with Tamoxifen.
The main controversial question is that my tumor was weekly ER+ something like 6-7% ER+ from the mastectomy sample. Strange thing was that 15 days prior to my surgery when punch biopsy was done the n they had said my tumor was 80% ER+. So it was always an iffy thing.
I will better go on LUPRON and secure myself from Estrogen side.
I would hate the side effects though.
Regards,
Rupali

[kristen8594]

Hi,

I had my period return after chemo putting me in menopause for 15 months, while on tamoxifen. When it came back it came every 21 days for three months, then was not regular...skipping a month here and there. My blood work came back as premenopausal. was also getting ovarian cysts which the gyn kept and eye on through ultrasound. Now I have not had a period in 3 months. My oncol said that probably by this time next year I will be post menopausal.
Kristen

Rupali

I am man and not a sufferer so I can only begin to imagine the impact of the questions you are facing.

From what I have read some things are clear;
1. The group with highest treatment dissatisfaction is young women.
2. It is recogised that in many instances young women are not sufficiently informed from within the "system". The emphasis is often on any level of potential survival gain, no matter what the outcome in terms of fertility / sexuality. It appears from literature that treatment issues are often not weighed against fertility, energy, general well being, sexuality etc.
3. There are limited statistics for the fertile sufferers group.
4. There is conflict as to the impact of retained fertility (oestrogen etc) on re occurence / survival and hence some people who retain fertility are ablated surgically or chemically. There are a lot of trials looking at the outcome statistics which might be of interest to you.
5. I have seen some suggestion that some chemical ablation is reversible in terms of fertility sexuality.
6. I will post a very powerful poem from a sufferer that gives a pesonal perspective from one set of circumstances on a separate post.
7. Subsequent fertility / impact of pregnancy is an issue on its own. Statistics are again limited, but look grimer than often portrayed.
8 HRT use is reported as carrying a high risk. Natural hormone replacement is discouraged.

I have included a rather lengthy list of links I have saved at one point or another that deal with aspects of the subject. I suggest you skim through them as a minimum, and I suspect it will become evident to you that you are potentially faced with huge life decisions, which justify as much research as you have time for. You with your advisors will have to weigh the different risk profiles, monitoring options, treatment side effects etc. There are real choices. My instinct is that as a minimum being as informed as possible outcomes and options will reduce the potential for what if's at a future date.

I hope you find the links useful. You are your own best advocate, and I have no words to begin to understand the decisions you face.

RB



Information

http://store.yahoo.com/annieapplesee...nwomproba.html

http://www.cancerline.com/cancerline...261_2_0_0.aspx

http://www.jco.org/cgi/content/full/23/19/4259

http://www.abreastinthewest.ca/news2.cfm?Num=52

http://jncicancerspectrum.oxfordjour...ono;2005/34/40

http://www.allheadlinenews.com/articles/2236462302

http://www.cancer.org/docroot/MED/co...p?sitearea=MED

http://caonline.amcancersoc.org/cgi/.../full/55/4/211

http://medicineworld.org/cancer/lead...fertility.html

http://www.komen.org/stellent/groups.../spbcyoung.pdf

http://www.asco.org/ac/1,1003,_12-00...-004265,00.asp

http://my.webmd.com/content/article/95/103281.htm

http://store.yahoo.com/annieapplesee...ct/chemam.html

http://www.emaxhealth.com/98/2223.html

http://www.bcaction.org/Pages/Search...etter049C.html

http://www.sciencedaily.com/releases...0203234441.htm

http://www.nci.nih.gov/cancertopics/...e7#Section_261

http://www.nci.nih.gov/cancertopics/...e7#Section_261

http://www.thelocal.se/article.php?I...&date=20050901

http://www.sciencedaily.com/releases...0413064628.htm

http://www.nci.nih.gov/cancertopics/.../Patient/page6

http://store.yahoo.com/annieapplesee...ct/chemam.html

http://professional.cancerconsultant....aspx?id=29053

http://professional.cancerconsultant....aspx?id=29165

http://professional.cancerconsultant....aspx?id=29170





STATISTICS

http://www.cancernews.com/articles/cancer&fertility.htm

http://professional.cancerconsultant....aspx?id=31354


ARTICLES

Avis NE et al. Psychosocial problems among younger women with breast cancer. Psychooncology 2004;13(5):295-308. Abstract

Brenner H, Hakulinen T. Are patients diagnosed with breast cancer before age 50 years ever cured? J Clin Oncol 2004;22(3):432-8. Abstract

Casso D et al. Quality of life of 5-10 year breast cancer survivors diagnosed between age 40 and 49. Health Qual Life Outcomes 2004;2(1):25. Abstract
Chia KS et al. Do younger female breast cancer patients have a poorer prognosis? Results from a population-based survival analysis. Int J Cancer 2004;108(5):761-5. Abstract

Curigliano G et al. Adjuvant therapy for very young women with breast cancer: Response according to biologic and endocrine features. Clin Breast Cancer 2004;5(2):125-30. Abstract

Foxcroft LM et al. The diagnosis of breast cancer in women younger than 40. Breast 2004;13(4):297- 306. Abstract

Friedlander M, Thewes B. Counting the costs of treatment: The reproductive and gynaecological consequences of adjuvant therapy in young women with breast cancer. Intern Med J 2003;33(8):372-9. Abstract

Ganz PA et al. Breast cancer in younger women: Reproductive and late health effects of treatment. J Clin Oncol 2003;21(22):4184-93. Abstract
Grosser L. Meeting the needs of younger women with breast cancer. Nurs Times 2003;99(42):20-2. Abstract

Phillips KA et al. Prognosis of premenopausal breast cancer and childbirth prior to diagnosis. J Clin Oncol 2004;22(4):699-705. Abstract

Thewes B et al. The psychosocial needs of breast cancer survivors; a qualitative study of the shared and unique needs of younger versus older survivors. Psychooncology 2004;13(3):177-89. Abstract






Fertility Links

http://www.ons.org/publications/jour...e3/3103515.asp

http://www.fertilehope.org/

Here is that poem.

