Tamoxifen, oestrogen levela

[Gill W]

I had a lumpectomy + lymph node sampling in Oct 2002.(+ radiotherapy)  My tumour was oestrogen dependant so I was put on Tamoxifen. I was lucky in that I had no side effects on it, except last November I was found to have several sizeable fibroids. It was thought these might shrink as I was having some hot flushes and thought I was becoming menopausal (I am 50 years of age and my periods stopped in March 2003, 3 months after starting tamoxifen)
I was therefore shocked to find that a blood test for oestrogen done last month showed my oestrogen level not to be menopausal, but to be 1 & 1/2 times the highest normal value for a PRE menopausal woman!  i.e. the tamoxifen is not supressing my ovaries at all.
Added to this I have just had another US scan which shows my fibroids to be growing quickly - the biggest one (of 4 ) was 9cm x 6cm x 8cm  6 months ago and is now 11cm x 7cm x 8cm. They also noted some follicular cysts on my ovaries and a endometrium just over the normal range - 6mm
My oncologist wants me to have a repeat oestrogen in 2 weeks time and then think about having my ovaries out if it's still high.
My questions are - does it matter if the next test is low ? if it's fluctuating isn't that just as dangerous ?  also would I be best to just have a total hysterectomy + ovaries out than just ovaries - although I know now they are more reluctant to do hysterectomies than they used to be.  I don't fancy Zoladex.
I will of course talk to my oncologist but I don't see him for a month and I wanted to consider my options.

                      Thank-you         Gill W

[CCF-RN,MSN-JS]

Dear Gill W, Tamoxifen is a Selective Estrogen Resceptor Modulator (SERM) which means it blocks estrogen in certain areas of the body and acts like estrogen in other areas of the body.  Continuing to have circulating estrogen is possible even though you have stopped having periods.  If the goal is to stop ovarian production of estrogen then shutting down the ovaries by removing them or use of medication such as Zoladex would accomplish that. In regard to the question of hysterectomy it might be considered in light of the fibroids and uterine thickening.  There is an increased risk of uterine cancer associated with Tamoxifen, this is uncommon, but should be considered.

[surgeon]

tamoxifen does not suppress ovaries; in a way, the opposite is true. It blocks the effects of estrogen on certain end-organs, meaning it interferes with the stimulation of some tumors by interfering, at the cellular level, with the binding of estrogen to areas of those tumor cells. And, in some cases, the blocking effect can cause the brain (the pituitary) to increase stimulation of the ovaries as it reads lower estrogen by virtue of the blocking of the estrogen by tamoxifen. So it's not rare in women on tamoxifen to have elevated levels of estrogen in their blood. The question is, is that harmful or not, given that in theory the effect of that increased estrogen on the tumor is blocked by the tamoxifen.

[ritavv]

Wow, this post could have been written by me a couple of years ago.  I was 50 when diagnosed and still premenopausal.  I started taking Tamoxifen in March 2001 and my periods stopped.  Unfortunately, my estrogen levels skyrocketed and stayed that way and I developed fibroids and ovarian cysts.  My oncologist thought the added estrogen was competing too much with the Tamoxifen, so recommended ovarian ablation...either surgically or with Lupron.  Since I figured I was close to menopause, I chose the Lupron.  I was on it for 6 months and it worked great.  Then when I stopped, my estrogen levels went up again and I got ovarian cysts again.  This time I went on the Lupron for a year.  I thought surely I'd be menopausal when I stopped last Sept but I wasn't.  Luckily this time my estrogen stayed normal, but not menopausal. So here I am over 3 years without a period and last week I started spotting.  So I guess it's time to see the gynocologist again.  At this point I'm wishing I would have had the surgery.