Importance of menopausal status

Our bodies naturally make hormones such as estrogen, progesterone, and androgen (testosterone). These hormones prompt cell action in our system in different ways. Estrogen is the best known hormone in women, but the body makes all three. They are all important for good health. Estrogen helps sex organs develop, makes pregnancy possible, strengthens bones, and more.

Some hormonal therapy is recommended for all women, and some is specific to your menopausal status.

Premenopausal and perimenopausal

If you are premenopausal, you still get your period. During premenopause, your ovaries make most of the body’s estrogen and you are able to become pregnant. If you have hormone-sensitive breast cancer, the high levels of estrogen made by your ovaries helps the breast cancer cells to grow. Your healthcare team will recommend hormonal therapies that slow or stop estrogen from being made.

Even if your periods stopped during treatment, you still may be premenopausal and making estrogen from your ovaries. Talk with your doctor about your situation.

If you are perimenopausal, you are in-between having your period and stopping your period completely. You might only have your period a few times a year or from time to time. Perimenopause happens as you age and your ovaries slow down and make less estrogen, usually a few years before menopause.

Doctors consider you postmenopausal if you do not have your period for at least a year. But what if you get your period every now and then, or it only stopped because of treatment? Tests of hormone levels may help, but they are not used routinely because levels can go up and down dramatically, especially during perimenopause.

If there is any doubt about your menopausal status, your doctor is likely to recommend hormonal therapies for premenopausal women. Ask why these options might be right for you.

Therapies recommended for premenopausal and perimenopausal women are:

• Tamoxifen
• Oophorectomy
• Goserelin (Zoladex)
• Leuprolide (Lupron)
• Triptorelin (Trelstar)
• Fulvestrant (Faslodex)
• Megestrol Acetate (Megace)
• Anastrozole (Arimidex and generic), Exemestane (Aromasin and generic) or Letrozole (Femara and generic) in combination with ovarian suppression

Postmenopausal

If you are postmenopausal, you stopped having your period for 12 months in a row. In postmenopause, your ovaries stop making estradiol, the most active estrogen, and you can no longer become pregnant. Still, your body continues to make estrone, an estrogen created by converting the male sex hormone androstenedione from the adrenal glands, fat cells, and muscle. The enzyme called aromatase converts that hormone into estrogen.

Your healthcare team will likely recommend aromatase inhibitors as your first hormonal therapy, because they target the aromatase that creates estrogen. Therapies recommended for postmenopausal women are:

• Anastrozole (Arimidex and generic)
• Elacestrant (Orserdu)
• Exemestane (Aromasin and generic), alone or with everolimus (Afinitor)
• Letrozole (Femara and generic), alone or with palbociclib (Ibrance)
• Tamoxifen
• Toremifene (Fareston)
• Fulvestrant (Faslodex)
• Megestrol Acetate (Megace)