ER-Positive Tumors and Hormone Therapy My chemotherapy treatment for invasive cancer put me into menopause, and my oncologist put me on Arimidex. Is this the right drug for me? I'm also taking Fosamax, which my doctor prescribed to help maintain my bone mass. Anastrozole (brand name Arimidex) is an aromatase inhibitor. Although pre- and postmenopausal women can use tamoxifen as hormonal therapy, only postmenopausal women can use an aromatase inhibitor. That's because postmenopausal women get most of their estrogen from the conversion of androgens into estrogen by the aromatase enzyme. In contrast, premenopausal women get most of their estrogen directly from their ovaries (which the aromatase inhibitors cannot block).
You did not mention how old you are. The older you are, the more likely it is that the menopause you are experiencing will be permanent. But if you are in your 30s or even your early 40s, there is a chance that your periods will come back. And if this were to occur, the Arimidex would not be effective. I am concerned about your being on an aromatase inhibitor because we don't know if your periods are going to come back or not. If you want to stay on the Arimidex, your doctor will need to continually monitor the hormone production by your ovaries to determine whether it looks like your periods will be starting. Alternatively, you could take one of the drugs that put a woman into temporary menopause by suppressing ovarian functioning and reducing estrogen levels. The drugs used for this purpose are goserelin (brand name Zoladex), leuprolide (brand name Lupron), and triptorelin (brand name Trelstar).
Because you are taking an aromatase inhibitor, bone loss is a real concern. Alendronate (brand name Fosamax) is a bisphosphonate that is used to treat osteoporosis. Your doctor is prescribing this drug to try to help you maintain your bone density while on Arimidex. The problem is that we don't know what effect these drugs will have when they are given long-term to women who don't yet have osteoporosis to try to prevent this bone disease from occurring.
If you decide to take tamoxifen, your doctor may also want you to consider taking a drug to suppress ovarian functioning. But you would not need to take the Fosamax, because tamoxifen does not decrease bone mass; in fact, it helps maintain it.
When a drug like Zoladex that suppresses ovarian functioning is taken along with tamoxifen, it is referred to as a "combined estrogen blockade" because tamoxifen is blocking estrogen from getting into the estrogen receptor on the breast cancer cells while the Zoladex is decreasing the amount of estrogen in the body by suppressing ovarian functioning.
Researchers have found that when women with advanced breast cancer use Zoladex along with tamoxifen, their cancer is more likely to stay in remission longer than if they take only Zoladex. In addition, for women with early breast cancer, adding Zoladex to tamoxifen following surgery, chemotherapy, or radiation has been shown to decrease the risk for recurrence and death.
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