Breast Cancer Mini Series: Decreasing Side Effects of Breast Cancer Hormone Therapies Naturally

Breast cancer affects 1 in 8 women during their lifetime, and approximately half of these breast cancers are estrogen or progesterone receptor positive cancers. This is where hormone therapies can be used to help treat and decrease risks for recurrence.  

If your medication has a long list of potential side effects like hormone therapies do, it might feel impossible to start and even continue on them!  

You might worry that if a medication has side effects, you’re stuck to suffer through it, that there’s nothing that can and will help improve these side effects and that can feel so disempowering! 

The truth is…just because it’s normal or common doesn’t mean it’s unchangeable!

There are many natural strategies to help decrease these side effects – and if you’re on these medications for a number of years this can be so important!

But first – what potential side effects can hormone therapies like tamoxifen, letrozole, anastrozole and exemestane cause?

Just as a reminder – tamoxifen works differently from aromatase inhibitors like letrozole.

While tamoxifen blocks estrogen receptors from binding to estrogen, aromatase inhibitors work by decreasing the amount of estrogen that is produced. Even though they work differently – a large number of the side effects are similar!


Side effects of these treatments can include:

  • Hot flashes
  • Hair thinning
  • Weight gain
  • Fatigue
  • Gut issues (nausea/vomiting, constipation or diarrhea)
  • Joint and muscle pain 
  • Sleep issues
  • Mood swings
  • And more. . . 


These side effects are thought to impact up to 94% of patients on these therapies in some way.

While you may not be able to completely get rid of these side effects – there are many natural strategies that can help improve them or prevent late effects like osteoporosis and heart disease, so you can feel better while on them and decrease risks for possible late effects.

Here are a just a few natural strategies that have been found to be helpful for some of these side effects.

Hot flashes

Hot flashes can feel like a sensation of heat and sweating accompanied by anxiety and may even be followed by chills. While this can be common for any woman going through menopause – breast cancer survivors seem to be 5.3x’s more likely than women in the general population to experience this type of menopausal symptom.  

As high as 80% of women on tamoxifen may experience hot flashes.  In fact, it’s one of the most common and bothersome side effects of tamoxifen.  If you’re wondering about aromatase inhibitors, women on these tend to experience it less but hot flashes are still a very common side effect. 

Why does it happen?  It’s not fully understood, but a decline in estrogen can change how our body regulates hot and cold temperatures.  

Natural strategies that may help: 

Lifestyle: something as simple as drinking cold water as soon as you feel a hot flash coming on can help to immediately cool your body down.  Wearing cotton and layering can help make it easier for you to cool down when you do feel one coming on!

Diet: research has shown that soy and plant centered diets may help reduce moderate to severe hot flashes.  In fact, soy was seen to reduce the frequency of hot flashes by up to 20% and improve symptoms by up to 26%!  (*Worried about soy?  Check out my first article “Soy and Breast Cancer Recurrence” in this series for clarification around this!)  What’s more, high fat and high sugar diets may increase the risk of hot flashes.  Spicy and caffeinated food as well as alcohol have also been shown to increase the frequency and severity of hot flashes!

Healthy weight: reaching a healthy weight may be helpful as it can help decrease the frequency and severity of these hot flashes.

Fatigue

You might feel tired all the time or in certain parts of the day, like that afternoon slump or after work. Fatigue is one of the most common side effects of cancer treatments and menopausal changes can lead to sleep issues making things worse!  In fact, moderate to severe fatigue is reported by at least 50% of women on aromatase inhibitors.  In general, this lack of energy can be one of the most uncomfortable symptoms cancer survivors experience.

Natural strategies that may help:

Exercise: many studies show that exercise (light or moderate) may actually help improve energy in the long run. This includes both resistance and strength training exercises and may also help reach a healthy weight which can help boost energy as well.

Diet: focusing on staying well hydrated can help with energy. Research shows even mild dehydration can cause fatigue.  Also ensuring foods are nutrient dense whole foods (vegetables, fruits, whole grains, lean meats, healthy fats, etc) can help as it provides your body with the nutrients it needs to boost longer lasting energy!  

Prioritize sleep: it seems impossible to get sleep in when other side effects may be impacting it but it is possible!  One of the things that can help include resetting day/night cycles (ie. ensuring bright light exposure in the morning and darkness at night to boost melatonin production!)

 

Muscle and Joint pain

Women taking aromatase inhibitors can be twice as likely to experience muscle and joint pain compared to those using tamoxifen. How severe the discomfort or pain is can vary and can increase the longer people are on these medications.  This side effect is one of the most common reasons people may choose to discontinue or change therapy so it is incredibly important to have some options to help decrease this.


