What Are The Risks Of Taking Hormone Therapy
While hormone therapy helps many women get through menopause, the treatment is not risk-free. Known health risks include:
- An increased risk of endometrial cancer .
- Increased risk of blood clots and stroke.
- Increased chance of gallbladder/gallstone problems.
- Increased risk of dementia if hormone therapy is started after midlife. HT started during midlife is associated with a reduced risk of Alzheimers disease and dementia.
- Increased risk of breast cancer with long-term use.
Mental And Emotional Health
A cancer diagnosis and cancer treatment may affect how you feel mentally and emotionally. Hormone therapy can cause:
- A drop in mental sharpness
If you have any of these side effects, your doctor may recommend medication, counseling, or both.
Research shows that hormone therapy for prostate cancer may lead to problems with short-term memory, language, thinking, and concentration. But these problems are usually mild. Researchers are still studying the effect of hormone therapy on the brain.
When you stop taking hormone therapy, emotional and mental side effects usually disappear. But if youâve taken the drugs for many years, they may not fully go away.
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How Do You Determine If Hormone Therapy Is Right For Me
Your RMCC oncologist will determine whether hormone therapy may be a promising treatment option for you. He or she will do this by considering your specific cancer type, treatment goals, and personal preferences.
The most common types of cancer treated by hormone therapy are breast cancer and prostate cancer. However, this treatment option may be available to patients with certain types of endometrial cancer and adrenal cancer.
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What Is Menopausal Hormone Therapy
Menopausal hormone therapy also called postmenopausal hormone therapy and hormone replacement therapyis a treatment that doctors may recommend to relieve common symptoms of menopause and to address long-term biological changes, such as bone loss, that result from declining levels of the natural hormonesestrogen and progesterone in a womans body during and after menopause.
MHT usually involves treatment with estrogen alone or estrogen plus progestin, a synthetic hormone whose effects are similar to those of progesterone.
Women who have a uterusthat is, who have not had a hysterectomyare generally prescribed estrogen plus progestin for MHT. This is because estrogen alone is associated with an increased risk of endometrial cancer, but estrogen plus progestin is not. Estrogen is used alone only in women who have had a hysterectomy.
Are There Alternatives For Women Who Choose Not To Take Menopausal Hormone Therapy
Women who are concerned about the changes that occur naturally with the decline in hormone production that occurs during menopause can make changes in their lifestyle and diet to reduce the risk of certain health effects. For example, eating foods that are rich in calcium and vitamin D or taking dietary supplements containing these nutrients may help to prevent osteoporosis. FDA-approved drugs such as alendronate , raloxifene , and risedronate have been shown in randomized trials to prevent bone loss.
Medications approved by the FDA for treating depression and seizures may help to relieve menopausal symptoms such as hot flashes . Drugs that have been shown in randomized clinical trials to be effective in treating hot flashes include venlafaxine , desvenlafaxine , paroxetine , fluoxetine , citalopram , gabapentin , and pregabalin .
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Drugs That Stop Androgens From Working
Anti-androgens
For most prostate cancer cells to grow, androgens have to attach to a protein in the prostate cancer cell called an androgen receptor. Anti-androgens are drugs that also connect to these receptors, keeping the androgens from causing tumor growth. Anti-androgens are also sometimes called androgen receptor antagonists.
Drugs of this type include:
They are taken daily as pills.
In the United States, anti-androgens are not often used by themselves:
- An anti-androgen may be added to treatment if orchiectomy or an LHRH agonist or antagonist is no longer working by itself.
- An anti-androgen is also sometimes given for a few weeks when an LHRH agonist is first started. This can help prevent a tumor flare.
- An anti-androgen can also be combined with orchiectomy or an LHRH agonist as first-line hormone therapy. This is called combined androgen blockade . There is still some debate as to whether CAB is more effective in this setting than using orchiectomy or an LHRH agonist alone. If there is a benefit, it appears to be small.
- In some men, if an anti-androgen is no longer working, simply stopping the anti-androgen can cause the cancer to stop growing for a short time. This is called the anti-androgen withdrawal effect, although it is not clear why it happens.
Newer anti-androgens
Enzalutamide , apalutamide and darolutamide are newer types of anti-androgens. They can sometimes be helpful even when older anti-androgens are not.
These drugs are taken as pills each day.
Guidelines On Ovarian Suppression Therapy
The American Society of Clinical Oncology has put forth guidelines for the treatment of premenopausal women with breast cancer. Itâs important to note that these guidelines are suggestions based on the most recent research, but not absolute rules. There are many nuances when it comes to cancer that general guidelines do not take into account.
In general, premenopausal women who have stage II or stage III breast cancers for which chemotherapy is recommended should receive ovarian suppression therapy. The treatment should also be offered to some women with stage I breast cancer who have a greater risk of recurrence .
In contrast, women with stage I breast cancers for which chemotherapy is not recommended, or who have tumors that are node-negative and 1 centimeter or less in diameter should not receive ovarian suppression therapy.
For those who have a high risk of recurrence, for example, women with lymph node positive or larger tumors, the use of an aromatase inhibitor may be considered over tamoxifen because of further reduction in recurrence risk.
