Hysterectomy/Oophorectomy and A1 Blockers

Not sure why he says you must make an immediate change. I’m 19 years postmenopause and am taking tamoxifen. I think you’re right that AIs reduce estrogen to a much lower level throughout the body than tamoxifen.

AIs have a slightly better response to preventing a recurrence. For myself, I didn’t want the effects of the AI and chose tamoxifen, the risk levels were very close between the two.

Maybe there is an issue with tamoxifen as your body adjusts to the surgery? Maybe a hormone therapy holiday would be okay during that time? Then resume tamoxifen?

After reading so many posts by so many people it seems that some oncologists require the use of AIs because they do have a “significant” better response. But that statistically significant number is VERY low. Many of the research articles I’ve read have said the difference is so close as to not make a real difference. A drug choice should, of course, consider the top med options but should also include the patient’s individual body issues and their life choices.

One big issue though is whether you are at risk for deep vein thrombosis and endometrial cancer. If those risk levels will be high in postmenopause, then tamoxifen would not be a good choice.

@triciaot
Thank you for your response.
I guess I need to ask more questions….he just said that after the surgery, he wants to do bloodwork and switch the medication to one that is meant for someone in Menopause. I am already really nervous about the surgery and the Menopause side effects and then to read the A1 can make them worse….lots of anxiety!

Hi! I am going through the same dilemma right now and I’m curious as to your opinion and expediting on tamoxifen after a total hysterectomy. How did it go for you?

@chhirsch
It’s been a year since my hysterectomy and I am actually still on the Tamoxifen because my Oncologist is a little concerned with switching due to my family history of heart disease. Apparently the A1’s can increase risk for that.
And I finally adjusted to the crazy Tamoxifen side effects and I have been scared to switch.
So far so good, just had my mammogram and before that an MRI and both came back ok.

Thank you for responding! I'm so glad to hear you're doing well with the Tamoxifen and that your tests were clear! I am thinking of doing exactly the same thing. My mom has heart disease as well and I had a heart ablation for PVC's the month before my BC diagnosis. Take care!

@mchler73 My understanding is that an AI shows what is labeled “significant” better outcomes than Tamoxifen but that they’re talking very minor differences in risk. In the scheme of things a half a percent of risk, while maybe scientifically significant, might not be important to me.
I agree with any heart issues an AI should be critically evaluated for how your entire health would be benefited or not.

I’m editing this before edit window closes - I’m leaving my original comment above. But I just searched about Tamoxifen and skin cancer - looks like it acts as an agonist to estrogen availability in the skin, and may increase the risk of developing skin cancer. I know this is your other concern right now.
The link for the info below - but you may want to investigate further. I’m sorry that the decision making is like a game of Jenga. Which block will hold it all up, and which will topple it.
https://www.tandfonline.com/doi/full/10.2147/cia.s798#d1e624

@triciaot
Interesting! Thank you so much for the information and link! I will discuss with my Oncologist and see what her recommendation is.

Yes, it’s so hard to know what to do with all of the different side effects, which one is worse in the long run…..

The risk for stroke is higher with Tamoxifen was what my oncologist told me.