What to Expect: Hormonal Side Effects from Breast Cancer Treatment

Author(s):

An expert gives an overview of common endocrine-related side effects that premenopausal women with breast cancer may experience — and what can be done to address them.

Anti-estrogen breast cancer treatment often comes with endocrine-related side effects, such as joint pain or hot flashes. However, there are strategies that patients and their clinicians can employ to decrease the instance or severity of these toxicities.

At the 2024 Miami Breast Cancer Conference, CURE® sat down with Dr. Jennifer Litton, from the Department of Breast Medical Oncology at The University of Texas MD Anderson Cancer Center, who explained what patients can expect when on these hormone therapies — especially if they have not yet gone through menopause.

Transcript

A lot of these medications can either block estrogen or decrease the amount of estrogen in your body, and how that can affect everyone is individual. I will say that most of the toxicities appear to be at their worst, about a month after starting the therapy. And then at about five, six months, we get a good idea of [how] it can even out in some patients.

Most of my patients say they have really significant joint stiffness — it's not usually just the right knee, it's all over. And the way that I tried to think about this [was] from a different [perspective]. Is it from the toxicity of the pill? Or is it something else, and everyone's always worried “Is this the cancer?” For these drugs, they tend to [cause] a lot of stiffness when you've been sitting or when you wake up in the morning. But as you move and stretch … that side effect gets better. So stretching, yoga, regular activity is very helpful. There's been a lot of studies looking at different supplements to see if they could help, and they've been really mixed. So we're not routinely recommending those across the board.

For hot flashes, you should definitely talk to your caregiver. The medicines we have, and we do have some that are not estrogen, they won't make your hot flashes go all the way away, but they certainly could decrease how often you get them and how severe you get them, making it a little bit more tolerable.

Especially because these are medications we're asking you to take for five and sometimes 10 years, it is really important. I think there was a really intriguing study that may be taking a little break a little holiday for a month and restarting sometimes helps bring those side effects down, as well. So I think the important thing is, is that unfortunately, they do have side effects, but speak with your caregiver because we can try a number of different things to make this more tolerable.

You do need to watch for your bone health. There can be sexual side effects and vaginal dryness and using vaginal lubricants can be very helpful. I think it's also really important to talk to your caregiver about your plans if you're hoping for a future family so that you have that discussion at multiple time points [from] the time you're first diagnosed, all the way till the time where you're contemplating potentially having a child.
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