Endocrine Therapy for Premenopausal and Postmenopausal for Women: Breast Cancer

Endocrine Therapy for Premenopausal and Postmenopausal for Women are very essential in the cancer treatment for all women of all ages

At the mention of the disease cancer people frown and frustration follows almost immediately. Knowing how the kind of pain and suffering the cancer patients go through, a painless treatment solution would be highly recommended. Unfortunately as things stand now this is not the case further complicating the painful lives of cancer patients. Even though cancer does not discriminate on gender or otherwise, women are hard hit by this unhealthy condition. A lot of treatment procedures are being used including the endocrine therapy for premenopausal and postmenopausal for women. Speaking to doctor Dalal Akoury MD and founder of AWAREmed Health and Wellness Resource Center about this condition, she states that women who have been diagnosed with estrogen receptor-positive breast cancer will often most likely be prescribed for daily oral medication after all other treatment ends. However, it is important to note that for endocrine therapy prescription will be done differently for each patient depending on whether they are premenopausal or postmenopausal.

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Endocrine Therapy for Premenopausal Women

Under normal circumstances premenopausal women with breast cancers that express the estrogen or progesterone receptor (ER or PR-positive) will in most cases advised to take tamoxifen for sometimes normally up to five years. This drug impacts the effects of estrogen in cancer cells and helps reduce the risk that the breast cancer will recur in women of any age by almost 50 percent.

Remember that this medication (Tamoxifen) can also be helpful in the reduction of the risk of developing a new breast cancer in the portions of the breast not affected yet. In some cases, women who are younger than 35-40 may also be considered for combined endocrine therapy with medications that temporarily stop ovarian function.

Doctor Akoury registers that in many cases majority of women stop menstruating after receiving chemotherapy, often for several months even though this may extend to a few years. It is also possible that these women despite this changes they are experiencing could still have functioning ovaries and premenopausal hormonal levels despite the absence of their menstrual periods. Besides, the ovarian function could still return unexpectedly. That said, women who are premenopausal, regardless of whether they experience temporary menopause because of treatments, should not be prescribed aromatase inhibitors (unless they are participating in specific clinical research studies). Aromatase inhibitors are typically reserved for postmenopausal women with breast cancer.

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Side effects of tamoxifen

Like with all other drugs the side effects of tamoxifen are generally mild and decreases with time. They include:

• Hot flashes
• Decreased interest in sexual activity
• Weight changes
• Insomnia or trouble sleeping
• Vaginal discharge
• Fertility issues
• Memory loss
• Fatigue
• Joint pain
• Headaches
• Hair loss
• Skin changes
• Menstrual irregularity
• Increased sweating
• Nausea
• Mood swings

Note that some side these effects can be alleviated through symptom management and other positive lifestyle changes.

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Risk Factors

Serious complications with tamoxifen are rare, especially in women below the age of 50. Some of the complications may include blood clots (deep venous thrombosis or pulmonary embolism) or uterine (endometrial) cancer.

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Ovarian Suppression or Ablation

For premenopausal women with estrogen receptor-positive breast tumors, ovarian ablation or suppression (stopping ovary function) may be an option. Since a premenopausal woman’s ovaries are the main source of estrogen production, temporarily or permanently shutting off their function has been shown to be effective (when used alone) in reducing the chances of a breast cancer recurrence. Studies are now confirming their usefulness when given with tamoxifen instead of chemotherapy or after chemotherapy. This is called ovarian ablation or suppression and can be done through surgery (permanently) or monthly hormonal injections (temporarily). The injection of medication will prevent you from ovulating or menstruating and will put you in temporary menopause. Surgery will prevent you from having to undergo monthly injections, but will put you in irreversible menopause. You should speak to your doctor regarding any plans to conceive children so that together you can decide which option is best for you and your family.

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Ovarian Ablation

A bilateral oophorectomy or ovarian ablation is the surgical removal of your ovaries. This procedure is sometimes recommended if you have been identified as carrying a BRCA1 or BRCA2 genetic mutation and have an increased risk of developing ovarian cancer.  The surgical removal of your ovaries will reduce circulating estrogens in your body down to postmenopausal levels. This surgery is permanent and cannot be undone. For premenopausal women, an oophorectomy will prevent you from conceiving children and will cause permanent menopause.

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Ovarian Suppression

Ovary suppression can be achieved by hormonal drug injections known as gonadotropin-releasing hormone (LH-RH or GnRH) agonist. This works by temporarily suppressing ovulation and, as a result, limiting the amount of estrogen circulating in your body. Estrogen levels usually are reduced to postmenopausal levels within two weeks. Treatment is generally administered by monthly injections. Although you will be in a temporary menopause while taking this drug, it is important to note that this is generally reversible and menstruation often begins shortly after treatment stops. This is not a fail-proof birth control method so you should use a non-hormonal form of contraception too, like an IUD or barrier methods such as condoms or a diaphragm. Side effects are similar to menopausal symptoms and include decreased sex drive, hot flashes, weight gain and bone pain. And to maximize on its effectiveness, ovarian suppression drugs and tamoxifen can be prescribed alongside.

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Drug interactions

Antidepressants – It is estimated that as many as 30 percent of all breast cancer patients in the United States are prescribed an antidepressant at some time during their treatment. However some of these antidepressants may interfere with how tamoxifen works and therefore should be avoided. The following are some of the antidepressants which are expected to interfere with tamoxifen:

Paxil^® (paroxetine)
Prozac^® (fluoxetine)
Wellbutrin^® (bupropion)

In conclusion the endocrine therapy for premenopausal is conclusively addressed in this article and we are going to be concentrating on the postmenopausal in the next article. We want to request you to stay on the link for more health information. But in the meantime, if you have any concern you can about such treatments, you can schedule for an appointment with doctor Akoury for more professional clarification.

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Breast Cancer