FEMARA
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Yes honey you are much younger. It has just hit me that I can not have that many hormones floating around anymore. I will be continuing to keep up my blood work and having my scans and mammograms. I just choose not to add unwanted chemicals to my body any longer. I do hope some of the side effects will lessen. The long lasting chemo effects are still there. Chemo is the gift is the gift that keeps on giving. But what do you do.
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Mimi, I think it is funny(well not really) that I have spent my whole life eating organic and staying away from chemicals etc. I never did birth control b//c I did not want all those extra chemicals in my body. and now here I am! Maybe it would have happened sooner!LOL
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60 days of Femora after 7 months of arimidex. MO switched me because of headaches. General aches also seem much better but I feel like an emotional roller-coaster. Losing my patience very easily over very minor things. And then I'm mad at myself. Back to MO? anti-anxiety medication? From MO or FP? Opinions welcomed.
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Taco- glad the pains are better, sorry you’re on edge. You could try short term solutions like Xanax to start or see about some Wellbutrin, Effexor or Lexapro. Either your FP or MO should be able to prescribe them. If your MO will just call something in with a phone call or email to him, I’d go that route. If an office visit is required then I’d go with whichever doc has lower copay and could get me in the quickest. Hope this helps!
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taco, sorry about tha rollercoaster ride. I also have mood swings and find myself crying alot. I spoke to my loved ones and explained the side effects and that I wanted to stay on the meds if possible. If you feel you need the meds either MD can do just make sure your MO knows. I just felt like for me the side effects kept leading to them offering more meds and more meds. I have started yoga (which I do on DVD at home) and chamomile tea to help me relax. I take somethin for sleep to make sure my body is rested. Do a lot of self care. Make sure you are having fun and doing things you like - without guilt. Good luck and keep us informed. Hugs
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Taco
Im sorry you are having issue, While I have not had any issues I can say are directly related to Letrozole, I to have the mood swings and I did have to get anti-anxiety medication from Dr. Some days Im playing with my dogs and 10 mins later I hate them. I find myself biting my lip 100 times a day and have a very low tolerance for BS. Is this the meds or just life and dealing with the added stress of this bomb that got dropped on us. I don't know . Actually I guess I do have one side effect from the medicine, Im gaining weight like crazy and its making me miserable whch might be the reason for my attitude. When my FAT pants are getting tight its time to do something, but then again Im lazy when it comes actually working out on any kind of machine or boring video. A friend told me of a good quality Hemp oil that has worked wonders for her ( NO its does not contain THC) as in Marijuana. I wish you well, PLease let us know how things are going for you .
Huggs
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Honey, come join us on the "lets post our daily exercise "thread, It is a good place for encouragement!
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HapB- yes I'm able to function. The anti-anxiety meds actually make it so I'm able to function much better. I was already on Wellbutrin daily and Xanax only for times of severe stress for years before breast cancer entered the picture. I have a high stress job, dealt with 2 prior cancers as an adult before the BC diagnosis, family stress with sick in-laws that my DH & I were the primary caregivers for and plenty of various drama with my family. I took myself off the Wellbutrin when I started tamoxifen (drug-drug interaction) but had to go back on it (and happy to) when I started femara. Many people think of these meds as an unnecessary crutch and that you should just be able to deal with life. If only it were that easy. The reality is that the brain isn't getting enough serotonin and/or norepinephrine to keep you on an even keel. There are many reasons this can happen including stress from the outside, stress from within, and/or physical stress. A significant drop in estrogen from menopause and/or anti-hormonal therapy is 1 of many causes. The meds help correct that so that you can function.
I’m far more worried about literally choking to death on the extra calcium, magnesium, and biotin pills I now have to take.
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Thanks for your advice. I had another terrible day today. I've decided that if I am still the "crazy" next week, I will ask for an appointment with MO (not scheduled to see her again until April). I think part of my anxiety is "anniversary" related. Started chemo a year ago this week, my best friend died etc. I had expected to get my anniversary doctors appointments over this week and it just isn't happening. And I am spending way, way too much time listing for the beeps on the answering machines. I do have some xanax left from surgery.
