Hot Flashes, Aching Joints, Mood Changes: A Compassionate Guide to Metastatic Breast Cancer Hormone Therapy Side Effects

Managing MBC hormone therapy side effects may feel daunting, but you have plenty of integrative strategies to choose from for relief. These solutions can’t replace your cancer treatment itself, and it’s important to discuss any new therapy with your care team before you try it. But in collaboration with your providers, you can ease side effects and live well during MBC treatment.

You can follow these tips to lessen joint pain during MBC treatment:

• Try gentle stretching. When you have to spend lots of time resting during MBC hormone treatment, joint pain and stiffness can get worse, but mild stretches can counteract these effects, says Farah Brasfield, MD, a hematologist and oncologist with Kaiser Permanente in Southern California. “Start slow with gentle movements, stretching the joints and muscles, [and] work up to low-impact exercises such as tai chi, yoga, or aquatic exercises to help strengthen muscles and improve joint stability,” she says.
• Take walks. Studies show that regular walking at a moderate pace can help lessen joint pain and stiffness, says Katherine Reeder-Hayes, MD, the section chief of breast oncology at UNC Lineberger Comprehensive Cancer Center and a professor in the division of oncology at the University of North Carolina School of Medicine in Chapel Hill.

  [7]

   Be sure to go slow and take a break if you feel worsening pain.

  [8]

• Apply heat and cold. “Heating pads and warm showers or baths can also help reduce stiffness,” says Dr. Brasfield. Cold packs can reduce swelling. Applied 20 minutes at a time, hot or cold packs can lessen joint inflammation and help muscles relax, easing pain.

  [8]

  [9]

• Follow an anti-inflammatory diet. Eating foods that promote less inflammation can also decrease joint pain. The best foods to fight inflammation include fruits, vegetables, whole grains, and healthy fats.

  [10]

• Ask about pain medication. Over-the-counter pain medication, like acetaminophen (Tylenol) or ibuprofen (Advil), can be effective for joint pain.

  [11]

   “But patients should always talk with their doctor before taking any medication,” says Brasfield.
• Consider acupuncture. The practice of placing very thin needles into the skin, called acupuncture, has also shown promise in research for improving joint pain and stiffness, says Dr. Reeder-Hayes.

  [12]

• Selective estrogen receptor modulators (SERMs), like tamoxifen (Soltamox) and toremifene (Fareston)
• Selective estrogen receptor degraders (SERDs), like elacestrant, fulvestrant, and imlunestrant
• Aromatase inhibitors, like anastrozole, exemestane, and letrozole

Brasfield recommends these techniques to find hot flash relief:

• Avoid drinking alcohol and caffeine.
• Choose mild alternatives to spicy foods and hot drinks.
• Wear lightweight clothing.
• Stay indoors on hot days.
• Avoid hot environments, like crowded rooms.

Ask other women for their hot flash tips and tricks, says Reeder-Hayes, like sleeping with a fan and wearing layers. With advice from others and some trial and error, you can stay cool when hot flashes hit.

“First, patients should work with their healthcare team to rule out or address any reversible causes of fatigue or brain fog, such as anemia, low thyroid, vitamin deficiency, or depression,” says Brasfield. But once these causes are eliminated, you can add some simple habits to your routine to reduce fatigue and brain fog, she says.

To boost your energy and brain power, Brasfield recommends these tips:

• Keep sleep consistent. Try to go to bed and wake up at the same time every day, with limits on daytime naps.
• Manage plans with a calendar. Keeping a detailed calendar can help you remember important appointments or events.
• Create a distraction-free zone. When you need to focus, find a quiet environment to reduce distractions.
• Try walking or stretching. You can increase your energy by doing light physical activity, like walking or stretching. One study including 178 people with advanced breast cancer found that after six months of supervised exercise, participants reported less fatigue and a better quality of life.

  [17]

• Train your brain. Boost your cognitive function using mobile apps, puzzles, or board games.

Besides hormone changes, other side effects can affect sexual desire, like nausea, constipation, fatigue, depression, or vaginal discharge, says Brasfield. “[But] there are several strategies that have proven effective to support intimacy for some women,” she says.

Brasfield recommends these tips for better sex during hormone treatment for MBC:

• Incorporate exercise. Regular physical activity improves both cardiovascular health and mood, which indirectly enhances sexual function.

  [20]

• Speak to a counselor. A mental health professional can help you and your partner address intimacy changes.
• Use lubricants. Applying nonhormonal, water-based lubricants can combat vaginal dryness.

  [21]

If you need more support, your provider can help. “While your care team can recommend a variety of effective vaginal lubricants for mild conditions, input from a gynecologist, a pelvic floor physical therapist, or a sex therapist are also needed for many women depending on their circumstances,” says Reeder-Hayes. “Do not be afraid to advocate for yourself!”

It’s completely normal to experience mood swings during any cancer treatment, says Brasfield. “This could be driven by medication side effects, pain, or anxiety about treatment or what lies ahead,” she says.

But if you’d like to smooth your moods and pursue emotional wellness, you can try these tips:

• Try stress-reduction techniques. You can combat stress with deep breathing exercises, yoga, or meditation and mindfulness.

  [24]

• Lean on support systems. Many people find individual or group therapy helpful, whether they attend in person or virtually, says Brasfield. “Group sessions can build connections with others who are going through similar journeys, which can really help alleviate anxiety and feelings of isolation or depression,” she says.
• Talk to a professional. Mental health professionals can walk you through treatments like cognitive behavioral therapy and relaxation training, which can help decrease anxiety and improve quality of life.

  [25]

  [15]

• Get as active as you can. You may not be able to exercise the same way you did before you started treatment, but your healthcare provider can help you understand your limits and develop a doable exercise plan (like taking daily short, slow walks) to stay as active as possible.

  [28]

• Talk to a nutrition specialist. You can ask your provider for a referral to a registered dietitian or nutritionist for guidance on your diet, says Brasfield.
• Ask about support. Changes in your appearance during breast cancer treatment can be difficult to accept, and many women find speaking to someone about it helps. To cope with these changes, you can speak with a mental health professional, a support group, or someone who has gone through the same thing.

• Hormone therapy for MBC can come with side effects like joint pain, hot flashes, fatigue, low libido, emotional distress, and weight gain, but you have options to lessen these symptoms.
• You can wear lightweight clothing to protect against hot flashes, lean on a support network and mindfulness practices for emotional wellness, and try low-impact exercises for pain, fatigue, sexual function, and better mental health.
• Everyone experiences a unique blend of side effects with hormone therapy for MBC. If you need help managing them, reach out to your healthcare provider, who can make recommendations specific to you.