Living with anti-estrogen medicines

Breast cancer can be triggered by the hormone estrogen. Because of this, many women take anti-estrogen medicine to prevent breast cancer, treat it, or prevent it from coming back. 
There are two types of anti-estrogen medications: estrogen blocking agents and estrogen production inhibitors. Tamoxifen (Nolvadex®) is an estrogen blocker. Tamoxifen prevents estrogen from binding to breast tissue. It is used by itself or combined with other medicines both to treat breast cancer and avoid its recurrence in high-risk women. 
Another type of anti-estrogen medicine works by reducing estrogen production inside the body. Less estrogen means less potential to stimulate cancer cells lurking in breast tissue. In women who have gone through menopause, a particular enzyme called aromatase is responsible for creating estrogen. 
Medications that interfere with aromatase are called aromatase inhibitors. Aromatase inhibitors like anastrozole (Arimidex®) and letrozole (Femara®) are often prescribed for 5 years or more after initial breast cancer treatment to decrease the risk of recurrence.
The most common adverse effects of anti-estrogen medicines are fatigue, weight gain, dry skin and hair, vaginal dryness and discomfort, hot flashes or night sweats, and aching muscles or joints. 
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 in place of vegetable oil or butter. I’m not a fan of the taste of olive oil, so I use avocado oil instead. The tall glass bottle of avocado oil at Costco is a great value. 
Hot flashes and night sweats are common side effects of taking tamoxifen or aromatase inhibitors. Unfortunately, these types of hot flashes from the medicines don’t seem to respond to soy or supplements containing black cohosh like Remifemin® or red clover. 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 concerned about your risk of breast cancer. Fortunately, some prescription medicines can relieve menopausal symptoms without estrogen, like the anti-depressants venlafaxine and citalopram, and gabapentin, a drug that relieves seizures and nerve pain.
Nearly half of women taking an aromatase inhibitor suffer from aching muscles or painful joints. Glucosamine may offer relief and has no significant side effects; it can also be added to other medicines without causing problems. I recommend using 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. 
Another option for aches and pains is Tylenol Arthritis® Extended Relief, which lasts twice as long as Tylenol® Extra Strength. Try taking two of the 650mg tablets twice daily every day for at least a week.
Other muscle aches options include anti-inflammatories like ibuprofen (Motrin-IB), naproxen (Aleve®), and fish oil capsules. Cannabidiol (CBDs) extracts sold in health food stores are made from hemp oil. CBDs contain less than 0.3% THC and may provide relief without risking a positive THC test.
If these don’t help, please talk to your doctor. People differ widely in how drugs can affect them, and a different medicine could make a huge difference.
Here are 5 Tips for Taking 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.
Don't take concentrated soy products or herbal supplements marketed for menopausal symptoms. Although much weaker than prescription-strength estrogen, these alternatives 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 your mood, and may reduce the muscle aches and joint pain experienced by nearly half of women who take an aromatase inhibitor like anastrozole or letrozole. If you notice that your muscles or joints ache, don’t blame old age; it may be your medicine. 
Glucosamine powder, Tylenol® Arthritis (650mg tablets), Aleve® (naproxen), Motrin-IB (ibuprofen), fish oil capsules, or even CBD elixirs can help you stay more active.
4. Talk to your doctor.
For hot flashes and night sweats, prescription medicines like the anti-depressants venlafaxine or citalopram, or the anti-seizure medicine gabapentin may help. 
5.  Speak UP. 
Talk to your doctor if your muscles or joints hurt. There are other medicines available for breast cancer prevention that you may tolerate better. 
Dr. Louise Achey, Doctor of Pharmacy, is a 40-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Check out her NEW website for daily tips on how to take your medicine safely. 2020 Louise Achey


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