Hormone Therapy Can Cause Side Effects
Because hormone therapy blocks your bodys ability to produce hormones or interferes with how hormones behave, it can cause unwanted side effects. The side effects you have will depend on the type of hormone therapy you receive and how your body responds to it. People respond differently to the same treatment, so not everyone gets the same side effects. Some side effects also differ if you are a man or a woman.
Some common side effects for men who receive hormone therapy for prostate cancer include
Why Would A Woman In Menopause Take Hrt Some Women Take Hormone Replacement Therapy To Ease Menopausal Symptoms Hrt Is Medicine That Contains Hormones That The Ovaries Make Less Of As Women Age And Reach Menopause Hrt Can Be Taken As Estrogen Only Or As A Combination Of Estrogen Plus Progestin Combined Hrt Is Most Commonly Used Estrogen
Combined HRT may help relieve menopausal symptoms, protect against osteoporosis and reduce the risk of colon cancer.
Research shows that long-term use of combined HRT increases the risk of breast and ovarian cancer, heart disease, stroke and pulmonary embolism . The research suggests that the risks of long-term combined HRT use outweigh the benefits for most women.
The decision to take HRT is personal and should be made with the help of your doctor. Concerns about cancer, heart disease and stroke should be discussed when considering the benefits and risks of HRT.
What Are Hormones And Hormone Receptors
Hormones are substances that function as chemical messengers in the body. They affect the actions of cells and tissues at various locations in the body, often reaching their targets through the bloodstream.
The hormones estrogen and progesterone are produced by the ovaries in premenopausal women and by some other tissues, including fat and skin, in both premenopausal and postmenopausal women and in men. Estrogen promotes the development and maintenance of female sex characteristics and the growth of long bones. Progesterone plays a role in the menstrual cycle and pregnancy.
Estrogen and progesterone also promote the growth of some breast cancers, which are called hormone-sensitive breast cancers. Hormone-sensitive breast cancer cells contain proteins called hormone receptors that become activated when hormones bind to them. The activated receptors cause changes in the expression of specific genes, which can stimulate cell growth.
Breast cancers that lack ERs are called ER negative, and if they lack both ER and PR they may be called HR negative.
Approximately 67%80% of breast cancers in women are ER positive . Approximately 90% of breast cancers in men are ER positive and approximately 80% are PR positive .
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Types Of Hormone Therapy For Prostate Cancer
Hormone therapy may be part of prostate cancer treatment if the cancer has spread and cant be cured by surgery or radiation therapyor if the patient isnt a candidate for these other types of treatment. It may also be recommended if cancer remains or returns after surgery or radiation therapy, or to shrink the cancer before radiation therapy.
Additionally, hormone therapy may be combined with radiation therapy initially if theres a high risk of cancer recurrence. It can also be given before radiation therapy to shrink the cancer and make other treatments more effective. Other types of hormone therapy for prostate cancer include:
What Are Male Sex Hormones
Hormones are substances that are made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs.
Androgens are a class of hormones that control the development and maintenance of male characteristics. The most abundant androgens in men are testosterone and dihydrotestosterone .
Androgens are required for normal growth and function of the prostate, a gland in the male reproductive system that helps make . Androgens are also necessary for prostate cancers to grow. Androgens promote the growth of both normal and cancerous prostate cells by binding to and activating the androgen receptor, a protein that is expressed in prostate cells . Once activated, the androgen receptor stimulates the expression of specific genes that cause prostate cells to grow .
Almost all testosterone is produced in the testicles a small amount is produced by the adrenal glands. Although prostate cells do not normally make testosterone, some prostate cancer cells acquire the ability to do so .
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Use Of Hrt In Women With Cancer
An increasing number of women with cancer experience menopausal symptoms. HRT is contraindicated in patients with breast cancer and oestrogen-dependent cancers but not in patients with other cancers and authors have argued against the denial of HRT in these patients except when based upon evidence, given the benefits of HRT . Numerous researchers have made recommendations, based upon limited evidence, for and against the use of HRT in patients with cancer depending upon the site of their cancer .
How Does Hormone Therapy Work
About 2 out of 3 breast cancers are hormone receptor-positive. Their cells have receptors for estrogen and/or progesterone which help the cancer cells grow and spread.
There are several types of hormone therapy for breast cancer. Most types of hormone therapy either lower estrogen levels in the body or stop estrogen from helping breast cancer cells grow.
