Once surgery is done and you finish chemotherapy or radiation as well, it is easy to think you have gotten over a big hurdle. But if it is hormone receptor-positive breast cancer, it does not end there; a truly long fight has just begun. One pill every day, for as long as ten years. The helplessness of asking back "Five years? Ten years?" when you first hear this, those who have been through it know. Anti-hormone therapy has a clear effect of noticeably lowering the risk of recurrence, but the problem is how to endure that long stretch of time.
The drugs broadly split into two paths. Before menopause, the tamoxifen class is usually used; after menopause, aromatase inhibitors (such as letrozole, anastrozole, and exemestane). Since the two work differently, the discomforts that come with them differ somewhat. With tamoxifen, hot flashes where the face suddenly flares up, cold sweats, and changes in vaginal discharge are common, and rarely the lining of the uterus may thicken or a blood clot may form in a leg vein, so if only one leg swells or your calf aches as if being pulled, you should not just let it pass. With aromatase inhibitors, the biggest troubles are stiff, aching joint pain and osteoporosis where the bones weaken. Many people get depressed, thinking "am I already like this?" when their fingers will not straighten on waking in the morning, or their knees twinge when going down stairs.
Once you actually endure it, side effects are not something you must just bear with your hands tied; much of it can be managed quite a bit. For hot flashes, cutting down on caffeine, spicy food, and hot soup, and layering thin clothes so you can take them off as needed, makes it much better. Joint pain, surprisingly, gets worse when you stay still. Walking lightly within reason and moving your body often with stretching or water exercise can slow the stiffening. For bone health, take calcium and vitamin D, but the key is to keep an eye on the numbers with regular bone density tests. If needed, the medical team may separately recommend a drug to strengthen the bones.
In truth, what collapses most easily is not the body but the heart. That feeling of being reminded "I was a patient" each time you swallow the pill every day, the frustration of not seeing an end. As that goes on, there are cases where you skip the medication once or twice and then quietly stop taking it. By the statistics too, quite a few people stop their medication midway. But anti-hormone therapy delivers its full value only when you keep it up steadily. If the side effects are too hard, do not decide on your own to stop the medication; be sure to discuss it with your doctor. There is clearly room to adjust, such as switching to a different drug within the same class, or pausing for a while before continuing.
And this is something I really want to say: I hope you will not hold the side effects alone, thinking "this is just how it is, so I have to endure it." You have to bring out specific words in the consultation room, like "my joints hurt," "I cannot sleep," "my mood keeps sinking," so that the medical team can do something. Many people are comforted by a single phrase like "everyone is the same" at a gathering of people in the same situation or in a patient community. Seen over the long run, this drug is not trying to torment you; it is closer to a companion that guards you against the greater danger of recurrence.
What is written here is only general information, so your body's condition and medication adjustments are, in the end, best decided together with your doctor in the consultation room.