1/8/21: My Medical Oncology NP Called Me

She called to give me an update after having talked to my medical oncologist and OB/GYN about my spotting. 

First, she asked me to go in on Monday, after my ultrasound, to get my blood drawn. They want to test again for FSH and estradiol, to see if the numbers fluctuate at all.

She said the most important message my medical oncologist wanted her to convey is that the situation is not catastrophic. We are still gathering information, and we will figure this out. It may take a few weeks, but should not drag on for months.

I appreciated this explicit message because part of me had already gone down this thought train: "So, if the spotting is a light period, that means I'm producing estrogen, which means the Lupron is not sufficiently suppressing my ovaries... I'll have to get my ovaries out, but in the meantime, what if all the estrogen is fueling cancer cells again!? But wait, the chemo was supposed to have killed all the cancer in me, so what are the chances of there being any lingering cancer cells that managed to evade the chemo, or any altogether new cancer cells?"

Anyway, the NP reassured me that there are many patients who end up having to temporarily discontinue Lupron or exemestane due to side effects or other surgeries or any number of reasons, so not having effective Lupron for a couple months is not an unusual situation. 

She also said that getting an oophorectomy was only one of a number of options my medical oncologist mentioned, if the problem turns out to be the Lupron. She said something about looking into whether or not Lupron can be given more frequently than once a month, but I have never heard anyone on any of the Facebook groups mention that. She also said something about switching from exemestane to Tamoxifen, and not doing any ovarian suppression; from what I've read, this was the typical pre-menopausal line of treatment until studies showed that ovarian suppression with an aromatase inhibitor (like exemestane) actually works better. 

I was hoping to wait until after natural menopause to get my ovaries out because this article says that "women under 45 who had ovary removal without hormone replacement therapy were at increased risk of dying from a range of medical conditions later in life," and this other article says, "There seems to be no increase in medical side effects if oophorectomy is performed after a woman undergoes natural menopause." It's not clear but I suspect both articles are referring to the same study. Anyway, my OB/GYN already pointed out that cancer is the more pressing threat right now, so I should weigh the possibility of cancer recurrence with more priority than the possibility of unknown mortality risks later in life. She hasn't come right out and said it, but I get the feeling she thinks an oophorectomy would make sense, and the risks are acceptable. 

Okay, I am obviously going down the rabbit hole that my NP specifically didn't want me going down just yet. Who knows, maybe the ultrasound will show something completely unexpected... I need to stop speculating. I will get the ultrasound and blood test on Monday, and then I'll re-group again with my medical oncologist or NP.