Which Aromatase Inhibitor Causes Less Side Effects
Like all drugs, aromatase inhibitors can cause side effects. Everyone reacts differently to drugs and its not possible to predict how any of the drugs will affect an individual.
The side effects of all three drugs are similar. However, some people may get on better with one drug than another.
If youre finding it hard to cope with side effects from one aromatase inhibitor, your specialist may recommend changing to a different aromatase inhibitor or another hormone therapy drug.
Find out more about coping with:
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How To Switch To A Tamoxifen Alternative
Hormone therapy for breast cancer is typically started after surgery. Switching to a tamoxifen alternative may depend on the response to treatment. The timeline for hormone therapy may look like one of the following:
- Start an aromatase inhibitor two to three years after treatment with tamoxifen. Continue taking the aromatase inhibitor for two to three years for a total of five years of treatment with tamoxifen and the aromatase inhibitor. This treatment timeline is appropriate for postmenopausal women.
- Start an aromatase inhibitor two to three years after treatment with tamoxifen. Continue taking the aromatase inhibitor for five years for a total of seven to eight years of treatment with tamoxifen and the aromatase inhibitor. This treatment timeline is appropriate for postmenopausal women.
- Start an aromatase inhibitor five years after treatment with tamoxifen and ovarian suppression therapy. Continue taking the aromatase inhibitor for five years for a total of 10 years of treatment with tamoxifen and the aromatase inhibitor. This treatment timeline is appropriate for women who are premenopausal at the time of diagnosis.
An oncologist will recommend follow-up care every few months to assess the effects after treatment with hormone therapy. They will also assess the risk of recurrence of cancer and determine the next steps for treatment as needed.
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Lifestyle For A Lifetime
The most effective alternative to hormone therapy, however, doesn’t come in a bottle. Physicians say that preventing heart disease, osteoporosis and cancer often boils down to lifestyle, one that includes regular exercise and a healthy diet. A diet high in calcium along with weight-bearing exercise bolsters bones. Avoiding high-fat foods and participating in regular aerobic exercise keeps the heart healthy.
These habits can prevent the diseases studies have proven it over and over again. Consider it, Greenwood advises. “Those things are so much more effective than any pill you can put in your mouth.”
Nelson Watts, MD, director of the Osteoporosis and Bone Health Program at The Emory Clinic in Atlanta, and principal investigator at the Atlanta site of the Women’s Health Initiative, offers a word of caution. “Often, diet and exercise are not enough by themselves.” he tells WebMD. “A woman needs to first talk with her doctor about what symptoms she wants to relieve, and look at the treatment options.”
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Side Effects Of Tamoxifen And Toremifene
The most common side effects of tamoxifen and toremifene are:
- Vaginal dryness or discharge
- Changes in the menstrual cycle
When tamoxifen treatment starts, a small number of women with cancer that has spread to the bones might have a tumor flare which can cause bone pain. This usually decreases quickly, but in some rare cases a woman may also develop a high calcium level in the blood that is hard to control. If this happens, the treatment may need to be stopped for a time.
Rare, but more serious side effects are also possible:
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Future Prospect Of Herbal Management
Presently the traditional treatment approaches that are being used for breast cancer treatment are being interrupted by a number of impediments mainly for the toxic effects accompanied by drug resistance. Chemotherapy or radiotherapy is creating a number of adverse effects in patients which are inevitable. Again due to drug resistance, the responses of these therapies become poor. In this case natural compounds from dietary sources can be blessings, in view of the fact that they can show synergistic action with many chemotherapeutics and can induce the efficacy of them. A number of natural compounds are reported to have a very positive outcome if taken with other medicines in breast cancer treatment. Following this strategy, a number of medicines and dietary components combination are reported. Among them some examples are combination of genistein and doxorubicin provides a synergistic effect , equol induces the efficacy of tamoxifen, pomegranate also reported to increase cell death and enhance tamoxifen-induced inhibition on cell viability , and DIM works synergistically with Paclitaxel and helps to induce apoptosis . Rosemary extract can increase activity of anti-breast-cancer agent tamoxifen, trastuzumab, and paclitaxel . These can be great fields for future research on natural compounds and can be a successful alternative approach for treating breast cancer.
Hormone Therapy After Surgery For Breast Cancer
After surgery, hormone therapy can be given to reduce the risk of the cancer coming back. Taking an AI, either alone or after tamoxifen, has been shown to work better than taking just tamoxifen for 5 years.
