After surgery, women diagnosed with hormone-receptor-positive breast cancer usually take hormonal therapy medicine to reduce the risk of the cancer coming back (recurrence). Hormonal therapy medicines work in two ways:
- by lowering the amount of estrogen in the body
- by blocking the action of estrogen on breast cancer cells
There are several types of hormonal therapy medicines. Tamoxifen, a selective estrogen receptor modulator (SERM), is one of the most well-known. Tamoxifen can be used to treat both premenopausal and postmenopausal women. In the early 2000s, the aromatase inhibitors:
- Arimidex (chemical name: anastrozole)
- Aromasin (chemical name: exemestane)
- Femara (chemical name: letrozole)
were shown to be more effective at reducing recurrence risk in postmenopausal women and are now used more often than tamoxifen to treat women who’ve gone through menopause. Aromatase inhibitors aren’t used to reduce recurrence risk in premenopausal women.
You usually take hormonal therapy for 5 years after surgery. Still, research published in December 2012 found that taking tamoxifen for 10 years instead of 5 years after surgery reduced the number of recurrences and improved overall survival. Many doctors are now prescribing tamoxifen for 10 years and some doctors wonder if taking an aromatase inhibitor after 10 years of tamoxifen would help keep recurrence risk as low as it can be.
Still, both tamoxifen and the aromatase inhibitors can cause upsetting side effects. Tamoxifen may cause hot flashes and increase the risk of blood clots and stroke. Aromatase inhibitors may cause muscle and joint aches and pains. Less common but more severe side effects of aromatase inhibitors are heart problems, osteoporosis, and broken bones.
Research has shown that about 25% of women who are prescribed hormonal therapy to reduce the risk of recurrence either don’t start the medicine or stop taking it early because of troubling side effects.
While the side effects of hormonal therapy can be painful, difficult, and annoying, they’re overshadowed by the reality that hormone-receptor-positive breast cancer can come back. Hormonal therapy after surgery reduces that risk. If you’ve been prescribed hormonal therapy after surgery, it’s important to remember this.
There are effective ways to get rid of any obstacles stopping you from doing all you can to lower your recurrence risk. If side effects are a major problem for you, talk to your doctor about ways to manage them. You also may be able to switch to a different hormonal therapy.
Here are some tips to ease some of the most common hormonal therapy side effects.
Bone and joint pain
- Talk to your doctor as soon as you have bone or joint pain. Don’t let the pain become intolerable. You may be able to switch to a different hormonal therapy medicine that may ease your pain.
- Pain medicines, such as naproxen and ibuprofen may help you manage bone and joint pain.
- Some complementary and holistic medicine techniques have been shown to ease bone pain, including acupuncture, chiropractic therapy, massage, music therapy, and hypnosis.
- Hot or cold packs, or a combination of the two, can soothe sore areas. Heat can help reduce muscle spasms and cold can help reduce inflammation.
- Eat a healthy diet that includes enough calcium and vitamin D to keep your bones as strong as they can be.
- Maintain a healthy weight to ease stress and strain on your joints.
- Exercise regularly. Exercise keeps your bones strong and helps your joints stay flexible. A study presented in December 2013 found that exercise can ease the joint pain caused by aromatase inhibitors.
Visit the Bone and Joint Pain page for more information.
- Talk to your doctor as soon as you start having hot flashes. Don’t wait until they become severe. You may be able to stop your treatment for a week or two, restart it at a lower dose, and slowly increase it. Your body may be better able to adjust to the changes this way. You also may be able to switch to a different medicine that doesn’t cause you as many hot flashes.
- Avoid hot flash triggers such as stress, cigarettes, alcohol, caffeine, diet pills, spicy food, hot food or drink, hot tubs, saunas, hot showers, hot rooms, and hot weather.
- Reduce the fat in your diet. Over time, a low-fat diet helps some people with hot flashes. Losing excess weight helps, but losing too much weight, or being too thin, can make hot flashes worse.
- Dress in layers so you can peel off one layer after another as you get warmer.
