Breast Cancer Survivor's Struggle with Long-Term Medication

“I don’t think I can take this medicine for the next five months, let alone five years,” insisted Robbie, a 61-year-old breast cancer survivor.

After completing chemotherapy and surgery six months ago, Robbie’s doctor prescribed an anti-estrogen medicine called Arimidex® (anastrozole) to help prevent it from coming back. He wants her to take it for five years. But two weeks after starting it, she was ready to quit.

Anti-estrogen medicines are widely used to treat and prevent breast cancer. There are two types of anti-estrogen medications: those that reduce estrogen production and those that block its action on the body. 

In women who have gone through menopause, an enzyme called aromatase is needed to create estrogen. Medications interfering with estrogen production by aromatase are called aromatase inhibitors. Anastrozole (Arimidex®) and letrozole (Femara®) are aromatase inhibitors often prescribed for five years after initial breast cancer treatment to decrease the risk of recurrence.

Estrogen-blocking medicines prevent estrogen from binding to breast tissue. The estrogen blocker tamoxifen (Nolvadex®) is used alone or with other drugs to treat breast cancer and avoid recurrence in high-risk women.

Anti-estrogen medicines' most common side effects are aching muscles or joints, hot flashes or night sweats, weight gain, dry skin and hair, and vaginal dryness and discomfort.

One way to combat dry skin and hair is to eat a “good fat” diet with olive oil like in the Mediterranean diet, or coconut oil instead of vegetable oil or butter. I’m not a fan of the taste of olive oil. I prefer avocado oil, which has a buttery flavor.

Hot flashes and night sweats are common side effects of tamoxifen or aromatase inhibitors. Unfortunately, hot flashes from these medicines don’t seem to respond to eating soy or taking black cohosh (Remifemin®) or red clover supplements.

Unfortunately, Remifemin® and other herbal products sold for menopausal symptoms like hot flashes CAN act like estrogen in breast tissue. This is precisely what you DON’T need if you are trying to decrease your risk of breast cancer.

Fortunately, some prescription medicines can help relieve menopausal symptoms without estrogen. Antidepressants like venlafaxine, citalopram and nerve medications like gabapentin can ease hot flush and night sweats.

Like Robbie, nearly half of women taking aromatase inhibitors experience aching muscles or painful joints. Although non-prescription medicines may offer relief, no option is better than any other.

One place to start is with either Tylenol 8-Hour® or Tylenol Arthritis® Extended Relief, which lasts twice as long as Tylenol® Extra Strength. Sarah could try one or two of the 650mg tablets twice daily every day.

Anti-inflammatory medications may also help muscle aches and joint pain, like Ibuprofen (Motrin-IB), naproxen (Aleve®), fish oil capsules, and cannabidiol (CBD).

Glucosamine may offer relief and has minimal side effects; it can also be added to other medicines without causing problems. I recommend glucosamine powder twice daily because it is less expensive and better absorbed than taking the pill form. Allow 4-6 weeks of taking glucosamine to see the full effect before deciding if it’s helping you.

If these don’t help, please talk to your doctor. People differ widely in how drugs affect them. Switching to a similar medicine can make a huge difference.

Here are 5 Tips for Living With Anti-Estrogen Medicines:

1. Try a "good fat" diet.

To help relieve dry skin and hair, switch from a "low-fat" to a "good-fat" diet like the Mediterranean diet. “Good fats” include coconut, avocado, and olive oil. Taking a fish oil supplement may also help.

2. Avoid soy and menopause relief supplements.

Don't take concentrated soy products and herbal supplements marketed for hot flush symptoms. Although weaker than prescription-strength estrogen, these alternatives can have similar effects on breast tissue and should be avoided by women at risk for breast cancer.

3. Keep moving.

Physical activity discourages weight gain, boosts mood, and may reduce the muscle aches and joint pain experienced by nearly half of women who take an aromatase inhibitor, like Robbie. If your muscles or joints ache, don’t blame old age; it may instead be due to your medicine.

Glucosamine powder, Tylenol® Arthritis (650mg tablets), Aleve® (naproxen), Motrin-IB (ibuprofen), fish oil capsules, and even CBD elixirs can help you stay more active.

4. Talk to your doctor.

For hot flashes and night sweats, prescription medicines like the antidepressants venlafaxine and citalopram or anti-seizure gabapentin may help.

5. Don’t suffer, speak up!

Talk to your doctor if your muscles or joints hurt. Switching to another medicine may improve Robbie’s symptoms, making the five years of taking anti-estrogen pills more bearable. 

Dr. Louise Achey, Doctor of Pharmacy, is a 44-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog, TheMedicationInsider.com.

©2023 Louise Achey