It is only one outlook. Others may have had a much less severe result, but it is a powerful heartfelt protrayal of one womens experience that sears into the memory.

RB

Sorry the brain got carried away and I forgot the link.

RB

http://www.cancerlynx.com/bonedry.html

[Rupali]

Hi Kristen,

Was your tumor also wekly ER+. Did the oncologist talk about Lupron or Zoladex when your periods came back on Tamoxifen.
Regards,
Rupali

Her is another link on the subject

RB

http://www.arimidex.net/9370_13860_12_,_.aspx

[kristen8594]

Hi Rupali,

There was no talk of shutting my ovaries down with lupron because personally I would not have done that. Although, I am older than you (44) I am finished having my children (11year twins) so I would have gotten removal of my ovaries before I did lupron. But, you are much younger and lupron is a good way to preserve the ovaires if you want children. Since my period has been skipping months they feel I am heading to menopause anyway. I am on the tamoxifen and have been since 10/03. The first plan was keeping on that for the full five years then switching over to amridex. Now she is wanting me to be deciding on femora and armidex this time next year. If I am not menopausal by then, then I will have them take my ovaries out. I could push to have my ovaries out now, but mentally I am not ready for another surgery or recovery time.
Hope this helps some, feel free to email me anytime.
Kristen

[Rupali]

Hi all and Kristen,
Thanks for the responses. I met with my oncologist yesterday and told her about spotting which has converted to flowing today.
She said it is both good and bad. The good thing is that it means that the ovaries are still ok and there is no menopause and due to my age they would have been worried if I did not have my periods.
The bad thing is that to make maximum use of Tamoxifen it is importnat to have no periods.So she will talk to my other oncologist who is at MGH Boston to decide if they will go for lupron/Zoloadex for me or are ok without that.
Today I opened up my record file and saw that my tumor was weekly less that 10% ER+ and PR+ and Her2++ (6.2) amplified.
So I am debating to myself that this clealry means that my tumor was not initiated with estrogen.
At the same time the whole confusion is that my first punch biopsy that was done 20 days prior to my mastectomy had figures of 80% ER+.
Later the doctors got confused and said that they would go with Mastectomy Hormone readings and not wory abt the biopsy readings.

I will like to know what would you have done in such a situation.
My husband is a strong beliver in natural way of things and says that the body is trying tocome back to normalcy but these doctors will try to suppress it again with this Lupron shots.

Second issue I have been having is that I just got my blood report back and the hemoglobin is down to 10.1 from 12.1 recorded on 11/08/06.

I have been on primarily Vegan diet and we are planning to kick in eggs and Salmon and chicken now as the hemoglobin doesnt seem to stabilise in last 6 months.
Please reply....

[Becky]

Dear Rupali


I also got my periods back and went the course of Cyntheia (started on tamoxifen and then got my ovaries removed so I could switch to Arimidex). I did this because research indicates that Herceptin and Arimidex are a good combination. I also just turned 47 and did this when I was 46. I was definitely finished having children.

I think exploring Lupron or Zoladex shots with an added AI is a good idea. Your ovaries work if you need them to in a few years if you want to pursue having children in the future. I did get my period back (nice and normal) on Tamoxifen. In my case, it was not welcome due to my age and the desire to switch to an AI. The oophorectomy was fine - it felt like I did too many situps for a couple of days (if you go that route).

Besides being Her 2+, I am ER+ (50%) and PR negative.

Best wishes to you

Becky

PS - for the hemoglobin - try lots of green leafy veggies or try Slow Fe (iron supplement every other day until the hemo comes back up)

SALMON

Farmed salmon does not have the same level of omeg threes as wild fish. What animals are fed will reflect in their own fat compostion. High grain consumption will lead to high omega six in livestock , and fish.

You are better eating wild caught fish mackerel etc.

The same theory must be applicable to chicken and EGGS, and I have read does apply to cattle.

Nutritionalists have a duality about eggs. The only thought that occupies my mind and in respect of which I have come to no conclusion is that eggs are a source of arachnadoic acid AA which is one of the omega six products.

See post on articles of interest "The importance of omega three and six to breast cancer".

If you need protein in addition to fish consider taking cold extracted whey protein (consider the large body builders tubs of whey protein as you may find it more economical). Whey is reported as having a favourable impact on breast cancer, and is made up of amino acids which are the fundamental building block of the body. It is very effectively digested unlike some proteins

AND FINALLY read "The Raw Food Diet" by Adelle Davies in my personal amatuer view is essential reading for vegitarians.

As usual it is all out there - try searching on the annieapplseed site - the permutations of cancer are so complex you have got to look for yourself and decide what is best for you.

RB

[Rupali]

Hi Rb and Becky,

Thanks for your response.
I take wild salmon at least 2 servings a week. I am starting now for a short time to take chicken once a week and increase 2 servings of salmon to 4 a week.
Besides this I have been drinking a 12 oz glass of green leafy vegetable juice. I use vegetables like collard, Kale, Chard , cabbage, kiwi.
Also I take 6 oz wheatgrass juice every morning.

Last time I had this HGB issue then my nutritionist had suggested increasing the prtien by 1 serving a day.
I am trying that again this time with egg, chicken and salmon.
Any other tips, please write.
Regards,
RUpali