After my mastectomy, I entered the world of endocrine/hormone therapy. This is done to prevent cancer recurrence. I’ve been on hormone therapy for seven months now. Sometimes it feels like forever, sometimes it feels like I only just started yesterday. My cancer was highly estrogen and progesterone positive (ER/PR +). This means that the naturally occurring estrogen and progesterone present in the body attach to the receptors of the cancer cells, and this helps the cancer grow.
So to prevent cancer recurrence in premenopausal women, the first thing to do would be to try to reduce the amount of estrogen and progesterone in the body. If the hormones are not there to bind onto the cancer cell receptors, the cancer cannot grow. This is where the ovarian suppression needle does its magic. As its name suggests, it shuts down the ovaries so they can’t produce estrogen anymore. Basically, you get induced into a state of menopause. This isn’t a necessary part of the treatment for everyone though.
I also take tamoxifen every night, the tamoxifen has a slightly different job. Even though the needles shut down the ovaries, the kidneys and body fat still produce some estrogen. This is where tamoxifen does its own magic. To prevent whatever estrogen is still present in the body from stimulating the cancer growth, tamoxifen locks on to the cancer cell receptors first. This means that the receptors are occupied so the estrogen and progesterone can’t attach, which means the cancer can’t grow. Tamoxifen is known as a selective estrogen receptor modulator (SERM). This means that even though it blocks estrogen activity in the breast, it actually acts like estrogen in other parts of the body. The one part of the body where Tamoxifen may be harmful by acting like estrogen is in the uterus because there is a slight chance it may cause uterine cancer. This is why pelvic ultrasounds are done every few months while taking Tamoxifen.
The side effects of hormone therapy are daunting some days. For me, it’s been mainly the hot/cold flashes and night sweats. They really come on strong sometimes- it’s overwhelming. I also haven’t had proper sleep in forever which means I’m constantly tired during the day. I wake up sometimes to really bad leg cramps, they are not often, but when they happen they are intense. Brain fog has definitely made an appearance too- I seem to forget a lot and can’t concentrate at times. And my nails – they have never been as short as they are these days, they are constantly cracking. Another thing to watch out for are potential blood clots. On the flip side, I can go swimming any day I want now, no monthly visitor that ruins my plans. Also now that I have a glimpse of what menopause is like, I’ll be fully prepared when it happens naturally. I’m hoping to add a few more positives to hormone therapy with time. For now, this is all I have. I am actually grateful I could even list some positives because I wouldn’t have been able to come up with anything a few months ago!
Last week at the clinic, I remember staring at the doctor as he went about preparing the concoction from the vials in the medication box. I was surprised because I wasn’t thinking “I hate this” as I usually do. I was actually filled with gratitude. Some days I hate the medications with all my heart and there have been a few times where I’ve typed out a text to my oncologist saying I decided to stop treatment, but I never actually sent any of these texts. I always ended up deleting them. Other days I am thankful that I have options to prevent the cancer from coming back.
My relationship with hormone therapy is definitely bittersweet. A love hate relationship. Some days I feel like giving up, other days I feel so strong. But then again, isn’t this the case with us all in life? We have some days we feel like we can rule the world, and other days we just want to crawl into bed and stay under the covers. And that’s ok – as long as we get back up again.
“Courage is not defined by those who fought and did not fall, but by those who fought, fell and rose again.”Adrienne Rich