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Just had my 3-month blood work done since I was switched from Femara to tamoxifen. When I switched I had high cholesterol and triglycerides. After 3 months both have dropped by over 60 points into normal range. I have been taking some supplements to help, but don't know if the switch or the supplements did the trick. Just happy I didn't need another pill!
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Hello ladies. I read your comments and so much of it sounds like it could be me talking. I desperately need a magic cure for weight gain and hair loss. I promise I will manage my moodiness better if I could just fix these two things! Do share info on the hemp oil.
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Hello, I just thought I would join this conversation as I start Femara I believe in March. My GP phoned yesterday and I guess I have got to get the baseline tests for bone density and heart disease. I am 47 and looking at the high rate of bone fractures on this therapy and I think - jeesh I am going to be doomed with crippling skeletal issues before I even reach retirement (assuming I live that long). I also see that you take one drug to help deal with cancer but then you got to take another drug to help deal with the side effects of that one...
Do you find that your mental state - thoughts/emotions are impacted by Femara? I'm already being treated for major depression. This cancer diagnosis and treatments has just reeked havoc on me and I'm struggling every day to cope with it all. So I am wondering if my meds will need to be changed again while on Femera. Any one else diagnosed with a mental health issue and taking Femara?
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Shelly-biotin supplements helped with my hair loss. Start with 2500mg/day and bump to 5000mg/day if needed. If that doesn’t work, try a product called It Works. It was recommended by one of the nurses I had at the hospital for women like us. Weight is tricky. A good option is to try to make veggies and protein the primary foods on your plate. You still need carbs, but they should only make up about 1/4 of your plate. The veggies and protein will also help you feel fuller between meals. Staying active in your daily life also helps. If you are taking anything for anxiety or depression or for hot flashes, check to see if there is a more weight friendly option.
Roaming Star-I take Wellbutrin everyday for anxiety and clonazepam when needed. I have not had to change up my meds while on femara. My GYN recommended adding Zoloft to my regimen to help with hot flashes and I had to stop it because it made me so very tired. I’d rather flash than need to sleep all day. Hope this helps!
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I certainly am finding myself more short tempered and bothered by "the small stuff" since I started femora. Not to the point of wanting professional intervention but I did storm out of the lab in tears yesterday when they couldn't find my mammogram order. Had to reschedule that and my 6 month appointment with BS. Cancer certainly is a gift that keeps on giving!
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Good to know that you both didn't need to change or have medication for drepession or anxiety while on Femara. Thanks for your responses!
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thank you Lula. I’m already in Biotin but am going to check into It Works!! I need to work harder on mamas girl my weight. I’ve always been fairly thin so this is all new to me. Thanks for the tips.
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I think meditation, mindfulness,yoga etc can all be useful for helping with mood isdues. Obviously professional help is also useful, and sometimes necessary.
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I am wondering what my MO would think about half dose of Femara. Is anyone aware of studies on this? How was this dose of 2.5 mg established? I have to assume it was not arbitrary but perhaps it was just the dosage where at higher levels the SEs became unmanageable. After 5 years i will inquire about that half dose option. That should offer some level of protection and give me some peace of mind while causing less SEs. Thoughts?
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With people with severe liver disease, the dosage is 2.5 every other day. My guess is that the 2.5 is the dosage required to get the effect needed, but that's a guess; I did not go back and read the phase II trials, which are the trials where they determine dosage.
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http://cancerres.aacrjournals.org/content/68/12/45...
Stopping Treatment Can Reverse Acquired Resistance to Letrozole
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Cancer Prev Res (Phila). Author manuscript; available in PMC 2017 Feb 1.
