I think I WANT a hysterectomy - am I right

I'm new to this "too good to be true" site ! I'm 50, had a lumpectomy for breast cancer 2 years ago, and as I was oestrogen +ve put on tamoxifen. This has caused quite big fibroids + I had to have a hysteroscopy for a small bleed. However no "quality of life" side effects, felt fine, put it all to the back of my mind and got on with life.
Then out of the blue my oncologist sends me a letter to say my oestrogen is WAY up and he needs to talk to me. He wants me either to have my ovaries out and then have tamoxifen or arimadex OR to have Zoladex (I'm english I think you call it Lupron) every 3 months for 5 years + arimadex.
I feel I would like to have everything got rid of so I could just try and forget it all again. Trouble is I haemorrhaged during my breast op (lost 5 pints) and then vomited for 2 weeks - so they don't think I'm a good candidate for surgery !
Im told the advantage of the injections is it's reversible and I could stop then - but then my oestrogen level could rise again.
Anyone out there any experience of this sort of choice ?

Gil,

Hi...UK lady!!

I went on (3) months of lupron shots to shrink my fibroids for surgery. I too had a high level of estrogen which helped my fibroids to grow.

Sounds like your Dr. is going over options with you. From my experience with lupron, my Dr. did not want me to go on it longer than 3 months. From what my Dr. told me, one major long term side effect of lupron is bone loss.

Also, since you are 50, has your Dr. talked to you about a decrease in estrogen due to being close to menopausel age?? With taking out your ovaries, you will then go into surgical menopause. And it sounds like HRT may or may ot be an option because of your breast cancer.

Has your Dr. possibly discussed removing one ovary instead of both?? That would possibly help to decrease the high estrogen levels and you would not go through surgical menopause but natural menopause.

Also, have you maybe checked out a laparoscopic surgery?? It is less evasive than an abdominal surgery and the recovery time is generally shorter. I had a laparoscopic surgery and I am very pleased with the results!!

I have a co-worker who had a laparoscopic surgery to remove just one ovary. She had a growth on it. She did great with her surgery!!

Anyway, just some ideas. Hope a hostess posts some links for you.

Good Luck!!

Hi (((gill159))) Sorry you've already had to go through so much already and are facing a decision about even more.

I wanted to ask... if you're on Tamoxifen, why is it an issue that your estrogen level is up? The Tamoxifen would oppose the estrogen in your breast tissue... if necessary, you could increase the dosage of Tamoxifen, since you sound like you're doing well on it. (Kudos to you - I wasn't able to tolerate it .) You might have to be very careful to have your uterus checked periodically (sometimes this is done by ultrasound) because Tamoxifen does cause an increased risk of endometrial cancer.

At 50, you are probably close to menopause... I would think the goal would be to just do something short term to get you there, and then switch over to Arimidex or other aromatase inhibitor? I just think it sounds like removing your ovaries might be a bit drastic, especially given you're not a good surgical risk.

Or, you could try the Lupron... it is true that if you don't do well on it, you could just stop having the injections (whereas you can't put back ovaries that have been removed). Lupron sometimes causes symptoms of menopause; however, removing your ovaries does that pretty much all the time, and if your DR is concerned about breast cancer risk, chances are you won't be allowed to use HRT.

Another option some women have done well with is using Lupron and then something like Livial (Tibolone) to help manage menopausal symptoms. Has your DR discussed that possibility with you at all?

I hope this helps... good for you for researching your options!

s,
-Linda

	Quote:
Trouble is I haemorrhaged during my breast op (lost 5 pints)

I hope you had a full hematology workup -- that sort of hemorrhaging may point to some clotting factor problem that could be treated to make surgery (IF needed) safer for you. Clotting problems are far more frequent than people realize, particularly if you belong to certain ethnic groups or are a fair-skinned redhead. But they CAN be treated. It's worth it to find out, whether or not you decide upon an operation now.

Good luck as you make these decisions. Lupron is not without its side effects, either, especially if your doctor is recommending five years . Bone density is going to be an issue for you as well!



Audrey

Thank-you for the useful replies. I'll just have to talk it out with my gynaecologist on Thusrday I think. Just to answer the queries - a high oestrogen level on Tamoxifen seems logical as you say Linda, but they don't seem to know definately that it isn't harmful so I think my oncologist is playing for safety (which is what I would want!) It's actually going up & down in fairly drastic waves and I think he's worried about the "surges".
They thought my haemorrhaging was due to me being oversensitive to the anti-coag injection before the op. But they were a bit vague so I shall ask more about that as you suggested Audrey.
I don't know about the one ovary idea, historylady, I'll ask. Also about the bone loss you mentioned with the zoladex (lupron).
Thanks so much for the ideas and support ! Gill

Just to say although my oncologist talked of options my gynaecologist was very sure a hysterectomy was the best & obvious solution. So there it is - I have an abdominal hysterctomy (fibroids too big for a vaginal one) and ovaries out too, in September. Probably 20th. I shall now send for the book and start reading ! Gill