These hormone therapy schedules are known to be helpful for women who are post-menopausal when diagnosed:
- Tamoxifen for 2 to 3 years, followed by an AI for 2 to 3 years
- Tamoxifen for 2 to 3 years, followed by an AI for 5 years
- Tamoxifen for 4½ to 6 years, followed by an AI for 5 years
- Tamoxifen for 5 to 10 years
- An AI for 5 to 10 years
- An AI for 2 to 3 years, followed by tamoxifen for 2 to 3 years
- For women who are unable to take an AI, tamoxifen for 5 to 10 years is an option
For most post-menopausal women whose cancers are hormone receptor-positive, most doctors recommend taking an AI at some point during adjuvant therapy. Standard treatment is to take these drugs for about 5 years, or to take in sequence with tamoxifen for 5 to 10 years. For women at a higher risk of recurrence, hormone treatment for longer than 5 years may be recommended. Tamoxifen is an option for some women who cannot take an AI. Taking tamoxifen for 10 years is considered more effective than taking it for 5 years, but you and your doctor will decide the best schedule of treatment for you.
These therapy schedules are known to be helpful forwomen who are pre-menopausal when diagnosed:
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What Are Hormones And Hormone Receptors
Hormones are substances that function as chemical messengers in the body. They affect the actions of cells and tissues at various locations in the body, often reaching their targets through the bloodstream.
The hormones estrogen and progesterone are produced by the ovaries in premenopausal women and by some other tissues, including fat and skin, in both premenopausal and postmenopausal women and in men. Estrogen promotes the development and maintenance of female sex characteristics and the growth of long bones. Progesterone plays a role in the menstrual cycle and pregnancy.
Estrogen and progesterone also promote the growth of some breast cancers, which are called hormone-sensitive breast cancers. Hormone-sensitive breast cancer cells contain proteins called hormone receptors that become activated when hormones bind to them. The activated receptors cause changes in the expression of specific genes, which can stimulate cell growth.
Breast cancers that lack ERs are called ER negative, and if they lack both ER and PR they may be called HR negative.
Approximately 67%80% of breast cancers in women are ER positive . Approximately 90% of breast cancers in men are ER positive and approximately 80% are PR positive .
Natural Products Targeting Aromatase Gene Promoters
Among the natural products tested as AIs, phytoestrogens, such as flavones and isoflavones are able to bind ER and induce estrogen action . The binding characteristics and the structural requirements necessary for the inhibition of human aromatase by flavones and isoflavones were obtained by using computer modeling and confirmed by site-directed mutagenesis . It was found that these compounds bind to the active site of aromatase in an orientation in which their rings A and C mimic rings D and C of the androgen substrate, respectively . Until now ~ 300 natural products, most of them are phytoestrogens, have been evaluated for their ability to inhibit aromatase using noncellular , cell-based, and in vivo aromatase inhibition assays however, only a few studies have been reported for their effect on aromatase promoter I.4, I.3/II activity . The exact mechanisms how these plant products adapted to inhibit aromatase gene expression or enzyme activity is not fully understood.
Figure 3
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What Are The Positive Effects Of Estrogens
The many positive functions of estrogens and their effects on health are often underestimated.
Estrogens are responsible for the development of reproductive tissues and female secondary sexual characteristics at puberty. They also maintain bone density and decrease the risk of osteoporosis, which can result in brittle bones that break easily. But the role estrogens play in womens health goes far beyond reproductive health and bone density.
Some of the most profound effects of estrogens are in the brain. For instance, hot flashes, which many women experience while going through menopause, are due to the loss of estrogens acting on brain areas involved in temperature regulation.
They can also influence cognitive function how we think, particularly verbal memory and fluency, which is the memory of words and how we express ourselves in language. And around the time of menopause in many women, they are believed to have an anti-depressive effect.
Sleep disturbances during menopause are believed to be caused by absence of the estrogens acting on sleep centers in the brain. The decreased actions of estrogens on the brain during menopause may also influence sexual desire.
And finally, estrogens may be protective in the brain. This has been demonstrated in nonhuman primates. In women, estrogens may decrease the incidence of Alzheimers disease if hormone replacement begins soon after menopause.
Possible Side Effects Of Ais
The most common side effects of AIs are:
- Bone and joint pain
AIs tend to have side effects different from tamoxifen. They don’t cause uterine cancers and very rarely cause blood clots. They can, however, cause muscle pain and joint stiffness and/or pain. The joint pain may be similar to a feeling of having arthritis in many different joints at one time. Options for treating this side effect include, stopping the AI and then switching to a different AI, taking a medicine called duloxetine , or routine exercise with nonsteroidal anti-inflammatory drugs . But the muscle and joint pain has led some women to stop treatment. If this happens, most doctors recommend using tamoxifen to complete 5 to 10 years of hormone treatment.
Because AIs drastically lower the estrogen level in women after menopause, they can also cause bone thinning, sometimes leading to osteoporosis and even fractures. If you are taking an AI, your bone density may be tested regularly and you may also be given bisphosphonates or denosumab , to strengthen your bones.
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The Aromatase Gene And Tissue
Figure 2
Partial structure of human CYP19 gene. Human aromatase gene is located on chromosome 15 and transcribes from telomere towards centromere. The aromatase gene is ~ 123 kb long contains nine coding exons and two alternative polyadenylation sites. Partially tissue specific promoters direct aromatase gene transcription.
