Long Term Hormonal Therapy and Joint Pain

by Jane Ashley

Post-menopausal women who had hormone-positive breast cancer usually take an Aromatase inhibitors (AIs) to help prevent a recurrence of their breast cancer. Post-menopausal women still produce estrogen — an enzyme called aromatase converts androgens (sex hormones produced by the adrenal glands) into estrogen. The AI (aromatase inhibitor) prevents this conversion to estrogen.

Post Menopausal Women

The AI is effective in reducing the chance of recurrence, but it puts women at higher risk for osteoporosis. The AI is also responsible for joint (and muscle) pain. This pain usually develops within the first three months on AI therapy. Joints affected include fingers, hands, wrists, elbows, shoulders, knees and ankles. Patients may also develop carpal tunnel syndrome and trigger finger and also may suffer from bursitis and tendonitis.

*Hormone Therapy*

Unfortunately, some women’s pain and discomfort is so severe that they discontinue this useful therapy.

Why do AIs cause joint pain?

Researchers don’t know why. It doesn’t appear that switching to a different AI helps either. However, if you want to switch, some experts suggest that you stop therapy for 6-to-8 weeks to make sure that the AI you were taking is the cause of your joint pain.

Researchers believe that decreasing levels of estrogen are responsible for joint and muscle pain and discomfort.
About half of all women on AIs develop joint pain. It is estimated that some 20 percent stop taking their AI due to the severity of their pain.
It’s important that patients work with their medical team to control their joint and/or muscle pain so that they continue to take their AI for the full five years, as recommended.

Coping with joint and muscle pain while taking an AI

Patient education is important — if the patient is told that they may experience joint or muscle pain as a side effect of their medication, they are more likely to be able to tolerate the discomfort. Healthcare professionals should also offer the possible solutions before patients begin AI therapy.

Be sure to let your oncologist know about your joint or muscle pain so that the two of you can best address your particular situation.

Acupuncture. A study, published in July 2018 in JAMA, compared acupuncture to sham/faux acupuncture and control (no acupuncture). The study confirmed that acupuncture is effective for joint and bone pain along with the stiffness that some patients suffer.

Acupuncture

Heather Greenlee, N.D., Ph.D., a co-author of the study, suggests that breast cancer survivors seek out an acupuncturist who is experienced with working with oncology patients and who will follow the study’s recommended point protocol.

Acupuncture does present a couple of disadvantages. Some potential patients are afraid of needles. The other drawback is cost. Medicare does not cover acupuncture — private insurance coverage is limited. Costs per session average between $50 and $75. Lower cost clinics are available through POCA.

Exercise. A Yale study of women who were experiencing joint and muscle pain while taking AIs reported less pain, felt physically stronger and daily living activities were easier after just two months of exercise.

Many people believe that exercise would hurt more — but they soon learn that the opposite is true. Exercise does relieve joint pain. One patient who experienced terrible joint pain in her fingers took up knitting on advice from a friend. To her amazement, knitting (aka exercise for her hands) relieved her pain and allowed her to keep moving her fingers. 

(NOTE: I have arthritis in my right hand, and my joints are quite swollen. I find that just flexing my fingers several times a day relieves the stiffness and discomfort.)

Resistance bands and lifting some weights (just 5 or 7.5 pounds is sufficient) helps us build muscle mass which, in turn, lessens joint pain. You don’t need to go to a gym. You can buy inexpensive weights at Walmart or Goodwill.

Knitting

Walking is free and helps our knees and hips.

Vitamin D. Studies show that muscle strength improves as vitamin D levels increase. Some patients seem to benefit from taking extra vitamin D. Be sure to talk to your oncologist before you begin supplementing with vitamin D. A simple blood test shows your vitamin D level.

Weight loss. AI joint and muscle pain is worse in women who are overweight. Losing weight is an effective treatment for simple arthritis. Weight loss also helps prevent recurrence of breast cancer.

Yoga. Turning Point reports that yoga and tai chi may help reduce pain caused by AI therapy. Yoga and tai chi are also mood boosters, helping patients better cope with their discomfort.

Note: Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen are generally not recommended because of their wide-ranging side effects, including gastrointestinal, cardiovascular and kidney problems.

Don’t suffer in silence. Talk to your healthcare provider about your joint and/or muscle pain if you are taking an Aromatase inhibitors (AIs) to help prevent a recurrence of your breast cancer. Adherence to the recommended length of time of treatment is critical to reducing your risk for recurrence. Be proactive to take care of yourself.

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