- Don’t wear heavy or thick fabrics such as wool, synthetics, or silk. Wear loose and airy fabrics such as cotton, linen, and rayon.
- Keep ice water nearby so you can sip it to cool down. Pack a small cooler full of cold water to carry with you.
- Lower the room temperature by turning down the thermostat, turning on the air conditioner, or turning on the ceiling fan.
- Sleep in cotton pajamas or a nightgown. If you have hot flashes and perspire at night, the nightclothes are easier to change than the sheets.
- Put cotton sheets on your bed. Cotton soaks up sweat and dries quickly.
- Take a cool shower before going to bed.
- Consider complementary and holistic therapies. Techniques that may help include meditation, massage, yoga, and acupuncture.
- Ask your doctor about techniques to help you sleep through the night if your hot flashes are affecting your sleep.
- Be patient. Your body is going through changes. Once the changes take place, you’ll feel more like yourself again.
Visit Hot Flashes for more details.
- Talk to your doctor. You may be able to switch to a different hormonal therapy medicine that may ease your fatigue.
- Some complementary and holistic medicine techniques have been shown to reduce fatigue, including acupuncture, massage, meditation, tai chi, and yoga.
- Eat a healthy diet that includes lots of fresh, unprocessed food, including fruits, vegetables, and lean protein.
- Exercise regularly. Exercise helps improve your stamina and has been shown to ease fatigue.
- Try a catnap. Beware of long naps, though. You might end up wide awake in the middle of the night. Daytime naps should be no more than 30 minutes, so you won't fall into deep sleep. (Waking up groggy usually means you've napped too long.) If you find you need a nap every day, take it at a regularly scheduled hour, but try not to nap after 2 p.m.
- Keep to a routine. Go to bed at the same time each night and get up at the same time each morning. Don't stay in bed after you wake up. Make sure you get enough sleep and that you sleep for the same amount of time each night.
- Keep a diary of how you feel each day. Keep a daily diary of your fatigue to identify when it's the worst and when it's least troubling.
- Plan activities during the times you have the most energy. Schedule rest periods when your energy is lowest. Make sure you balance each activity with a rest period if you need it.
- Organize each day. Figure out what you have to do and when you need to do it. Pacing yourself helps to conserve your energy.
- Ask for help. Accept offers of help and goodwill from family and friends. If no one has offered to help and everyone seems too busy, ask for what you need — even if asking is one of the hardest things for you to do. Get help with little things: taking out the trash, folding the laundry, or paying bills. Keep a list of things you need done so when people ask what they can do, you can give them the list.
- Join a support group. Sharing your feelings with others can ease the burden of your fatigue and give you more ideas about how you can cope with the condition. Your nurse or doctor can put you in touch with a support group in your area. For an online support group, visit the Breastcancer.org Discussion Boards.
- Keep lists and make notes to remind you of important things if your memory and concentration are affected by fatigue. Also, give yourself more time for activities that take concentration.
- Be kind to yourself. If you're fatigued, don't beat yourself up because you can't do what you're "supposed" to do. That browbeating takes energy you can't afford to waste and can add to depression. Do nice things for yourself and give yourself permission to rest and recover, for as long as it takes.
Visit the Managing Fatigue section for more information.
- Eat small amounts of food all day long, so you don’t feel full too quickly.
- Eat dry foods that are less likely to upset your stomach, such as crackers, toast, and cereal.
- Stay away from greasy foods that might disagree with your stomach.
- Try ginger-based foods to help ease nausea. These include ginger ale, ginger tea, or crystallized ginger eaten as a snack.
- Sit up after eating — lying down after meals may disrupt digestion.
- Rinse your mouth before and after meals to get rid of any bad tastes that may make you nauseated.
- Ask someone to cook for you or order take-out so you can avoid strong smells that may be unpleasant for you.
- Ask your doctor about anti-nausea medications that you can take before or along with your breast cancer treatment. There are also anti-nausea medications you can take along with with pain medications that nauseate you.
- Consider complementary and holistic techniques such as acupuncture, relaxation, and visualization to reduce nausea.