Determination of Menopausal Status

Gail · New User Joined: 29 Oct 2004 Posts: 4

Hi,

I was wondering if anyone could shed some light on the 'accepted' method for categorizing someone as pre or post menopausal. The reason I'm asking is because some cancer treatment is based on that status and I got different responses from two different doctors. Before starting my chemo this year I was 50 and still having some periods but they were spread out, not a regular monthly thing anymore as I presume I was heading toward menopause. When I initially met with my oncologist he said he would do some blood work to determine my menopausal status and from that he said I was post menopausal and that after treatments I would go on Arimidex (vs Tamoxifen). Thereafter I spoke with another doctor to get a seond opinion on some things and that doctor said if I had had a period in the recent past I was still pre-menopausal and did not give any merit to any blood work to determine the menopausal status. That doctor said I should go on Tamoxifen after treatment rather than Arimidex. I'd appreciate any comments on this differing assessment and how I should really be categorized, pre or post?

Thanks

leo · Contributor Joined: 23 Sep 2004 Posts: 1575

Hi

Menopause by definition is lack of periods for 1 year, and elevated FSH (follicle stimulating hormone). You can have a transitional phase referred to as perimenopause or climateric phase, where you can have irregular periods, but your FSH will already be elevated. Many people call this phase menopause as well.

About the Arimidex versus Tamoxifen, many people use Tamoxifen as first-line therapy, however there is some evidence of Arimidex being superior, but this is debatable and opinions diverge at this point.

regards,
Leo
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Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

Gail · New User Joined: 29 Oct 2004 Posts: 4

I still have some confusion that maybe you can clarify.
It is my understanding that Arimidex is only for post menopausal women. 1) Why is that and what happens if it's take by someone who is pre- or peri- menopausal? 2) Given the status of my period as previously described would you say I should consider myself post menopausal and therefore a candidate for Arimidex? or only if I was to be tested now and find elevated FSH 3) I didn't have any further periods once I started the chemo so does that mean I should start out on Tamoxifen and then could switch to Arimidex once I have gone a year without a period?

It is great that you are able to make this forum available!

BFagan2067 · Experienced user Joined: 07 Oct 2004 Posts: 54

Gail, I too was premenopausal when I started chemo.. also started tomoxifen prior to chemo... but after I was done with chemo I was tested to be post menopausal. I also switched from the tomoxifen to the arimidex. I switched due to a skin reaction to tomoxifen, and this was after the testing showed that I was post menopausal. I was 45 at time of initial dx, and had my last period right after my first a/c chemo. If you were premenopausal when you started chemo, as I was, then the chemo put me into menopause. This has been my experience... thus I relied on the fsh test to dictate whether or not I was post menopausal. Best of luck to you in your further exploration of this.
HUGS!
Barbara

MuttsMom · Guest

you get the feeling I'm following you Barbara... lol

Same here Gail when the exception of age, but not by much, I had just turned 43 when I was dx. I never had a period again after I started chemo, started on Tamoxifen and because of being Stage III and Arimidex showing to be superior, my onco did a blood test to see my status. I was post MENTALpausal, so I changed to Arimidex. He thought I'd start again within 6 months, but when I didn't, that is when he ran the test.
Nancy

leo · Contributor Joined: 23 Sep 2004 Posts: 1575

Hi

The problem with receiving hormonal treatment if you are still producing estrogens is that the drug may not work well because it will compete with estrogens for receptors. Also, all the trials are made with clearly defined populations of post-menopausal women, therefore there is no data to know what happens with other groups of patients.

Based on what I know, if you have a high FSH I'd consider you post-menopausal. I'd talk to your doctor about these issues, including what you discussed with us, so he can explain the rationale for starting (or not) treatment.

regards,
Leo
_________________
Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

Gail · New User Joined: 29 Oct 2004 Posts: 4

Hi,

As I mentioned previously, after completing chemo my oncologist put me on tamoxifen which I have been taking for over a month now. Since starting the tamoxifen, I have become quite self conscious and embarrassed because I have grown a lot of facial hair. I did not ever recall anyone mentioning facial hair as a tamoxifen side effect but I was digging around for information on what might be causing it and came across the following side effect listed for tamoxifen at one of the breast cancer care web sites:

[quote][i][b]A small number of women notice an increase in downy facial hair or changes to their singing voice[/b][/i][/quote]

I know that I should just be happy to be alive but this side effect is driving me crazy and doing nothing to boost my already depleted self image or confidence as a woman. Has anyone else experienced this problem and does anyone know of any possible remedies? I guess there are some hair removal treatments but I don't know anything about them or how safe they are. Suggestions anyone?