Before beginning an aromatase inhibitor, however, women should have an ultra-sensitive estradiol blood test to make sure they are postmenopausal, and this should be repeated periodically unless permanent ovarian suppression via surgery is chosen.
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What Are The Side Effects Of Hormone Therapy
The side effects of hormone therapy depend largely on the specific drug or the type of treatment . The benefits and harms of taking hormone therapy should be carefully weighed for each person. A common switching strategy used for adjuvant therapy, in which patients take tamoxifen for 2 or 3 years, followed by an aromatase inhibitor for 2 or 3 years, may yield the best balance of benefits and harms of these two types of hormone therapy .
Hot flashes, night sweats, and vaginal dryness are common side effects of all hormone therapies. Hormone therapy also may disrupt the menstrual cycle in premenopausal women.
Less common but serious side effects of hormone therapy drugs are listed below.
Tamoxifen
- breathing problems, including painful breathing, shortness of breath, and cough
- loss of appetite
What Types Of Hormone Therapy Are Used For Breast Cancer
Several strategies are used to treat hormone-sensitive breast cancer:
Blocking ovarian function: Because the ovaries are the main source of estrogen in premenopausal women, estrogen levels in these women can be reduced by eliminating or suppressing ovarian function. Blocking ovarian function is called ovarian ablation.
Ovarian ablation can be done surgically in an operation to remove the ovaries or by treatment with radiation. This type of ovarian ablation is usually permanent.
Alternatively, ovarian function can be suppressed temporarily by treatment with drugs called gonadotropin-releasing hormone agonists, which are also known as luteinizing hormone-releasing hormone agonists. By mimicking GnRH, these medicines interfere with signals that stimulate the ovaries to produce estrogen.
Estrogen and progesterone production in premenopausal women. Drawing shows that in premenopausal women, estrogen and progesterone production by the ovaries is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which then causes the pituitary gland to make and secrete LH and follicle-stimulating hormone . LH and FSH cause the ovaries to make estrogen and progesterone, which act on the endometrium .
Examples of ovarian suppression drugs are goserelin and leuprolide .
Blocking estrogens effects: Several types of drugs interfere with estrogens ability to stimulate the growth of breast cancer cells:
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How To Get Started On Hrt
Speak to your local GP practice if youre interested in starting HRT.
You can usually begin HRT as soon as you start experiencing menopausal symptoms and will not usually need to have any tests first. However, a blood test to measure your hormone levels may be carried out if youre aged 40 to 45. Blood tests may also be carried out to help diagnose suspected premature menopause if youre under 40 and have menopausal symptoms.
Your GP can explain the different types of HRT available and help you choose one thats suitable for you.
Intermittent Or Continuous Therapy
Once prescribed, hormone therapy used to continue for life, but scientists are now reevaluating that strategy and investigating whether hormone therapy can be taken intermittently, with so-called holidays from treatment. The thinking is that this may not only help restore quality of life as, for example, returning libido and sexual health but also delay the hormone resistance that eventually develops in men taking hormone therapy.
Clinical trials evaluating whether intermittent therapy is as effective or more effective than continuous therapy are now under way, so it is too early to say for sure.
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What Is Hormone Therapy For Cancer
Also referred to as hormonal or endocrine therapy, this cancer treatment is different from menopausal hormone replacement therapy , which refers to the prescription of supplemental hormones to help relieve the symptoms of menopause.
Certain cancers rely on hormones to grow. In these cases, hormone therapy may slow or stop their spread by blocking the bodys ability to produce these particular hormones or changing how hormone receptors behave in the body.
Breast and prostate cancers are the two types most commonly treated with hormone therapy. Most breast cancers have either estrogen or progesterone receptors, or both, which means they need these hormones to grow and spread. By contrast, prostate cancer needs testosterone and other male sex hormones, such as dihydrotestosterone , to grow and spread. Hormone therapy may help make these hormones less available to growing cancer cells.
Hormone therapy is available via pills, injection or surgery that removes hormone-producing organs, namely the ovaries in women and the testicles in men. Its typically recommended along with other cancer treatments.
If hormone therapy is part of your treatment plan, discuss potential risks or side effects with your care team so that you know what to expect and can take steps to reduce them. Let doctors know about all your other medications to avoid interactions.
How Should This Medicine Be Used
Hormone replacement therapy comes as a tablet to take by mouth. It is usually taken once a day. To help you remember to take hormone replacement therapy, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take this medication exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Do not stop taking this medication without talking to your doctor.
Activella, FemHrt, and Prempro come as tablets containing estrogen and progestin. Take one tablet every day.
Ortho-Prefest comes in a blister card containing 30 tablets. Take one pink tablet once daily for 3 days, then take one white tablet once daily for 3 days. Repeat this process until you finish all the tablets on the card. Begin a new blister card the day after you finish the last one.
Premphase comes in a dispenser containing 28 tablets. Take one maroon tablet once daily on days 1 to 14, and take one light-blue tablet once daily on days 15 to 28. Begin a new dispenser the day after you finish the last one.
