Started Period While On Femara - Questions

[WolverineFan]

Hello Ladies,

I decided to turn to this wonderful board for answers because I haven't been able to talk directly to my oncologist and would like to hear what you have to say. I've learned so much from this board and have found tremendous support, so it seemed like the best place to start.

I started my period this Saturday after being on Femara for nearly one year. Per my onc's instructions, I have stopped taking Femara and went in today for some blood work. Results will be in tomorrow, but I am not even sure what she is looking for. I am guessing by what I read that she is checking my hormone levels. Searching on past threads, I learned that what will likely happen is that I will be put on Tomixifin with Lupron injections. However, and it certainly could have been how I searched this topic, I couldn't find out if this increases my risk. It seems like it would, but I don't want to worry if its merely a change in meds until my body gets back into a post menopausal state, but I would like to understand what all this means, if anything.

I had two tumors (one ER-/PR- and one highly ER+/PR+...info below) but was an early stager, so I don't want to overreact.

Any help you all could provide in helping me understand what this means for my risk factors, I would greatly, greatly appreciate it.

Thank you so much!

Hayley

[Becky]

Hi

This happened to me too but I was on Arimidex (same thing) but I was a bit older than you (46) so I had my ovaries removed. I do know that my second opinion onc at Sloane Kettering warned me that I should have bloodwork every 2 months because I was young enough to come out of chemopause since I was premenopausal prior to bc. Also, if in a state of perimenopause, AIs can bring your period on and it is given to women as a form of fertility drug.

Don't freak out even though I did. I got my period back about 7 months after my last chemo so it was quick for me. I also had late Herceptin that started about a month before I got my period back. I could have just taken Tamoxifen but said "what the hay" and had an oophorectomy and went back on Arimidex (of which I am still taking even though it has been 5 yrs since the ooph and going back on).

[WolverineFan]

Thank you, Becky. I appreciate very much you getting back with me. I do feel better. Thanks again.

[sassy]

I took Lupron shots to stay in menopause and continue taking Arimidex. The Lupron should put you back into menopause fairly quickly so that you can resume Femara. I took the Lupron shots for four years, then had my ovaries removed last November. Still on Arimidex and will continue indefinately.

[Chelee]

Hayley,
I was peri-meno when I started chemo. My onc told me I would stay menopausal even after I finished TCH. She didn't want me on Tamoxifen...but an AI instead due to my dx. I was concerned about my age at the time since I was peri-meno before starting chemo. I was afraid I would go back to peri-meno, and I knew your not suppose to be on an AI unless you are in menopause. A few months after starting Femara I felt like I was going to get my period back and expressed my concerned to my onc.

I insisted that we make sure I was still in menopausal range? So she ran my FSH (Follicle Stimulating Hormone), Estradiol, & LH (Luteinizing Hormone) and found out I was back to peri-meno. So no doubt your onc is running those lab tests on you. I ended up having the Zoledex shots in order to take an AI. But eventually I just had an ooph to put me in menopause to stay on Femara. So that is another option if you want to stay on an AI. I'm sure your onc will help you choose the best option once your lab results are back. Let us know what you find out.

Chelee

[Becky]

Hayley

I want to add that you (for the interim) need to think about birth control. My husband and I were lucky because he had had a vasectomy about 6 yrs prior. When I got my period back, besides my onc running FSH, LH and estradiol (as Chelee pointed out), my gyn gave me a uterine ultrasound just to be sure nothing else was going on. This was done about 2-3 weeks after I got that first period and low and behold, I was about to have a double ovulation on the left ovary. Can you imagine! But it was not possible to become pregnant because of the vasectomy. However, otherwise, I might have - with possibly twins and only 11 months after diagnosis and after just starting my coveted Herceptin.

Just a warning as I do not know your personal situation but getting your period back does mean that you could become pregnant (which I am only presuming that you do not want to).

[Lien]

Hi,

As you can see in my signature, I had Zoladex shots for 5 years so I could stay on an Aromatase Inhibitor. It wasn't fun, but it wasn't too bad either. When I quit Zoladex, my periods returned within a year. I was 50 at the time. I"m still debating going back on Zoladex so I can have 2 additional years of an AI. I once read somewhere that BC survival was slightly better if ovaries were permanently put out to pasture, but heart disease increased slightly, so all in all the effect on mortality was negligable. Can't find that article now, alas. I think that the improved quality of life after stopping hormonal therapy is an important factor as well. My libido totally disappeared for five years, but is back now, to my husband's delight. And mine. You are still quite young and this may be a factor for you to consider.

Jacqueline

[WolverineFan]

Hi All,

Thank you very, very much for all your responses. I appreciate the insight very much. I knew I could count on the people on this board to help me out!

I am a bit put out with onc, as I went in on Tuesday at 8:30 am to have my blood work, and I just now heard from her nurse. She told me that an FSH and Estradiol tests were run. The FSH said my body was still in a "post" menopause state and the Estradiol was high for being menopausal. This was all on my voice mail at work, so I don't exactly understand as I am sure I am showing my ignorance, but I didn't think I could have a period if I was in fact post menopausal. Also, she said because of this, my onc is prescribing Tomixifin and at my next appointment (which isn't until February), she would discuss with me having my ovaries removed. Just wanted to bounce all this off of you all and see if this sounds accurate. I called back but got the nurse's voice mail. It seems odd to me that I would be post menopausal and that she would not want to see me to further discuss options until February. Am I over reacting?

Thanks a million for all your help!

Hayley

[Becky]

If I were you, I would make an appointment and go in and see your doctor. My bloodwork was the same as yours, FSH saying postmenopausal but the estradiol was at premenopausal levels.

I was able to get my ovaries removed within 3 weeks so I just resumed Arimidex afterwards.

However, you have options - you could take Lupron or Zoladex shots and take Tamoxifen or the Femara. If you take the shots, you need to know the bloodwork criteria to stay on Femara. You also need to know the side effects of the shot and the dosing criteria (I think you need to have a shot every 3 months or so but I never took the shots so I don't know the timetable).

If you switch to Tamoxifen, you should also be discussing the side effects with your doctor - what are minor and what side effects are major (that you need to say something to your medical team right away). I don't think they should leave you hanging out there for 3+ months for this visit imho. This is a new plan whichever way you go and you should be given the courtsey of a visit to have all the options on a piece of paper to discuss. And there are more options than just calling in a prescription for Tamoxifen because you can take that with or without the shot (of one or the other of 2 different drugs). Plus the option of shots and Femara.

Just my two cents. If they won't see you, ask for your onc to call you to discuss your concerns and options.