Published in final edited form as:
Cancer Prev Res (Phila). 2016 Feb; 9(2): 142–148. Published online 2015 Dec 14. doi: 10.1158/1940-6207.CAPR-15-0322PMCID: PMC4740217NIHMSID: NIHMS745043
Double-blind, Randomized Trial of Alternative Letrozole Dosing Regimens in Postmenopausal Women with Increased Breast Cancer Risk
Ana Maria López,1Sandhya Pruthi,2Judy C. Boughey,3Marjorie Perloff,4Chiu-Hsieh Hsu,5Julie E. Lang,6Michele Ley,5Denise Frank,5Josephine A. Taverna,5 and H-H Sherry Chow5Author information ► Copyright and License information ►The publisher's final edited version of this article is available free at Cancer Prev Res (Phila)Go to:Abstract
Aromatase inhibitors (AIs) profoundly suppress estrogen levels in postmenopausal women and are effective in breast cancer prevention among high-risk postmenopausal women. Unfortunately, AI treatment is associated with undesirable side effects that limit patient acceptance for primary prevention of breast cancer. A double-blind, randomized trial was conducted to determine whether low and intermittent doses of letrozole can achieve effective estrogen suppression with a more favorable side effect profile. Overall, 112 postmenopausal women at increased risk for breast cancer were randomized to receive letrozole at 2.5 mg once daily (QD, standard dose arm), 2.5 mg every Monday, Wednesday, and Friday (Q-MWF), 1.0 mg Q-MWF or 0.25 mg Q-MWF for 24 weeks. Primary endpoint was suppression in serum estradiol levels at the end of letrozole intervention. Secondary endpoints included changes in serum estrone, testosterone, C-telopeptide (marker of bone resorption), lipid profile and quality of life measures (QoL) following treatment. Significant estrogen suppression was observed in all dose arms with an average of 75 – 78% and 86 – 93% reduction in serum estradiol and estrone levels, respectively. There were no differences among dose arms with respect to changes in C-telopeptide levels, lipid profile, adverse events (AEs) or QoL measures. We conclude that low and intermittent doses of letrozole are not inferior to standard dose in estrogen suppression and resulted in a similar side effect profile compared to standard dose. Further studies are needed to determine the feasibility of selecting an effective AI dosing schedule with better tolerability.
Keywords: letrozole, dosing regimens, breast cancer risk, estrogen suppression
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC47402...!po=36.9565
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Marijen, as always good info but if i am understanding this, lower doses did not help w QOL issues. Regardless, this might well be a better route to go especially after 5 years. I am leaning this way and it could well perpetuate the effectiveness for longer term use.
I wish i could go to a bc center as opposed to just a generic MO. There is so much info for doctors to keep up with. I am grateful for this board.
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NBJB - The only way to know for sure how it works for you is to try it.
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True Marijen. I have another year so who knows what will be the guidelines then but half dose sounds like a good option. Thanks for your post.
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Hi Yall - I've been on Letrozole for 7 days now. The First day - I felt depression like I've never felt before, how can that happen so quickly? Since then, I started taking my 2.5 pill in the evening, that seems to help somewhat with the depressed feeling. But I've had a headache every single day. The only thing that helps are the 800mg ibuprofens I had left from one of the surgeries, but I know that is not great for my kidneys. I've had some night sweats but I can deal with that. The head aches, the feeling of just being off.....
All of my docs except GP seem to want to push anti-depressants. I'm not depressed. Matter of fact I was feeling pretty darn good before I started taking this drug. I'm not against anti-depressants, but really? Is there another way? Does this get better?
What else I can do?
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RobinOhio - that is not good. I wonder if that will change for you as your body adjusts? Seems a bit early for anti-depressants. Have they said how long it would take to normalize in your system? Hang in there and keep us posted on how its going.
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RobinOH- yes you can experience changes in your body and mood that quick. You may level out over time and you may not. Leveling out may occur in a matter of days, weeks, months or years. There is no way to predict.
On the docs pushing anti-depressants, it helps to understand why they are pushing anti-depressants. When our hormone levels change it triggers changes in our body chemistry which can result in moodiness, depression, irritability, fatigue, hot flashes, sensitivity to cold and/or heat, skin changes (ie acne, oily or dry skin, etc), atrophy of estrogen sensitive tissues (ie vaginal walls and urinary tract,) just to name a few. This why we experience mood swings and develop acne on our period, develop PMS and/or PMDD, etc. So the decrease in estrogen that’s occurring by taking the AI can cause these type side effects to occur.
