- Question from Norma: I am 37, diagnosed last year, and taking tamoxifen. I am premenopausal. One month I have a period, the other I don't. I have very bad hot flashes, some night sweats and bad swings emotionally. My doctor wants me to take my ovaries out. What do you think?
Mindy Goldman, M.D.
The problem with taking the ovaries out is that it will make you permanently menopausal. There are certain times where an oncologist may feel that removing the ovaries is important for someone's breast cancer treatment, but this is pretty unusual. It's more likely that your side effects are due to tamoxifen. Most women notice changes in their menstrual period, and 25-50 percent of women will often complain of hot flashes. If your mood is also disturbed, I would recommend a low dose of an antidepressant such as Effexor, which may treat your mood, as well as your hot flashes.
If your doctor thinks that it would beneficial for you to be menopausal relative to your breast cancer, it is easier to use a reversible form such as drugs like Zoladex (chemical name: goserelin) or Lupron. There are some breast cancer patients, however, that may also be at a higher risk for ovarian cancer. If someone has a mutation in the breast and ovarian cancer genes, BRCA1/BRCA2, she is at risk not only for breast cancer, but also for ovarian cancer.
It is more common to have a mutation in one of these genes if you are diagnosed with breast cancer at a very young age, particularly in your 20s or early 30s. I recommend ovarian surveillance for anyone diagnosed with breast cancer younger than 40. This consists of pelvic ultrasounds and the tumor marker CA125. In general, this tumor marker, CA125, is not a good screening test for ovarian cancer because it has a lot of false positives, but in high-risk women we recommend performing the test anyway.
If you are known to have a mutation in one of these genes or are at high risk, some oncologists may recommend having your ovaries out once you have completed child bearing.
- Marisa C. Weiss, M.D. This is called prophylactic ovary removal. It's done to lower the risk of getting ovarian and/or breast cancer in the future.
On Wednesday, July 21, 2004, our Ask-the-Expert Online Conference was called Managing Menopausal Symptoms. Mindy Goldman, M.D. and Marisa Weiss, M.D. answered your questions about how to manage menopausal symptoms, including hot flashes, vaginal dryness, loss of libido, and more.
The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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