I've been trying to understand if there is "chrontherapeutic" best time to take endocrine therapies. Not much yet except some vague references to increased hormonal production at night. That, combined with other suggestions that side effects are lessened, suggests a night time swallow. I will mention that there seems to be an increasing recognition of "crosstalk" between her2 and ER. Imagine the cancer being pushed along an axis between estrogen and Her2 as it looks for food. Why give it a menu when you can starve it? In other words, you might want to lobby your onc for Herceptin or Lapatinib while you take Femara. They should know the research supports it. If not, have them look at this:
http://her2support.org/vbulletin/showthread.php?t=38998 If your onc is up for it and can swing it insurance-wise, methinks lapatinib+Letrozole(Femara) to be worth considering. Lapatinib seems to protect your all-important brain better, albeit at the expense of more trips to the the porcelain throne. If your onc is really listening, have them look at adding Metformin:
http://her2support.org/vbulletin/showthread.php?t=39740 Some boswellic acid (available at GNC) can help joint pain and is thought to fight cancer as well:
http://her2support.org/vbulletin/showthread.php?t=42084