The term Anti-depressant is a catchall classification for medications that have a positive impact on/increase the levels of serotonin and/or norepinephrine that is available between neurons in our brain and in our blood stream. Serotonin and norepinephrine are neurotransmitters that are naturally occurring in our body. They help regulate mood, sleep, digestion/appetite, social behavior, sexual desire & function. When your hormone levels change it induces a change in the serotonin and/or norepinephrine levels available for your body to use. Bumping those available levels up with an SSRI or SNRI (anti-depressants) helps to re-regulate those levels and this helps resolve some or all of the symptoms you’re experiencing. The pill doesn’t contain serotonin or norepinephrine however. The pill simply does not allow the serotonin/norepinephrine your body makes to be reuptaken by the receptors in your brain thus increasing the amount available to do their work in between neurons. So they are helping your body do what it should be doing but isn’t because of (in this instance) the hormone drop. Additionally, because of their effect on other areas of the body (GI tract, etc) they are also often used for appetite control (although some can cause weight gain too), anxiety, sexual dysfunction (although a side effect can be sexual dysfunction too), and to break certain addictions like smoking.
So why are the docs so quick to push them? Giving you estrogen replacement therapy or discontinuing your anti-hormonal therapy to level things out are not viable options. So we need to look to alternatives. The anti-depressant classes of medication are routinely used to help mitigate the effects of hormone swings and are quite effective for this purpose. Depression can also escalate quickly. Since your docs know this and they know that your body is definitely experiencing a significant hormone change they are going to be quick to try and reverse this before it progresses. The earlier you get relief the earlier your quality of life gets better and the less chance that you will end up in a deep depression and/or make unwise decisions based on a depressed frame of mind (ie thoughts of or actually a quitting a job you love, thoughts of or actually separating from your spouse when you hadn’t had problems prior, thoughts of or actually taking your life or doing yourself harm, etc) We often think it can’t or won’t happen to us or that it wouldn’t happen quickly or we would seek help way before any of that would happen. But the reality is it can, it does and it can happen way before you realize you’re in trouble. And right now is the warning stage. You reporting those symptoms lets your docs know that negative changes are already presenting. In turn they are offering tools to help reverse those negative symptoms.
I’m sorry this is so long, but hopefully it helps you to better understand what’s happening in your body and why the docs are making the recommendations that they are.
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HapB- I'm sorry if that's how my response to RobinOH's question sounded to you. That was not my intention. The example of the hormone fluctuations related to our cycle was only an example that we can all relate to changes in how we feel. I'm not saying every woman should be on them for that. And i did point out several of the (often seemingly contradictory) side effects of anti-depressants. Every single thing we put in our bodies has side effects, even all the all natural herbal supplements.
My point is that when someone is experiencing a known significant reduction in estrogen (as happens with AIs, tamoxifen and oophorectomy) depression, hot flashes, fatigue, etc are common and something to be watched for. Since replacing the estrogen is not a viable option to remedy the situation, looking to other solutions is reasonable. Untreated depression and/or sudden onset of dark thoughts, no matter the cause, is dangerous in and of itself. My personal opinion is I’d rather take an anti-depressant (being watchful of my response to it personally & with my dr) and risk those side effects than live 24/7 with dark thoughts and clinical depression that hasan organic cause (not a bogus diagnosis by a dr with ulterior motives for prescribing them) that can and often do destroy our life and often the lives of those around us as collateral damage. But i did not express my opinion in the earlier post as that was not what was asked for - I simply stated the facts on what happens when our body no longer gets estrogen, on how anti-depressants in the SSRI/SNRI classes work, and why the docs not only offer them but offer them early at the first sign of symptoms vs waiting. RobinOH asked a question and I answered it with facts.
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HapB I totally disagree with your opinion on antidepressants. They can be used very successfully in chronic illness, which cancer is. They can also lessen anxiety. I have an MSN and have prescribed them myself. I have also taken them and am on them now. They increase neurotransmitters in the brain which can be depleted by stress. No different than a diabetic taking insulin. If you choose not to take them that is your decision. Others choose differently in order to increase their quality of life
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