A little discussed fact is that for up to 20% of women of European descent, and 5% of those of Asian descent, tamoxifen is not properly metabolized in the liver. It is stated that for these patients taking tamoxifen is worse than doing nothing, likely due to unmanaged estrogen levels persisting in spite of supposed treatment. Docs know this, at least the decision-making bodies, and yet no testing is recommended -- presumably todave insurance companies money. Disgraceful if you ask me.
http://www.ncbi.nlm.nih.gov/books/NB...?report=reader
A gal in my online chemo group developed a massive amount of fibroids and ovarian cysts in a short amount of time while on tamox. She thought fine, I'll have a hyst. I have a lot of experience prior researching fibroids and I suggested that (since her surgery was delayed and she was in a lot of pain) that she ask her doc to switch her to Lupron of Zoladex which are GnRH inhibitors. These drugs both shrink fibroids as well as reduce estrogen in the body, also working for breast cancer patients.
Post-menopausal women should already be on aromatase inhibitors (unless perhaps you are weakly ER+ and doing natural methods to reduce estrogens). More recent studies have shown that ovarian suppression with lupron or zoladex plus an aromatase inhibitor seems to be more effective. None of these drugs are a walk in the park and estrogen depketion can increase cognitive impairment.
I hope this is helpful.
Ann