Letrozole

Hi
Short answer is, it is variable and the type of side effect or the severity is hard to predict. Joint pain is experienced by many and I have none at all. Flushes and menopausal symptoms also, I haven’t had any of those either. Vaginal dryness, yes but mine may also be compounded by age and the severity and impact experienced by others is from mild to severe. There are treatments and ways to alleviate this, with varying success and many don’t get it at all. Bone thinning can occur - if you don’t already know, wise to get a bone density test before you start, then you can accurately monitor any impact. Again, age can make a difference. But bottom line, give it a shot. I’m still on it 7 years in, don’t know if I’ll make 10 but we are working on it year by year. If it’s too difficult you can stop, but you’ll have done as much as you can to get any benefit. Best wishes. 

Not everyone has side effects that are troublesome.   For some there's niggles initially and in time the body adjusts.
Hopefully you are one that sails through.
Take care

Be aware, @Ctoo - but don't despair.  As the girls have said - not everyone gets all the side effects.  Fingers crossed that is you xx

Just get out there & keep doing what you love doing - keeping active is one of the ways to mitigate any side effects  xxx

I had  joint pain for about 6 months but found daily walking for an hour helped me walk thru it pretty well.I also participated in gentle exercise programs  and at the suggestion of my oncologist took a daily Krill oil tablet ( stronger than fish oil they say) - no idea if it workedbut managed ok so still taking it.For me the walking was and is very important - it also helps lower stress and gives me thinking time away from other daily distractions.

The big issue is to protect bone density as Letrozole thins bones. It’s wise to have it checked before starting and keep it monitored.I was osteoporotic prior to breast cancer so was put on Prolia injections 6 monthly  to counter bone thinning which I manage fine andhave the added benefit of reducing recurrence risk.

It also causes vaginal atrophy which makes Pap smears more uncomfortable and difficult to do.My oncologist agreed to oestrogen pessaries for 1 week prior my Pap smear. I think the latest research suggests oestrogen pessaries are safe to use regularly to counter vaginal atrophy for Er+ breast cancer patients on hormone therapy - but please check with your oncologist.

Finally Letrozole can cause a big increase in cholesterol- it doubled mine - so that needs to be monitored and maybe some dietary modifications/ statin tablets may be necessary.

Letrozole I think is doable but can be tough at the start - many can push thru this and continue. For those that can’t there are other hormone therapy tablets that may alleviate troubling side effects.Give it a go - track any side effects and report them to your oncologist who can help with alternatives.It’s worth a shot but be persistent as it can protect Er+ breast cancer patients from recurrence .

Just another thought.If you have difficulty with Letrozole and it doesn’t settle. Be aware that there are 8 (I think) different brands of Letrozole on the market in Australia. Whilst the drug itself is the same the fillers and coatings are not which may be causing problems for you so may be worth changing brands for a while.

I initially bought a brand from the local chemist which was fine but switched to one from Chemist King which was $12 less per packet.I used it for 3 months but found myself feeling quite low .I then tried another brand from Chemist Warehouse for the same price which agreed with me better which I have now used for 10 months .

Fillers and coatings is an often debated topic and from my own experience I would say there is some truth in people being sensitive to them.

I think it’s interesting to note the range of side effects from aromatase inhibitors like  Letrozol that can be from mild to life altering in a terrible way. I can’t believe how often people dismiss these side effects as if they are not much, despite a high incidence of sufferers and high drop out rate in taking these drugs. I am due to start an AI in the next couple of days and as someone who is not arthritic and doesn’t have any osteoporosis or joint or muscle  pain, I take the likely addition of such problems into my life very seriously.  I have breast cancer so I have to now be constantly grateful to the medical world,  but I am not doing that shit. 

I find your post extremely sad. Not everyone suffers badly and you maybe one of those.

Letrozole is just one of the AI group.

My medical team treats me with the utmost respect. I am sorry if yours is as you mentioned above.

Venting is a way of releasing frustration!

Don't be terrified of AIs, @Temple  - as @iserbrown and others have said - not everyone gets the side effects!  With a bit of luck - that will be you and @Ctoo!   

When you both DO start it, keep notes of any side effects so that you can discuss it with your Onc.  Hopefully they will be a good one (some of them are!) and help with mitigating the side effects, or try a different one,  

Putting off starting til after Xmas/New Year is probably not a bad idea anyway - it is unlikely to make any difference to your longterm treatment - but you should really let your Onc know.

I too am troubled by your post @Temple . It would seem your medical support team  has been disappointing. At the beginning of treatment I changed one of my oncologists as I did not feel comfortable - I guess I was lucky being a private patient I could choose my team.If you can maybe you should too.

Re Letrozole nobody starts hormone therapy lightly but we choose to do so as Er+ breast cancer in the hope that it prevents recurrence ie it’s the best shot we have post surgery/ chemo/radiotherapy - we are lucky in that our Triple negative sisters have no such option.

I do not defend Letrozole, it was the scariest part of my treatment for me esp given my pre existing osteoporosis but I’ve tried very hard to manage it’s side effects . I realise some find it very tough but many find it doable - I’ve been lucky to be in the latter.

Finally I think it’s important to try , garnering as much information as you can to try and find a pathway to manage side effects for the potential protective benefits.

My AI contains lengthy written advice about side effects. The list is huge but as with chemo, no-one will get all of them. It indicates a range. My oncologist also discussed some of the most likely side effects, many of which I don’t have. He takes the ones I do have seriously, and we are monitoring effects. He can’t tell what he doesn’t know  - research doesn’t indicate whether seven years is better than five only that ten is better than five. It’s something we work on together.