Before taking hormone replacement therapy, ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient and read it carefully.
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What Are The Risks Of Bioidentical Hormones
It has been shown in research studies that there are risks to taking hormones. It can increase the risk of blood clots, stroke, and gallbladder disease. Your risk of heart disease and breast cancer may also increase if you are older or use hormonal therapy for an extended period. Many healthcare providers who use bioidentical hormones claim they are safer than traditional hormone therapy treatments. But there have been no large research studies of bioidentical hormones to show evidence of this.
What Types Of Cancer Is Hormonal Therapy Used For
- Breast cancer: An estimated 80% of breast cancers are hormone-sensitive , which means they are fueled by hormones. More specifically, these are called estrogen-receptor-positive or progesterone-receptor-positive breast cancers. These terms mean this particular cancer has estrogen and/or progesterone receptors, which invite hormones to bind to them. Hormone-receptor-negative cancers are not influenced by hormones.
- Prostate cancer: Most prostate cancers are stimulated by male sex hormones called androgens, says Dr. Leapman this is why urologists also refer to this treatment as androgen deprivation therapy. These hormones are made in the adrenal glands and testicles. Hormonal therapy for prostate cancer is used in several ways, including as short-term therapy for men prior to and during radiation therapy, as well as for men with advanced or metastatic cancer.
Hormonal therapy is sometimes used to destroy hormone-sensitive cancer cells that have spread to other parts of the body or those that have returned .
Hormonal therapy can also be used to ease a cancer patients symptoms . This is especially helpful for patients who are not able to have surgery or radiotherapy because of other health concerns.
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Will I Have Other Treatments In Addition To Hormone Therapy
Your RMCC oncologist may recommend using hormone therapy in combination with other cancer treatments, such as chemotherapy and radiation therapy. When used with other treatments, hormone therapy can:
- Make a tumor smaller before surgery or radiation therapy. This is called neoadjuvant therapy.
- Lower the risk that cancer will come back after the primary treatment. This is called adjuvant therapy.
- Destroy cancer cells that have returned or spread to other parts of your body.
How Hormone Therapy Works
Hormone therapy can be obtained via surgery, injections, or pills. The surgery takes out the hormone-producing organs, predominantly the testes in men and ovaries in women.
Male hormones act like a source of fuel for cancer. Without an adequate hormone supply, the tumor wont thrive. Hormone treatment is meant to slowly yet surely starve the tumor from its much-needed hormone supply. It basically provides an androgen blockage.
Androgen deprivation puts a lid on testosterone release, thus preventing testosterone from acting on the prostate cancer cells. Androgen deprivation can be used in advanced prostate cancer to reduce the tumor.
When used in locally advanced prostate cancer, the therapy can make external beam radiation therapy more effective in curbing the risk of prostate cancer recurrence.
In certain individuals, the cancer cells respond well to the drop in testosterone level. But, for others, the block of testosterone is not enough. These cancer cells can thrive independently of testosterone. Therefore, the therapy wont affect them.
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What Is Unique About Receiving Hormone Therapy At Rocky Mountain Cancer Centers
At Rocky Mountain Cancer Centers, your cancer care team will design a personalized cancer treatment plan that provides the ideal combination of therapies for the best possible outcome. Under our care, you will be monitored closely to determine if your hormone therapy is working. This involves regular PSA tests for prostate cancer treatment and regular checkups for breast cancer treatment.
Rest assured, you are in good hands with Rocky Mountain Cancer Centers. We believe in treating the whole person, not just the disease, which is why we will work hard to create the best cancer treatment plan for you.
What Are The Side Effects
Hormone therapy is a systemic treatment, which means it can affect cells throughout the body.
As each hormone in the body has a specific function, altering the balance of hormones in the body can cause side effects. Whether or not you experience side effects, and how severe they are, depends on the type of hormone you are taking, the dose, and how long you take the treatment. Talk to your doctor about the risks and benefits of taking hormone therapy.
Common side effects include tiredness, hot flushes, mood changes, weight gain and sweating. Hormone therapy can also affect the fertility of both women and men, bring on menopause, and have an impact on your sexuality.
Hormone therapy may also cause bones to weaken and break more easily . Talk to your doctor about having a bone density test or taking medicine to prevent your bones from becoming weak. Regular exercise, eating calcium-rich foods and getting enough vitamin D will also help keep your bones strong.
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How Does Hormone Therapy Work Against Prostate Cancer
Early in their development, prostate cancers need androgens to grow. Hormone therapies, which are treatments that decrease androgen levels or block androgen action, can inhibit the growth of such prostate cancers, which are therefore called castration sensitive, androgen dependent, or androgen sensitive.
Most prostate cancers eventually stop responding to hormone therapy and become castration resistant. That is, they continue to grow even when androgen levels in the body are extremely low or undetectable. In the past, these tumors were also called hormone resistant, androgen independent, or hormone refractory however, these terms are rarely used now because the tumors are not truly independent of androgens for their growth. In fact, some newer hormone therapies have become available that can be used to treat tumors that have become castration resistant.