Natural strategies that may help: 

Exercise, massage, acupuncture: all of these have been shown to decrease muscle and joint pain.  

Switching medications: switching from one aromatase inhibitor to another or even to tamoxifen has the potential to help with decreasing these symptoms!  (Please speak to your oncologist to explore this option.) 

Healthy weight: research shows that things like a whole food diet and exercise can help with reaching a healthy weight which can in itself help increase muscle strength and help to decrease both muscle and joint pain.

Late effects of treatments:

Hormone therapies can increase risks for late effects like heart disease and osteoporosis.  This is why preventing and lowering risks is an important focus during hormone therapy as well! 

Heart Disease

The fact of the matter is – menopause – whether natural or forced has been shown to increase risks for heart disease as estrogen is thought to play a protective role.  All women, but especially those on aromatase inhibitors, should be screened for high blood pressure and high cholesterol levels.

Natural strategies that may help:

Smoking cessation: smoking can increase risks of heart disease by increasing plaque deposits in blood vessels. What’s more, chemicals in cigarettes can also thicken the blood and increase risks for clots. 

Exercise and diet: regular activity can help lower high blood pressure risks, control stress, keep weight in check!  Consuming less sodium ie. limiting salty foods especially seen in processed, canned and fast foods and eating more potassium rich foods (ie. found in beans, lentils, fruits, veggies, nuts, chicken, fish) can help to regulate blood pressure and decrease heart disease risk.

Osteoporosis: 

Estrogen has a protective effect on our bones.  A reduction of this hormone can trigger more bone loss increasing our risks for osteoporosis.  Forced menopause through cancer treatments can decrease estrogen levels and could even increase bone loss by 2 to 4 fold compared to normal postmenopausal bone density loss.


Natural strategies that may help:

Exercise: our bones are still considered living tissue and can become stronger with exercise. It can, not only, help to strengthen but also maintain bone mass.  This can come in the form of weight bearing exercises and resistance exercises (ie. walking, climbing stairs, dancing, light weights, stretch bands). It’s never too late to start exercising to help with all aspects of health including bone health!

Smoking cessation: smoking may actually decrease our ability to absorb calcium from our diet increasing risks for osteoporosis further. 

Nutrients: calcium rich foods, as well as calcium supplements and vitamin D play an important part in calcium absorption and bone health. Decreasing consumption of alcohol could also be important as it has been shown to have a negative impact on bone health.

Cancer recovery and prevention strategies can make a huge difference in how we can decrease side effects of medications so we can thrive after cancer even while on hormone therapies!  These strategies and consistency can help us feel more empowered and help us feel our best!

Sources:

  1. Saghatchian M, Lesur A. Gestion des effets secondaires de l’hormonothérapie du cancer du sein chez la femme jeune [Management of side effects related to adjuvant hormone therapy in young women with breast cancer]. Bull Cancer. 2019 Dec;106(12S1):S37-S42. French. doi: 10.1016/S0007-4551(20)30046-1. PMID: 32008736.
  2. Awan A, Esfahani K. Endocrine therapy for breast cancer in the primary care setting. Curr Oncol. 2018;25(4):285-291. doi:10.3747/co.25.4139
  3. Choo SB, Saifulbahri A, Zullkifli SN, Fadzil ML, Redzuan AM, Abdullah N, Bustamam RSA, Ahmad HZ, Shah NM. Adjuvant endocrine therapy side-effects among postmenopausal breast cancer patients in Malaysia. Climacteric. 2019 Apr;22(2):175-181. doi: 10.1080/13697137.2018.1540563. Epub 2018 Dec 17. PMID: 30556740.
  4. Dos Santos BS, Bordignon C, Rosa DD. Managing Common Estrogen Deprivation Side Effects in HR+ Breast Cancer: an Evidence-Based Review. Curr Oncol Rep. 2021 Apr 14;23(6):63. doi: 10.1007/s11912-021-01055-5. PMID: 33852059.
  5. Berkowitz MJ, Thompson CK, Zibecchi LT, et al. How patients experience endocrine therapy for breast cancer: an online survey of side effects, adherence, and medical team support. J Cancer Surviv. 2021;15(1):29-39. doi:10.1007/s11764-020-00908-5
  6. Franzoi MA, Agostinetto E, Perachino M, Del Mastro L, de Azambuja E, Vaz-Luis I, Partridge AH, Lambertini M. Evidence-based approaches for the management of side-effects of adjuvant endocrine therapy in patients with breast cancer. Lancet Oncol. 2021 Jul;22(7):e303-e313. doi: 10.1016/S1470-2045(20)30666-5. Epub 2021 Apr 20. PMID: 33891888.
  7. Perez EA, Weilbaecher K. Aromatase inhibitors and bone loss. Oncology (Williston Park). 2006 Aug;20(9):1029-39; discussion 1039-40, 1042, 1048. PMID: 16986348; PMCID: PMC2693896.
  8. Hadji P, Aapro MS, Body JJ, et al. Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG. J Bone Oncol. 2017;7:1-12. Published 2017 Mar 23. doi:10.1016/j.jbo.2017.03.001
  9. https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/osteoporosis-breast-cancer#:~:text=Women%20who%20have%20had%20breast,the%20hormone%20trigger%20bone%20loss.
  10. Arul Vijaya Vani S, Ananthanarayanan PH, Kadambari D, Harichandrakumar KT, Niranjjan R, Nandeesha H. Effects of vitamin D and calcium supplementation on side effects profile in patients of breast cancer treated with letrozole. Clin Chim Acta. 2016 Aug 1;459:53-56. doi: 10.1016/j.cca.2016.05.020. Epub 2016 May 21. PMID: 27221206.
  11. Rimawi MF and Osborne CK. Chapter 43: Adjuvant systemic therapy: endocrine therapy, in Harris JR, Lippman ME, Morrow M, Osborne CK. Diseases of the Breast, 5th edition. Lippincott Williams and Wilkins, 2014.
  12. Barnard ND, Kahleova H, Holtz DN, et al. The Women’s Study for the Alleviation of Vasomotor Symptoms (WAVS): a randomized, controlled trial of a plant-based diet and whole soybeans for postmenopausal women. Menopause. 2021;28(10):1150-1156. Published 2021 Jul 12. doi:10.1097/GME.0000000000001812
  13. Herber-Gast GC, Mishra GD. Fruit, Mediterranean-style, and high-fat and -sugar diets are associated with the risk of night sweats and hot flushes in midlife: results from a prospective cohort study. Am J Clin Nutr. 2013 May;97(5):1092-9. doi: 10.3945/ajcn.112.049965. Epub 2013 Apr 3. PMID: 23553160.
  14. Younus J, Kligman L. Management of aromatase inhibitor-induced arthralgia. Curr Oncol. 2010;17(1):87-90. doi:10.3747/co.v17i1.474
  15. Mao H, Bao T, Shen X, et al. Prevalence and risk factors for fatigue among breast cancer survivors on aromatase inhibitors. Eur J Cancer. 2018;101:47-54. doi:10.1016/j.ejca.2018.06.009
  16. Kligman L, Younus J. Management of hot flashes in women with breast cancer. Curr Oncol. 2010;17(1):81-86. doi:10.3747/co.v17i1.473
  17. Ahsan M, Mallick AK. The Effect of Soy Isoflavones on the Menopause Rating Scale Scoring in Perimenopausal and Postmenopausal Women: A Pilot Study. J Clin Diagn Res. 2017;11(9):FC13-FC16. doi:10.7860/JCDR/2017/26034.10654
  18. McCarthy DG, Wickham KA, Vermeulen TF, Nyman DL, Ferth S, Pereira JM, Larson DJ, Burr JF, Spriet LL. Impairment of Thermoregulation and Performance via Mild Dehydration in Ice Hockey Goaltenders. Int J Sports Physiol Perform. 2020 Feb 25;15(6):833-840. doi: 10.1123/ijspp.2019-0464. PMID: 32101792.
  19. www.cancer.org.  American Cancer Society. Accessed May 2022.
  20. www.cdc.gov.com. Centers for Disease Control and Prevention. Accessed May 2022.

Suggested for you

Most Popular Posts

Connect With Me

Dr. Becky Lee, ND

Dr. Becky Lee, ND

Dr. Becky Lee ND is a naturopathic doctor, cancer coach and cancer thriver, and founder of the Femme Thrive Method post treatment cancer recovery program. She was a medical advisor for the Colorectal Cancer Canada for a number of years, and enjoys volunteering her time and expertise at Gilda's Club and Wellspring. Her passion is helping women feel empowered, informed and supported to recover and reclaim their health and lives post cancer treatments and in doing so lower side effects of treatments, optimize overall health and lower recurrence risks. She is also a mom of three beautiful girls, a chaser of joy and beautiful memories.

Suggested for you