Conventional Treatment And Its Drawbacks
Presently applicable treatment strategies for patients of breast cancer include surgery, radiotherapy with an adjuvant chemotherapy, and hormone therapy which can provide positive feedback . Two early stages of breast cancer, stages I and II, are usually treated with breast-conserving surgery and radiation therapy. Radiation therapy following breast-conserving surgery reduces the risk of death and recurrence . However, it has been reported that there can be an incidence of brachial plexopathy, rib fracture, tissue necrosis, pericarditis, and second non-breast infield malignancies occurring in patients with early stage breast cancer treated with surgery and radiation therapy . In case of TNBC treatment, the only successful and systemic therapy is chemotherapy.
Furthermore, major side effects of chemotherapy may lead to the reduction of white blood cells and red blood cells thus increasing the possibility of infection and anemia, respectively, with reduced oxygen carrying capacity of the cells. Another significant side effect is hair loss resulting from conventional treatment. Fatigue, sore throat, nausea, ulcers, loss of appetite, change in taste, constipation, diarrhea, change in skin color, and various hormonal changes are other side effects which are also observed during these treatments .
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Other Serms Such As Evista And Fareston
Raloxifene and toremifene are other SERMs that act similarly to tamoxifen. They stop cancer growth by binding to estrogen receptors and blocking the ability of estrogen to bind to these receptors. However, SERMs can also mimic the effects of estrogen in other parts of the body, such as the uterus, which can increase the risk of certain cancers. These drugs are not usually recommended if previous treatment with tamoxifen has not been successful. Toremifene is only approved for the treatment of metastatic breast cancer in postmenopausal women, so its uses are more limited than those of tamoxifen.
Some healthcare providers may prescribe raloxifene over tamoxifen due to its lower risk of serious side effects, such as uterine cancer. Raloxifene may be prescribed to postmenopausal women with osteoporosis who are at a high risk of invasive breast cancer. However, raloxifene may be less effective at preventing breast cancer than tamoxifen and has only been tested in postmenopausal women. On the other hand, tamoxifen is an option to prevent breast cancer in premenopausal women.
SERMs are generally taken by mouth. Side effects may include hot flashes, muscle or joint pain, and leg cramps. Serious side effects may include an increased risk of uterine or endometrial cancer and blood clots in the legs or lungs.
Our Natural Estrogen Blocker: Estro Clear
Estro Clear is an all-natural, clinical-grade estrogen blocker for men. Estro Clear works as part of a healthy diet and lifestyle to help reduce excess estrogen for men with estrogen dominance or low testosterone levels.
Studies show the active ingredients in this natural hormone treatment have a clear anti-estrogenic effect. This, therefore, helps to rebalance your hormone levels which have a positive impact on your sexual and prostate health. Moreover, by lowering their estrogen level, men can regain their masculine traits and may find it easier to lose weight naturally.
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Natural Estrogen Blockers For Men
Some medications block the enzyme aromatase. They include letrozole, anastrozole, exemestane, and many others. However, women with breast cancer are the ones who typically use them.
By dropping their estrogen levels, they stop the effects of estrogen on cancer cells and slow down cancer growth. In men, they can also balance testosterone and estrogen levels. However, theres a natural way to do it through a natural estrogen blocker.
In this section, we will name and explain the most important estrogen blockers for men:
There Is No Hormone Called Estrogen
First, a primer on what exactly estrogen is. There is actually no hormone called estrogen. Estrogens are a class of hormones. There are three different forms of estrogens in the body: estradiol, estriol and estrone. Although they are all pretty similar in function, they vary in potency. Estrogens found in plants, like soy, are also sometimes simply called estrogen, although their effects may differ from those of the estrogens produced in the body.
Estradiol is the dominant estrogen circulating prior to menopause. It is produced mainly in the ovaries. In most cases, this is the most potent form of estrogen. During pregnancy, the dominant form is estriol, produced by the placenta. And during menopause, when the levels of estradiol decrease, the dominant estrogen is estrone, produced in fat tissue.
The ovaries stop producing estrogens during menopause, resulting in lower levels of estrogens in the body. Yet other organs, including fat and the brain, continue to produce them. There are still estrogens doing whatever they were doing before, but because their levels are lower, they are not doing their work as effectively.
One class of estrogen blockers that is often prescribed for women with estrogen receptor-positive breast cancer does its job by blocking estrogens from getting to the receptors of the cells in the body, including cancer cells. The body still produces estrogens, but their effects are blocked in some cells.
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What Is An Estrogen Blocker
Estrogen blockers are chemicals that stop estrogen from carrying out its role in specific bodily functions. There are several types of estrogen blockers: aromatase inhibitors, antiestrogens, and specific estrogen receptor modulators. Aromatase inhibitors actually prevent the production of new estrogen. Antiestrogens and specific estrogen receptor modulators block estrogen receptors, so that the hormone cannot bind itself to certain body parts. Your doctor can prescribe this to you in the form of a pill or a monthly shot to be given in a doctor’s office.