What happens during a Zoladex implant injection appointment?

Today was my first ever Zoladex treatment. My breast cancer is oestrogen positive so to prevent another reoccurrence, this time I am being put in to the menopause.

Zoladex (also known as Goserelin) is used in the treatment of hormone-sensitive breast cancer, particularly in premenopausal women like me. Zoladex works by suppressing ovarian function, which in turn reduces the production of oestrogen—a hormone that unfortunately for me, has fuelled the growth of my oestrogen positive breast cancer. Essentially the Zoladex is will temporarily "shut down" my ovaries by sending signals to my brain to stop production of oestrogen. If I can cope with the symptoms of menopause then I will consider opting to have my ovaries removed. The great thing about Zoladex is that the effects are reversible, should my quality of life be impacted to a great extent.

In breast cancer treatment, Zoladex is often used in combination with other therapies such as surgery, chemotherapy, or hormonal treatments. It is typically prescribed to women who have early-stage hormone receptor-positive breast cancer or those who are at high risk of recurrence. By lowering oestrogen levels, Zoladex helps to shrink tumours, prevent cancer recurrence, and, in some cases, delay the need for chemotherapy.

Zoladex is an implant that sits under the skin and is administered via an injection, usually every month (like in my case) or every three months, depending on the treatment plan. While it is not a cure for breast cancer, it is a valuable tool in managing the disease and improving long-term outcomes for many patients. As with any medication, it carries potential side effects, including menopause-like symptoms such as hot flashes and changes in menstrual cycles and the one that they mention the most.... vaginal dryness. Everyone is different so I'll let you know how I get on. 

I recorded the injection in case anyone (like me) prefers to know what's coming...

Oncology Appointment

Another nervy day. I'm at Clatterbridge Aintree to discuss the benefits of chemo. My Oncoscore came back as 18. In women over 50 this usually means chemo isn't beneficial however because I'm a pre-menopausal 42 year old, they want to let me have all of the facts. 

The appointment takes place in a separate building to the normal breast clinic. It's bright an airy and John and I arrive on time for my 9am appointment. I check in and wait to be called. 

My oncologist Dr Hart calls be through. We go through my full cancer history since my first diagnosis back in 2017. She explains why my score of 18 is a grey area and discuss that there would be a 1.8% reduction in reoccurrence should I have the chemotherapy. 

The chemo itself would be a 9 week initial phase on one chemo drug and then a further 8/9 weeks on a different chemotherapy drug. Dr Hart explains that pre-menopausal women could in fact be seeing the benefit from chemo just from the side effects of being put in to early menopause. We discuss the side effects and potential issues as well as the benefits. John and I ask lots of questions but having heard the percentage benefit is so low, I immediately confirm that my decision is to avoid chemotherapy.

With the decision made, Dr Hart then talks us through the next steps for endocrine drugs to suppress my oestrogen production and the radiotherapy.

Radiotherapy

I'll start my having an initial consultation with the radiographer. I'll have a CT scan to gain a detailed scan off my top half so they can plan where the radiotherapy is needed. I'm told about the risks of the radiotherapy such as damage to my heart and the skin issues that will inevitably occur. 

I ask about whether tattoos are still needed to ensure my position in the machine. My nurse confirms I'll get 3 small dots tattooed. 

Endocrine Therapy

I'll be having two types of drugs to reduce the risk of reoccurrence. As both cancers have been oestrogen receptor positive - meaning oestrogen helps the cancer cells to grow these drugs will help stop me from producing oestrogen. :

Goserelin (Zoladex)

I'm briefly told that this drug comes in injection form and will be administered every 4 weeks. It will put my in to early menopause by stopping the production of oestrogen from my ovaries. It works by interfering with the signals in my brain, stopping my ovaries from doing their usual hormone producing job. 

Exemestane

Usually pre-menopausal women are prescribed a 5 or 10 year course of Tamoxifen. One of the risks of taking this drug is that in can increase the risk of DVT. As I suffered with a DVT during my second pregnancy, Dr Hart has suggested I take Exemestane, an aromatase inhibitor, as an alternative. I'll let you know more when I've read up on it!

I'm handed a lot of reading material and send off to read up.

So essentially in about a weeks time, I'm going to be thrown in to the menopause without any HRT support. Should I start to panic? Can anyone recommend anything that might help?