Zoladex vs. Oophorectomy

My 34 year old wife (mother of 3) underwent a radical mastectomy (nodal involvement), a prophylactic mastectomey, chemotherapy and radiation.  She has been on tamoxafin for about seven months (estrogen receptor positive) and will continue for the five years.  She just had her first period since starting the tamoxifin (tamoxifen).  Because of this her oncologist is concerned that tamoxifin (tamoxifen) is not doing enough to reduce the amount of estrogen.  He is recommending Zoladex injections once a month for a couple of years.  My wife is afraid of the quality of life side effects lasting for the entire time she is on Zoladex.  She wonders if she would do better to have an oophorectomy, thinking that she will experience the crash of the side effects all at once, but then her body will adjust.  What are the competing risks/side effects between taking Zoladex and undergoing an oophorectomy?

[CCF-RN,MSN-rf]

Dear wmm:  It is not uncommon for women to menstruate while on tamoxifen.  It is thought that it's antiestrogen properties are "selective" and affect breast tissue differently than uterine tissue.  Having said that, some oncologists feel that more complete ovarian ablation may be beneficial.  The choice of using zoladex or removing the ovaries largely is personal.  Obviously, the biggest difference is that Zoladex is temporary and removing the ovaries is permanent.  Either way, your wife may experience side effects and either way the body will adapt to some extent.  Removing the ovaries is a surgery, from which she will need to recover.  Some would argue that if you are going to open her up, the uterus should be removed as well, since she is on tamoxifen and there is some risk of uterine cancer.  But this is a bigger surgery.  Zoladex, an injection, is quick and easy, but must be repeated at regular intervals.  There is no absolute right or wrong answer here.