Feeling like I'm turning into a werewolf...
gail

DiO · Guest

Gail,

How interesting! I had the same problem after starting Arimidex in July with the fine, fuzzy facial hair. No one had mentioned this possibility to me either. I used a cream hair remover that said on the package could be used on the face in Sept before my daughter's wedding. It took it off and so far it hasn't come back. Time will tell!

God bless, Di

Guest

Hi Di,

Thanks so much for sharing! I guess switching from Tamoxifen to Arimidex probably isn't the answer based on your experience. Please post again in the future to let me know if the one hair remover treatment continues to work (or not) or what problems or successes you encounter in dealing with this side effect. I'm sure I won't come across many other people who've experienced this one...

Gail

Rita · Guest

Estrogen can come from 3 sources: ovaries, adrenal gland, and fat tissue. My understanding is that Tamoxifen blocks estrogen from any source. Arimidex stops the adrenal gland from producing estrogen. Therefore, your ovaries have to have stopped on their own (either through menopause or surgery) for Arimidex to be an option.

leo · Contributor Joined: 23 Sep 2004 Posts: 1575

Hello

Just a quick correction... Arimidex is a drug from the class of aromatase inhibitors. This class of drugs works by inhibiting the enzyme aromatase, which converts a molecule that is a precursor of estrogen into estrogen that is active. By that the active molecule is not formed and therefore the effects of estrogen are avoided. The adrenal glands do not produce estrogen, it produces androgens, glucocorticoids (ie cortisol), mineralocorticoids (aldosterone).

regards,
Leo
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Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

JM · Guest

I had a hysterectomy in 1998 at age 38, all was removed except for 1 ovary which was left in so that I wouldn't have to go on hormone replacement therapy. (Hysterectomy was due to endometriosis and fibroids that I had been dealing with for years). I met with my oncologist today as I will be starting my 1st round of dose dense chemo this Monday, Nov. 22nd. He said that when I finished with chemo and radiation treatments I would start on tamoxifen. I asked if I was pre or post menopausal since I still had one ovary. He said that since I hadn't had a period since my hysterectomy I was post menopausal. I thought the remaining ovary was still producing estrogen and that I should be concerned about it but he said that it is based on when my last period was. He didn't mention anything about FSH levels. So, now I'm confused. Any comments on this?
Thanks JM

leo · Contributor Joined: 23 Sep 2004 Posts: 1575

Hello

In my mind if your ovary is still producing estrogen, I would think you can be considered premenopausal. You don't have an uterus, therefore no periods, but the stimulation and hormonal factors are still there...

regards,
Leo
_________________
Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

JM · Posted: Mon Nov 22, 2004 10:22 am Post subject: that's what I was thinking leo

Leo,

thanks for taking the time to respond to my post. I am thinking along the same lines as you on this. I start my first round of chemo in a few hours so I won't discuss this with the oncologist again until I meet with him next Friday. But I will ask him for further clarification. Jan

sam52 · Regular Joined: 11 Oct 2004 Posts: 21 Location: London, UK

I'm just posting this to reassure all you gals who have suddenly got facial hair - it's most likely due to chemo, not tamoxifen. When your hair (head etc) starts growing again, for some reason you often end up with downy facial hair - like peach fuzz. But the good news is that it is only very temporary!!! I got it for a while, but it just seemed to drop out again.(phew!)A friend of mine who got chemo for Hodgkin's lymphoma ( and therefore no hormone treatment) got the facial hair too. Laughing

Sam
_________________
dx bc Oct 2001
tx - mast, chemo(FEC+taxotere), 25 rads.Now on tamoxifen

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