#377 The Role of Aromatase Inhibitors After Breast Cancer

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In today’s episode, we’re diving into a question I hear all the time: “Why do I need to take aromatase inhibitors if I’m post-menopausal? Isn’t my body done making estrogen?”

If you’ve wondered the same thing, you’re not alone! We’ll explore how your body still produces small amounts of estrogen even after menopause, and why this matters for breast cancer survivors.

I’ll explain where post-menopausal estrogen comes from—hint: it’s not just your ovaries—and how lifestyle factors can support your body’s hormone balance. You’ll also hear why aromatase inhibitors play an important role in preventing recurrence, but we won’t avoid discussing their risks, either.

We’re also diving into something that might surprise you—a genetic variation that can make one aromatase inhibitor less effective in some women. This genetic factor can impact how your body metabolizes the drug, which you want to hear about!

I’m excited for you to tune in to this episode, whether you’re currently on aromatase inhibitors, considering them, or just curious about how your body works post-menopause.

I’ll cover all of this and more to help you make the best choices for your health and healing after breast cancer. Don't miss it!

 

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Read the full transcript:

0:00
You're listening to better than before breast cancer with the breast cancer recovery coach, I'm your host, Laura lummer. I'm a certified life coach, and I'm a breast cancer thriver. In this podcast, I will give you the skills on the insides and the tools to move past the emotional and physical trauma of a breast cancer diagnosis if you're looking for a way to create a life that's even better than before breast cancer, you've come to the right place. Let's get started. Hey there, friends. Welcome to episode 377 of better than before breast cancer. I am your host, Laura lummer, and today, we're going to dig into a very common question that I get from clients. You know, when we get a breast cancer diagnosis, some of the glaring things that come up for us is hormones, right? Is it estrogen positive? Progesterone positive, her two new, positive, negative. How do I eat to control estrogen? What is estrogen dominance? And we get really concerned, and then we take aromatase inhibitors to try to suppress estrogen in our body. And so a lot of the questions that I get are around aromatase inhibitors, since there's such a common part of treatment after we have finished that active part of surgeries, potentially chemotherapy, radiation, that type of thing, and especially if we've gone through radiation, or if we're already menopausal. When we get a diagnosis, I often get asked, if I'm postmenopausal, why do I need to take aromatase inhibitors? Or if I'm past menopause, is my body even still making estrogen? If my estrogen is zero, why am I taking something to block estrogen? And so that's what we're going to dive into today. I want to explore how your body continues to make estrogen even after menopause, and how lifestyle factors can support healthy estrogen levels. What protective benefits and risks are associated with aromatase inhibitors, and I'll also touch on a pretty fascinating and I think, important genetic variation that can impact how well certain aromatase inhibitors, letrozole, specifically, can work in some women. All right, so let's dig in. Let's get started. So when you're postmenopausal, your estrogen levels drop significantly, and it's easy to assume that that means that you no longer produce estrogen at all, but that's really not the case. Even after menopause, your body continues to produce small amounts of estrogen, and this happens in a few different ways. So first, let's talk about the ovaries. So before menopause, your ovaries are the main source of estrogen production, particularly producing estradiol, which is the most potent form of estrogen during your reproductive years now after menopause, even though the ovaries no longer produce significant amounts of estradiol, after menopause, though the ovaries no longer produce significant amounts of estradiol, while we still have other sources of estrogen production in the body that can be really powerful, and that's where your adrenal glands and your body fat tissue comes into play. So your adrenal glands, this little, tiny gland that sits on top of your kidneys, they produce androgens, which are hormones like testosterone after menopause, androgens are converted into what's called estrone, and estrone is a weaker form of estrogen. This conversion happens in fat tissue through an enzyme called aromatase. Sound familiar aromatase inhibitors? Right? Aromatase activity continues after menopause, so even though your ovaries are not producing much estrogen, fat