Today's appointment was initially scheduled for April, but was re-scheduled 4 times due to COVID-19. Then I re-scheduled it one more time to get an earlier date after I had that unexpected spotting.
My monthly Lupron shots for ovarian suppression are supposed to put me in chemically-induced menopause, so any bleeding is unusual. My OB/GYN put in an order for a pelvic ultrasound, just to make sure there's nothing else going on.
She looked at my recent blood work, and apparently my FSH (follicle-stimulating hormone) level is not in the post-menopausal range. I learn something new every day, and today I learned about FSH. The pituary gland makes FSH to stimulate estrogen production. As menopause nears, the ovaries produces less estrogen, but it's like the body instinctively tries to put up a fight, and the level of FSH actually increases in an effort to get the ovaries to keep making estrogen. So, if the Lupron is working properly, I should have a high, post-menopausal level of FSH. But I don't. My FSH level is very low and in the normal range for pre-menopausal women. (1/12/21 Update: Actually, this is completely wrong. I correct my own misunderstanding in this post.)
(I guess when my oncology NP took a quick look and saw that all my blood work came back "normal", she forgot that my FSH isn't supposed to be in the "normal" range.)
I told my OB/GYN that my NP had also put in an order to test for estradiol, but those results still weren't available. The OB/GYN agreed that seeing the estradiol number would help determine whether or not my body is actually producing estrogen again. I also mentioned that I haven't had any hot flashes in a while, and I noticed around the same time as the spotting that my vaginal dryness had improved. She said both those things could be additional signs that my body is producing estrogen.
If that's the case, I think the problem goes back to my medical oncologist, to figure out what to do about it. I'm wondering if there is a higher dose of Lupron I could get, or if I'll have to get my ovaries removed after all. I reminded my OB/GYN about the concerns we discussed at my last visit, and she said that even if the possible long-term risks are valid, she thinks breast cancer is the bigger threat right now, and should be prioritized over possible problems that might develop later. If I do get an oophorectomy, she'd refer me to a gynecologic oncologist to do the procedure.
Maybe I'm getting ahead of myself. I guess my next steps right now are to wait and see what the estradiol number is, and what the pelvic ultrasound shows. Then I'll circle back with my medical oncologist and see what she says.
My OB/GYN did say that the internal exam looked fine, and she doesn't expect anything to come up in the ultrasound. She clarified, too, that my exam looked normal for my age, not for someone in menopause, which is another piece of data pointing to estrogen.
Back at home, I called to schedule my appointment for the pelvic ultrasound, which will be in a couple weeks. Apparently I need a full bladder for that procedure. I'm supposed to void my bladder 90 minutes before my appointment time, and then drink 24 oz. of water within the next 30 minutes, giving the water 60 minutes to get to my bladder. (I think "void the bladder" is a funny phrase. Why not just say "empty the bladder"?)
I have to say, I really appreciate it when people on the phone are kind and patient. I feel like the scheduler I spoke with understood that chances are, if someone needs to schedule a pelvic ultrasound, there is some amount of anxiety and fear involved, and just being nice can go a long way in making the caller feel better.
So all of this kind of feels like a blow. I had hoped that after I finished Herceptin and got my port out, I would finally settle into a stable phase of treatment with far fewer medical appointments. I've used this analogy before, that it feels like I am just being carried along on a river of cancer treatment. The DMX surgery and chemo felt like white water rafting, and this past year still felt like rough waters while I tried to manage my side effects. I was looking forward to having a nice stretch of smooth sailing, but it's like the river took an unexpected turn, and there might be more rocks up ahead.
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