How to Cope

QUESTION: I am in need of advice and reassurance. I am a 51-year-old female. I was diagnosis with carcinoma in situ a year ago in my left breast. I have been taking tamoxifen. My uterine lining is beginning to thicken. I was advised to have a total hysterectomy. My concerns are how to deal and cope with the new me. Since I cannot take estrogen, what can I use to help me with the many signs of menopause? This would help me face the surgery better. Are there answers and safe treatments for me?

All I was told was I could have more hot flashes. I am a teacher and it would be helpful if I knew I can make it and deal with menopause.

ANSWER: I'm sorry you are struggling with these difficult medical decisions. First, if your doctor feels that tamoxifen is an important part of your treatment for your prior breast cancer, and if your uterine lining is beginning to thicken, then it is important to consider whether tamoxifen may be contributing to this uterine change.

Be reassured that generalized thickening of the uterine lining does not mean that cancer is present-but your doctors are concerned about the possibility of cancer. Most experts in cancer in women do not recommend routine ultrasound of the uterus in women taking tamoxifen, because the results can be unreliable and difficult to interpret. They suggest evaluation only in women who have vaginal bleeding or other new symptoms. I would strongly recommend a second opinion from a doctor who specializes in women's cancers (a gynecologic oncologist).

If the doctors on your team, and those from whom you seek a second opinion, recommend removal of the uterus and ovaries, and you decide to proceed with it, then you need to ask your doctor about side effects to expect, including menopause-related symptoms.

Interestingly, 51 years of age is the average age of a woman going through menopause. If you have already shown signs of menopause, then removal of your ovaries may cause only minimal symptoms. But if your ovaries are still "rocking and rolling," then you may feel a range of symptoms alone or together, related to this abrupt transition. Our section on menopause deals with many of these changes and concerns. Bring some of our ideas and suggestions to your doctors and get their advice on your personal situation.

I hope this helps. Good luck with your decisions.

—Marisa Weiss, M.D.