The Decision No One Prepares You For: Navigating Hormone Therapy After Breast Cancer

It’s been five weeks since my DIEP flap reconstruction surgery. Physically, recovery has been okay — not terrible, not amazing — but slow. I'm about halfway through what’s considered the standard recovery timeline, but I’ll be honest: mentally, I’ve been struggling.

Sometimes the hardest decisions in survivorship aren’t black and white.

Yes — a 10% improvement is significant. But it’s not everything.

There’s something about the slower, quieter phase of healing that brings up all the emotions you didn’t fully have time or space to process while in the thick of breast cancer treatment.

And then, just as I’m trying to mentally and physically climb my way through this recovery, today I had to sit down and face another huge decision in my breast cancer survivorship journey:Do I go back on endocrine therapy?

My First Experience With Hormone Therapy

Earlier in my breast cancer treatment, I was prescribed an aromatase inhibitor (AI), which is a type of endocrine therapy used to block estrogen. I lasted only a few months before the side effects became unbearable.

The side effects were intense:

• Debilitating joint pain

• Severe mood fluctuations far beyond typical menopause symptoms

• Extreme fatigue

• Brain fog

• A feeling like I was rapidly aging overnight (I'd tell people I was 47, but didn't feel a day over 80)

  
  

I knew I couldn’t sustain life that way long-term. The quality of life cost felt too high, even though I fully understood why these medications are used to help prevent breast cancer recurrence.

That experience made the idea of revisiting hormone therapy extremely overwhelming and emotional.

What Is Endocrine Hormone Therapy After Breast Cancer?

If you’re unfamiliar, endocrine therapy after breast cancer is a treatment designed to lower estrogen or block its effects because many breast cancers (like mine) are fueled by hormones.

For hormone-positive breast cancer (ER+/PR+), doctors often recommend one or more of the following:

• Tamoxifen – blocks estrogen receptors (daily pill)

• Aromatase inhibitors (AIs) – lower overall estrogen production (daily pill)

• Ovarian suppression (Lupron or other medications) – shuts down ovarian function to stop estrogen at the source (monthly or every 3 month injection)

(I was on an Aromatase Inhibitor Letrozole and the Ovarian Suppression Lupron.)

Endocrine therapy is typically recommended for 5 to 10 years as part of long-term breast cancer recurrence prevention.

Why This Decision Feels So Heavy

What makes this decision so complicated is not just understanding the treatment — it’s understanding what’s actually at stake.

After my surgery, chemotherapy, radiation, targeted therapy (Herceptin), and reconstruction, I’ve already completed aggressive treatment.Right now, my estimated 10-year survival rate sits at 71%.

That means:

• Out of every 10 women like me, about 7 will still be alive in 10 years.

• About 3 will not survive breast cancer within that time.

  
  

*If I add endocrine therapy (Tamoxifen, and potentially Lupron), my survival rate increases to around 81%.

That means:

• Out of every 10 women like me, about 8 will survive 10 years.

• About 2 will not.

  
  

When you see it this way, you understand why doctors push for these treatments. Even a 10% absolute improvement in survival is significant.

But at the same time, these numbers are not everything. I also know firsthand what the side effects can feel like. And that's where the real-life decision gets heavy.

The Trade-Off No One Talks About

Endocrine therapy can absolutely save lives — but it can also drastically affect quality of life for some women. Side effects may include:

• Hot flashes and night sweats

• Mood swings, anxiety, or depression

• Sleep disturbances - Insomnia

• Joint pain and stiffness

• Vaginal dryness or sexual health challenges

• Weight changes

• Extreme fatigue

• Loss of bone density

  
  

Because I already experienced so many of these side effects with aromatase inhibitors, my oncologist is now recommending we try a different approach: Tamoxifen combined with ovarian suppression (Lupron).

The hope is that this combination will aggressively block estrogen but may be more tolerable than the AIs I previously struggled with.

My Decision: A Test Run

After a lot of discussion, tears, and research, I’ve decided to approach this next phase as a test run.

First, I will start the Lupron - see how my body responds.

Once I consult a hemotologist and he gives the go ahead (another complication of tomoxifen, is Blood Clots, which during all of this, I have a history of), I will start the Tamoxifen and Lupron combination and carefully monitor how my body responds.

If I tolerate it, I’ll continue. If the side effects become too overwhelming and impact my daily quality of life, I will stop.

Yes — a 10% survival benefit is meaningful.But no — I am not willing to sacrifice my ability to function, feel like myself, or enjoy my life in the process.

This is survivorship. And in survivorship, both survival and quality of life matter.

Why I’m Sharing This

Because no one prepared me for how hard this part of breast cancer treatment can be.

👉 You are allowed to try.👉 You are allowed to stop if it’s too much.👉 You are allowed to advocate for your quality of life.👉 Every bit of time on therapy still offers some protection.

Many women feel like failures if they can’t tolerate endocrine therapy. You are not a failure.

You are a woman making incredibly hard, personal decisions, weighing both science and your lived reality.

What’s Coming Next

As I walk through this phase of survivorship, I’m creating the very tools I wish had existed for me — and for every woman navigating hormone therapy after breast cancer.

Coming soon inside Grace Grit & Pink Ribbons:

• Hormone Therapy Decision Map

• Endocrine Therapy Empowerment Guide

• Survivorship Planning Tools

  
  

These free resources will be available soon to help you feel informed, supported, and empowered in your own journey.

If You’re Facing This Decision Too

You are not alone.

You are allowed to weigh your risks.You are allowed to protect your mental health.You are allowed to say yes, no, or "let’s see how it goes."You are allowed to change your mind at any time.

This is what breast cancer survivorship really looks like: balancing grace, grit, and pink ribbons every single day.

💗 With you, always.