tissue becomes a significant source of estrogen production. So this brings us to a really important point. The more body fat you have, the more estrogen your body is likely producing after menopause. Women with more fat tissue tend to have higher levels of estrogen than leaner women post menopause, and that's because there's more aromatase available to convert androgens into estrum. There can also be other things happening inside the body, and certain genetic snips that we have that make it difficult to break down estrogen in our body that make it difficult for our body to use estrogen in healthy ways, but we also have small amounts of estrogen that are produced in other tissues, including your brain, your bones and your blood vessels. And these small amounts of estrogen still play a role in regulating some body functions after menopause. So let's break down these three forms of estrogen that are present in your body after menopause. Estrogen or e1, is the main type of estrogen produced after menopause, and it comes primarily from the conversion of androgens in fat tissue, estradiol or e2, that's that potent form of estrogen and. Estradiol is one that drops significantly after menopause. Estriol e3 is a weaker form of estrogen, and it's typically associated with pregnancy, but it's still present in small amounts post menopause. So even though estrogen production decreases after menopause, it still plays an important role in your health. Estrogen supports bone health. It helps to maintain bone density, which is why women are at a higher risk for osteoporosis after menopause. Estrogen also has a protective effect on your cardiovascular system, and so its decline may contribute to an increased risk of heart disease after menopause. And hearing this that there's a relationship here with body fat. And what are some of the recommendations that we hear most often, maintain a healthy weight and keep moving your body. So as you listen to this, does that resonate with you? And do you see the role that maintaining a healthy weight and moving your body on a regular basis and exercising can play in helping to manage estrogen, right? Estrogen also helps maintain the elasticity of your skin and the health of your vaginal tissues. So when estrogen drops really low, women can experience vaginal dryness and changes in skin texture. So let's talk for a minute about aromatase inhibitors, because of course, those are going to impact estrogen as well. Aromatase inhibitors are prescribed for many postmenopausal women who have hormone receptor positive breast cancer. But why? Since fat tissue continues to produce estrogen after menopause, that estrogen can still potentially fuel the growth of breast cancer cells. Aromatase inhibitors work by blocking the enzyme aromatase, which reduces the amount of estrogen your body is able to produce, and this reduction in estrogen can help slow or stop the growth of hormone receptor positive breast cancers. So in many ways, aromatase inhibitors act like a line of defense by reducing estrogen levels and lowering the risk of cancer recurrence. And now, even though I'm talking about body fat and managing body fat, we're never not going to have any fat on our bodies, right? Even if we're at a healthy weight, we're still going to have some body fat. So treatments like aromatase inhibitors come with benefits and risks. So because these drugs reduce estrogen levels so significantly they can contribute to issues like joint pain, hot flashes and an increased risk of osteoporosis, because estrogen plays such an important role in maintaining bone health. And if you've taken an aromatase inhibitor, or you've taken tamoxifen, which is a little different than aromatase inhibitor, you know what I'm talking about. So it's also worth noting that some women can experience cardiovascular changes due to lower estrogen levels, and that obviously can increase the risk of heart disease, which is why lifestyle support, like maintaining a healthy diet, regular exercise, and then vitamin D, proper levels of calcium, all these things play a big role in bone health, but also so does supporting detoxification, watching out for toxins that we put in on and around our body, which can be hormone disruptors and influence the way that estrogen is managed, broken down And detoxified from our bodies. So let's talk about some lifestyle strategies that can support estrogen balance post menopause and minimize the negative effects of aromatase inhibitors. Because when you hear me talk about estrogen and the effects and the benefits, the point is not to stop taking aromatase inhibitors if there's something that you and your doctor decided will benefit you and potentially save your life. So what can we do to support filling as well as we possibly can, while we're taking some things that might be kind of driving some of the risk factors,

