Proven strategies for managing hormonal therapy side effects

Fatigue

It sounds crazy, but exercise is the one thing proven to increase your energy. Palliative care specialist Kimberly A. Curseen, MD, recommends a 20-minute walk before going to a movie. Look for activities you really enjoy, such as NIA dance, easy bike paths, or birdwatching. Establish good sleep hygiene: limit use of screens, caffeine, and alcohol near bedtime; use your bed only for sleep and sex; keep your bedroom cool and dark. Stay hydrated, and talk to a nutritionist or Naturopathic Doctor (ND) about foods and proven supplements that boost energy.

Joint stiffness and pain

Once again, exercise can help. Movement lubricates your joints and builds muscle tone. It also takes stress off your joints by preventing weight gain. Make it fun! Do it with friends or in a Zoom group. The American Association of Retired Persons (AARP) offers many free online classes at all levels for members. YMCAs and recreational centers often do the same.

Night sweats and hot flashes

Do what you can to keep your bedroom cool (have you tried a ceiling fan?). A portable air conditioner can keep your bedroom extra-chilly, and it prevents wasted energy if your house has central air conditioning. Sheets made of breathable, natural fibers such as cotton may trap less body heat. If you’re able to splurge, several companies make mattress toppers that use electricity or water to cool your bed while you sleep.

A new, non-estrogen prescription medication, Veozah (fezolinetant), has been FDA approved for moderate to severe hot flashes caused by menopause, but its safety in people with breast cancer has not been evaluated yet. Ask your doctor about it.

Antidepressants may be useful, but the selective serotonin reuptake inhibitors (SSRIs) cannot be taken with tamoxifen. Some prescription medications used for epilepsy may also help. Dr. Curseen advises against traditional sleeping pills because they are highly addictive and have other side effects. Some people find that melatonin supplements or medical marijuana (strains with low THC and high CBD) promote sleep. Involve your medical team in making decisions about these options.

Vaginal dryness, irritation, and painful intercourse

Your healthcare team can recommend safe, effective vaginal lubricants. Virginia Kaklamani, MD, DSc, from our Medical Advisory Board, suggests numbing the outside of the vagina before intercourse with a mild lidocaine solution (prescribed by your doctor) applied with a cotton ball. Vaginal creams and suppositories that contain estrogen are sometimes avoided by women with estrogen-sensitive cancer. However, Dr. Kaklamani explains that you can rebuild the thin, estrogen-deprived vaginal wall with topical estrogens in just a couple of weeks, after which these estrogens are not absorbed systemically and can be used safely.

Erectile dysfunction in men

Men with hormone-sensitive breast cancer can use prescription medications such as sildenafil (Viagra) for erectile difficulties. However, libido is an important factor in impotence, so read on.

Loss of libido

Many factors can contribute to a loss of interest in sex, including side effects of initial cancer treatment and hormonal therapy, fatigue, stress, anxiety, loss of confidence and self-esteem, negative feelings about your body, and medications such as antidepressants. Managing your other side effects may help restore your sexual self. If you have a partner, talk to them about how you feel and take the pressure of intercourse off the table. Hugging, cuddling, and kissing can be comforting and may help relax you. This relaxation and closeness may eventually lead to more arousal for both of you.

Mood swings and general wellbeing

Making art, attending concerts, and visiting museums are proven to benefit mental health. Consider coloring books for adults, singing in the shower, crafting, or expressive writing. Nature photography combines walking and creativity. Many museums now offer Zoom tours and art appreciation classes.

Mindfulness meditation has been proven to help people at all stages of cancer. It reduces stress and anxiety, eases pain, promotes restful sleep, and increases general wellbeing. Free apps and online resources provide guidance for various techniques. Even a few minutes a day can have many benefits.