I made this appointment even before I was diagnosed because my PCP thought all my breast-related appointments were an indication of having an increased risk for breast cancer, and she recommended I talk to an OB/GYN about non-hormonal birth control methods. There is some evidence that using hormone-based birth control may be related to a slightly higher risk for breast cancer. Anyway, once I was diagnosed, my NP said I definitely shouldn't be taking hormonal birth control.
This is probably another TMI post, but there's a lot of important information I want to record.
Most interestingly, the OB/GYN did not feel that an oophorectomy (removal of ovaries) has any serious long-term side effects that I should worry about. I asked her about possible long-term risks, and she said the information I had all seemed tied to one study that is over 10 years old, so she didn't give it much merit.
She was so unconcerned about the risks of ovary removal that she said I could consider an oophorectomy as a means for birth control. The Lupron is supposed to put me into a chemically-induced menopause, so I asked if birth control is still necessary? She said it is, because the purpose of the Lupron itself is not birth control. Another option is a non-hormonal IUD, but she warned that having one might mask other bleeding symptoms that might result from the Tamoxifen; Tamoxifen can increase the risk for uterine cancer, and one of the earliest symptoms can be abnormal bleeding. Barrier methods (which is recommended during chemo) actually seem the least problematic.
She also said I might want to consider an oophorectomy to avoid the monthly Lupron injections. I had already seen in the Facebook support groups that women with strong ER-positive breast cancer do sometimes choose surgical menopause over chemically-induced menopause. I'm not sure if there's a benefit other than avoiding the inconvenience of monthly appointments. My medical oncologist didn't mention it, but I suspect that's because it's in the OB/GYN domain. I'm still concerned about long-term risks, but it's not something that needs to be decided any time soon. I can see how the Lupron goes, and can always elect for an oophorectomy later.
The OB/GYN further discussed ovary removal in the context of my genetic testing. Even though the VUS in my BRCA2 gene wasn't enough to justify ovary removal in the opinion of the genetics specialist, my OB/GYN seemed to lean towards being cautious, similar to my breast surgeon. She confirmed that ovarian cancer is hard to detect, having only non-specific symptoms, so removing the ovaries would make that one less thing to worry about. It seems kind of drastic to me, since I don't even know that I do have an increased risk for ovarian cancer, but I guess I "may".
Overall, she gave me the impression that removing my ovaries could have a number of benefits, and she didn't seem too concerned about any risks. She didn't go so far as to "suggest" it, but she gave me a lot to think about.
We also spent some time talking about symptoms of menopause, so I'll know what to expect. (I still can't believe I have to worry about menopause at age 43.) She said the average age when natural menopause starts is 51, and it's technically when periods have stopped for at least a year. Since the Lupron is a pre-menopausal treatment, I asked how will I know when I'm in natural menopause. The oncology nurse had said that a blood test could measure hormone levels, but the OB/GYN said it's hard to tell unless I stop taking Lupron for a period of time before getting tested.
Oh that would be a drastic measure! seems like another surgery would be a lot to take on. I guess you could always do it later, like much later right? after finishing the year of treatments and fully recovered from the DMX....And it kinda makes sense that you wouldn't know when natural menopause hits when you're chemically-induced! I wondered about that too! Seems like the OBGYN definitely had more info than the oncologist did on these other fronts!
ReplyDeleteYeah, I think if I were to consider ovary removal, I would do it after I'm done with Herceptin, so at least a year away. And I kind of want to feel settled in my prescribed hormone therapy regimen, like in a stable place, before making further decisions.
DeleteI think it's interesting how my medical care is spread out across different specialties! I mean, it makes sense, each doctor is an expert in their own field. But there is also so much overlap. Like the breast surgeon deals with the local surgical treatment of breast cancer, but the medical oncologist deals with the systemic treatment. And the medical oncologist prescribes hormone treatment that will directly affect my estrogen levels and the functioning of my ovaries, so then you need the OB/GYN's expertise, too. I am really glad that all my doctors are in one hospital network, so they can see my history across all disciplines!