8:54
one of the best ways now I sound like a broken record, to maintain healthy less estrogen levels is to maintain a healthy way. So since fat tissue produces estrogen, having too much body fat can lead to estrogen dominance, and that definitely can increase the risk factors that have anything to do with breast cancer. Also consider phytoestrogens in your diet. Think about phytoestrogens from this perspective, a lot of people just hear the word estrogen, and then we get scared, and we think, Well, if plant foods have phytoestrogens, then that must work like estrogen, and estrogen can fuel cancer, so this must be bad. But phytoestrogens are actually plant based compounds, and they mimic the effects, the positive effects, of estrogen in the body. So foods like flaxseed, some legumes, soy, they contain compounds that can help balance your hormone levels naturally, because they actually can sit on some of those same receptors as the hormone estrogen, but they're way, way, way, way weaker, so they're not going to be that fuel of driving cancer. So. So we have to be careful when we're eating these kinds of foods to make sure that they're organic, especially soy, when 90 over 95% of soy is genetically modified. So you want to make sure that it's organic doesn't have all kinds of chemicals on it, and regular exercise will help to maintain that healthy body weight. Now I want to be clear on that regular exercise is not always a driver for managing weight in some people with certain genetic snips, exercise is always going to be good for your health. So when we're talking about some of the risks and some of the benefits of estrogen, and we talk about cardiovascular health, exercise is always going to play a beneficial role in cardiovascular health. And cardiopulmonary health right the transference of oxygen through your body also important when it's when we're talking about a cancer population. But exercise isn't always going to be effective, an effective tool when it comes to managing weight. It depends on your genetics. A lot of times it will always be good for your health. So we do it, but we don't want to judge ourselves and expect too much from exercise, unless we know for sure which a lot of people have genetic snips and say, Hey, exercise is going to be really beneficial as a tool in weight loss for you. So it depends where you fall on that genetic spectrum. But resistance training, that's going to help build bone density. So strength training, right things that we're pulling and actually dealing with a force, and those are really helpful when estrogen levels are lower, those things like a weight bearing exercise to increase our bone density and support those strong bones, and kind of, you know, lessen that impact of osteopenia or osteoporosis that may be being brought on by low estrogen levels and aromatase inhibitors. So since we're talking about genetics, I think it's really important to touch on something that I don't think we hear of very often. There's actually a genetic snip or a variation that some women have, and it can make the aromatase inhibitor letrozole. So there's many aromatase inhibitors, right? Anastrozole, letrozole, there's different ones, but specifically letrozole, if you have a genetic variation that's called a CYP two, a six gene, some women who have this snip may metabolize letrozole much more quickly, meaning the drug doesn't stay in their system long enough to really be effective. So if you're someone who's been prescribed letrozole and you're not experiencing the results you expected, it could be worth discussing this genetic factor with your doctor, so genetic testing can offer insights into how well certain medications can work for you, and it might be possible to adjust your treatment based on your unique genetic profile, something that I was really happy with my oncologist when I did my nutrition genome, is that he wanted to see those genetics. He's like, can you give me a list of all the genes that came up for you so we can look at that and see if any of the treatment protocols we have could be more effective, or if maybe anything we're doing now isn't as effective as it could be. So I was really happy that he has an open mind, and I think that with many doctors in the standard of care, that when it comes to genetics, because that is such a burgeoning field, and looking at genes and targeted therapies, that they are open to understanding that. So if you think this might be something that's working for you or working against you, it's definitely worth looking into and discussing with your doctor. So once again, we come back to as we often do, that your body is unique, that your genes are unique, your needs are unique. Different medicines are going to work differently for different people, and the different composition of your body is going to affect the way medications and hormones work in your body. I just often think that people don't realize how active body fat tissue is and why it's so important to maintain a healthy weight, and it can be really sensitive to discuss because we have personal feelings and thoughts and beliefs, and I mean, over the course of my journey, from the first time that I went through chemotherapy and all the steroid treatments and I went into chemically induced menopause, I have lost 75 pounds since that happened. There was a lot to deal with of gaining so much weight over a period of a couple of years that I felt like had no control over. So I totally understand how hard it is to wrap our heads around body fat tissue working against us, or what our body size is, and then we label it so much, and I wish we could just hold space for the metabolic effect of fat tissue instead of judging it as if our body size has something to do with our worth as a human being, because it doesn't. And there are so many ways this tissue can affect us. And of course, there's so many emotional issues involved in the things that can drive weight up or weight down, right? So it's definitely a topic that's worth. Diving into and just doing it from a place of compassion and care and understanding and not judgment and labeling and all of that crap that I hear just way too much of. So when we're talking about, why do I have to take this medicine? Or what will this medicine do to me? We're going to be taking into consideration lifestyle factors, the fact that there's going to be some estrogen going on in your body, and how your body might be contributing to that, and how your genes affect the role of all of this as well. So this hopefully gives you some clarity on that question of, Why do I need to take aromatase inhibitors? So we want to make sure you're taking care of your lifestyle. You're nourishing your body with the right foods, you're staying active and you're very mindful of your genetic makeup that influences your treatment and your health, you have so much power when it comes to shaping your healing journey. And hopefully some of this information that you get from this podcast will help you to feel more empowered and that you can take that information and use it in beneficial ways to support you. All right, if you have more questions, or you want to learn more about post menopause, weight management, anything we discussed here today, come and find me on Facebook and Instagram as the breast cancer recovery coach. DM me. Ask me your questions. Ask me your message. Email me your questions. If you want me to talk about something more on the podcast, I'm happy to do that as well. All right, friends, take good care of yourself, nourish yourself with love and kindness, and give that body all the support that it needs so that it can do the healing work that it wants to naturally do. And I'll talk to you next week.

 

 

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