Hysterectomy or Not?

I am writing for an expert opinion.  I am 32 years old and I have been currently diagnosed with Breast Cancer for the 2nd time.  Both times, the lumps have been estrogen based.  My Oncologist is wishing for me to speak to my GYN regarding a hysterectomy or at least removing my ovaries.  The problem is....she refuses to do this until I am at least 40.  Why is she doing this to me?  I would much rather suffer the consequences from early menopause than to fear the re-occurrence of Breast Cancer for a 3rd time.  If removing my ovaries reduces my risk, why not do it?  I have 1 child, which was a difficult pregnancy which led to me getting a tubal ligation performed.  My family is complete and I want to do everything possible to reduce the chances of the Breast Cancer coming back yet again.  I am scheduled to start a 2nd round of chemo on May 31, which will do quite a number on my ovaries.  Then, I will have to take the Tamoxifen for 5 years, which will also do a number on my ovaries and give me menopausal symptoms.  Do you have any recommendations?

[Machelle Seibel, MD]

I'm sorry to hear of your situation. I'm certain it must be very difficult for you and your family.

It is very common to have the uterus and ovaries (or at least the ovaries) removed in situations such as yours. You are correct in saying that the next round of chemo could potentially put you into menopause which may or may not rebound back to normally functioning ovaries in the months following. However, with estrogen positive breast cancer and a recurrence, many oncologists feel the negative side of removing the ovaries is worth the downside of the side effects.

Talk to another gyn or have your oncologist suggest a second opinion person. It is also important to prepare for the side effects. Have a mental health professional in place to deal with the impact of being a young woman with a recurrent cancer. Also, it will be helpful to have someone to work with you as you deal with some of the side effects.

There are non hormonal ways to deal with vaginal dryness such as the over the counter product Replens which will help relieve vaginal dryness. Use it daily for a week and then twice weekly.

Have a bone density done to determine your bone thickness now as the removal of your ovaries will put you at increased risk for osteoporosis (thinning of the bones). We don't want you to survive the cancer and then break your hip. There are also non hormonal medications you can take for bone thickness in addition to calcium and a multivitamin, though Tamoxifen helps with preventing osteoporosis somewhat. If your uterus is left in, it will also be important to have an ultrasound of your uterus done each year as Tamoxifen can cause abnormal build up of the uterine lining.

The fact that you are going through chemo has one inadvertent positive. The changes it causes to the ovaries lowers the amount of estrogen your body will be making. That means that if your ovaries are removed, the drop in estrogen will be less and hopefully, it will result in fewer symptoms such as hot flashes because your body will have gotten used to lower estrogen levels more gradually.

After you go through with the next round, and if you do have your ovaries out, in the Fall or sometimes after the chemo, you will see how much the symptoms are bothering you.  At that time, there are several non hormonal approaches for treatment. In the meantime, drinking a lot of water, exercise and relaxation methods are very helpful.

I wish you the best of luck as you continue to fight your cancer.
Machelle Seibel, MD