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Breast Cancer (Expert Forum)
High Estrogen Receptor Pos, menses on high dose FEC
Questions posted in the Breast Cancer Forum are answered by medical professionals from The Cleveland Clinic. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.
High Estrogen Receptor Pos, menses on high dose FEC
by wendini, Jan 17, 2006 12:00AM
I have read that in pre-menopausal women with ER+ the primary benefit of Chemo may be that you go into menopause or that estrogen is impacted. I am high estrogen and progesterone positive. I am 41, no family history, in excellent health;I had 1.3 cm, grade 3 on BR,invasive tumour removed (also some DCIS there,) at the chest wall,only 1 mm margins in one area in October/05. Negative nodes, tumour site suspicious for lymphatic invasion. Have been on Chemo, FEC100 since Nov.4. I have continued having heavy periods and bleed for 10 days. Why would this continue, is it my esrogen levels? I have had had two treatment delays due to low neutrafils and I have been doing well, but feel very weak. I wonder if I could quit the chemo and address the estrogen problem. What about doing something to my ovaries as well as Tamoxifin (tamoxifen). Also the dosage will now be reduced to FEC 75. and I have not been going on schedule, perhaps the effectiveness is less now. Just wonder if the estrogen alone could be my main focus and I could avoid this chemo with 3 more to go...I live in Victoria, British Columbia, Canada. Thank you very much.
Doctor's Answer
by CCF-RN,MSN-rf, Jan 18, 2006 12:00AM
Dear wendini: Chemotherapy has a different mechanism of action than hormone therapy. Although the ultimate goal (eradicating cancer) is the same, the goal of each therapy is somewhat different. Chemotherapy is not given to induce menopause - there are specific drugs that can be given if this is the goal of therapy. Your oncologist will be better able to address the purpose and expected benefit of the chemotherapy in your situation - and perhaps help you with that part of the decision (whether to continue with chemotherapy). If you decide to continue with the chemotherapy, you may also want to ask your doctor about the addition of a "growth factor" to help keep the white blood cells from falling so low.
With regard to your heavy periods, chemotherapy may damage the ovaries and cause a temporary or permanent menopause - but this is not always the case. In general, the closer a woman is to her natural menopause, the more likely this is. However, some women menstruate throughout chemotherapy (and tamoxifen as well) and it is possible to become pregnant (hence the recommendation for appropriate birth control). If your periods are unusually heavy, you may need to see your gynecologist to make sure all is okay, gynecologically speaking. Once this is confirmed and you arrive at the "hormone part" of your therapy, you can discuss with your doctor whether there is a role for ovarian ablation (chemical menopause) and, depending on this discussion, what type of estrogen blocker would be appropriate in your case.
With regard to your heavy periods, chemotherapy may damage the ovaries and cause a temporary or permanent menopause - but this is not always the case. In general, the closer a woman is to her natural menopause, the more likely this is. However, some women menstruate throughout chemotherapy (and tamoxifen as well) and it is possible to become pregnant (hence the recommendation for appropriate birth control). If your periods are unusually heavy, you may need to see your gynecologist to make sure all is okay, gynecologically speaking. Once this is confirmed and you arrive at the "hormone part" of your therapy, you can discuss with your doctor whether there is a role for ovarian ablation (chemical menopause) and, depending on this discussion, what type of estrogen blocker would be appropriate in your case.
