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So the main things you want to think about when you’re on an endocrine therapy are, what are the side effects from endocrine therapy? So sometimes I hear patients say that they’re on their chemo pill when they’re referring to their endocrine treatment, which isn’t true. So this is an anti-hormone medication, but they can still have side effects. So common side effects from both of these treatments, whether it’s pre-menopausal or post-menopausal, is that you can have basically menopausal type symptoms. And that’s because you’re going from a higher level of hormone to a lower level of hormone. And whether that’s pre-menopausal or post-menopausal, it’s still a change in the hormones. And so that can cause things like hot flashes, vaginal dryness, sometimes mood swings. And that’s pretty common with the treatment of both of these different medications.
But specifically for patients who are on aromatase inhibitors are post-menopausal patients, we also have to be a little bit concerned with things like bone health, because it’s completely blocking those female hormones and those female hormones are also what helps you keep up your bone health. Hence the reason why osteoporosis generally happens to women in older age. So for those women, we want to make sure that they’re taking calcium and vitamin D and they’re staying with a good vitamin D level. And they’re doing those good bone strengthening exercises as well. In addition on those medications, the aromatase inhibitors, you do want to make sure that you’re having either your oncologist or your primary care monitor your cholesterol, because it’s been shown that that can also alter your cholesterol when you’re on those medications. For younger patients or patients who aren’t a candidate for the aromatase inhibitors, generally they need to be aware, again, of those post-menopausal symptoms because they can also get those. So those patients who are taking the SERMs, they actually have a slightly increased risk of blood clots and also need to follow with their gynecologist if they still have their uterus, as they have a slightly increased risk of uterine cancer. So at times older patients or post-menopausal patients can be placed on a SERM because of other co-morbidities, especially if they have osteoporosis or thinning of their bones, as we don’t want to worsen that on that treatment.
