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Dr. David
Dr. David, Board Certified MD
Category: Medical
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Experience:  Board Certified Physician
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Dear Dr David I had a second opinion here at the Royal Marsden,

Resolved Question:

Dear Dr David
I had a second opinion here at the Royal Marsden, and it was suggested that I have ovarian ablation. I am due to have the first injection on Thusday, but I read that recent research suggests that ovarian ablation is better combined with AI's rather than tamoxifen. (I had a blood test which suggests I am perimenopausal) I wondered what you thought.
THank you
Frances
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. David replied 3 years ago.

Dr. David :

This is Dr. David

Dr. David :

AIs are only used for patients who are 1-2 years after their menopause.

Dr. David :

so you have to use tamoxifen for now

Dr. David :

and then 1-2 years after the ovaries are ablated,

Dr. David :

and your estrogen levels drop down, then you switch to an AI

Customer:

I think this was a report on the SOFT/TEXT trials which suggested that AI's would be better for premenopausal women?

Dr. David :

no.

Dr. David :

AIs are never used for premenopausal women.

Dr. David :

AIs block the conversion of steroids into estrogen.

Dr. David :

tamoxifen blocks estrogen from going into estrogen receptors.

Dr. David :

so tamoxifen can be used for both pre and post menopausal women

Dr. David :

AIs are only used for postmenopausal women.

Dr. David :

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Dr. David :

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Dr. David :

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Customer:

I thought the trial compared ovarian ablation plus exemestane and ovarian ablation plus tamoxifen and concluded that o.a + exemestane was more beneficial?

Dr. David :

the ovarian ablation has to be done first and then exemestane (aromasin) can be given since the patients are then postmenopausal

Dr. David :

since the ovaries are then ablated.

Dr. David :

so you can have ovarian ablation and then an AI.

Dr. David :

the ovarian ablation causes you to be postmenopausal.

Customer:

So do you think ovarian ablation is a good idea? When would I change to an AI? Also, I read on adjuvant online that it is thought that tamoxifen can act as a weak oestrogen in low oestrogen states, so that is a concern.

Dr. David :

that is not a worry about tamoxifen.

Dr. David :

if you are perimenopausal, best to still use tamoxifen for now.

Dr. David :

get your ovarian ablation

Dr. David :

and then switch to an AI 6-12 months after the ablation.

Customer:

Thank you for explaining. I think it's monthly injections to begin with.

Dr. David :

the ovarian ablation? yes.

Dr. David :

good luck

Dr. David :

let me know if you have other questions.

Dr. David :

if done, please leave positive feedback below

Dr. David :

thanks for requesting me.

Dr. David :

thanks for using JustAnswer.com

Customer:

Thank you, ***** ***** been very helpful again

Customer:

Francesx

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