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How Hormone Therapy Is Given
Hormone therapy may be given in many ways:
- Oral. Hormone therapy comes in pills that you swallow.
- Injection. The hormone therapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly.
- Surgery. You may have surgery to remove organs that produce hormones. In women, the ovaries are removed. In men, the testicles are removed.
Reducing The Cancer Risks Of Hormone Therapy
If you and your doctor decide that MHT is the best way to treat symptoms or problems caused by menopause, keep in mind that it is medicine and like any other medicine its best to use it at the lowest dose needed for as short a time as possible. And just as you would if you were taking another type of medicine, you need to see your doctor regularly. Your doctor can see how well the treatment is working, monitor you for side effects, and let you know what other treatments are available for your symptoms.
All women should report any vaginal bleeding that happens after menopause to their doctors right away it may be a symptom of endometrial cancer. A woman who takes EPT does not have a higher risk of endometrial cancer, but she can still get it.
Women using vaginal cream, rings, or tablets containing only estrogen should talk to their doctors about follow-up and the possible need for progestin treatment.
For women who have had a hysterectomy , a progestin does not need to be a part of hormone therapy because theres no risk of endometrial cancer. Adding a progestin does raise the risk of breast cancer, so ET is a better option for women without a uterus.
Women should follow the American Cancer Society guidelines for cancer early detection, especially those for breast cancer. These guidelines can be found in Breast Cancer Early Detection.
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How Much Hormone Therapy Costs
The cost of hormone therapy depends on
- the types of hormone therapy you receive
- how long and how often you receive hormone therapy
- the part of the country where you live
Talk with your health insurance company about what services it will pay for. Most insurance plans pay for hormone therapy for their members. To learn more, talk with the business office where you go for treatment. You can also go to the National Cancer Institute database, Organizations that Offer Support Services and search “financial assistance.” Or call toll-free 1-800-4-CANCER to ask for help.
Ethics Approval And Consent To Participate
Approval for analysis of the Welsh data has been obtained from the SAIL Databank Information Governance Review Panel and approval for the analysis of the Scottish data has been obtained from the Public Benefit and Privacy Panel for Health and Social Care . In both Scotland and Wales only de-identified data will be used and therefore written informed consent was not obtained. However patients from Wales included in SAIL Databank are informed that their anonymous routine data is being used for research and can opt-out by informing their GP . Similarly, patients from Scotland are informed that their non-identifiable routine data is being used for research and have the right to object to its use .
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Hormonal Therapy For Endometrial Cancer
Cancer of the uterus or its lining, the endometrium, may respond to hormone therapy with progestins. Other types of hormone therapy for endometrial cancer include:
- Aromatase inhibitors
When and why theyre used: Hormone therapy is typically reserved for advanced uterine or endometrial cancer, or for cancer that has returned after treatment. Its often combined with chemotherapy.
Risks: Side effects are similar to those seen with hormone treatment for other types of cancer.
Expert cancer care
Who Can Have Hormone Therapy
Hormone therapy is an option for many people with prostate cancer, but its used in different ways depending on whether your cancer has spread.
Localised prostate cancer
If your cancer hasnt spread outside the prostate , you might have hormone therapy alongside your main treatment. Hormone therapy can shrink the prostate and any cancer inside it, which makes the cancer easier to treat. It can also make your main treatment more effective. You might have hormone therapy:
- for six months before, during or after external beam radiotherapy
- for up to three years after external beam radiotherapy, if there is a risk of your cancer spreading outside the prostate
- for a few months before starting permanent seed brachytherapy, and before and after high dose-rate brachytherapy both are types of internal radiotherapy
- before having high-intensity focused ultrasound .
Hormone therapy is not usually given to men having surgery to remove their prostate .
Read more about localised prostate cancer.
Locally advanced prostate cancer
If your cancer has spread to the area just outside the prostate , you may have hormone therapy before, during and after radiotherapy. Hormone therapy can help shrink the prostate and any cancer that has spread, and make the treatment more effective.
You may be offered hormone therapy for up to six months before radiotherapy. And you may continue to have hormone therapy during and after your radiotherapy, for up to three years.
Advanced prostate cancer
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Treatment To Lower Testicular Androgen Levels
Androgen deprivation therapy, also called ADT, uses surgery or medicines to lower the levels of androgens made by the testicles.
Orchiectomy
Even though this is a type of surgery, its main effect is as a form of hormone therapy. In this operation, the surgeon removes the testicles, where most of the androgens are made. This causes most prostate cancers to stop growing or shrink for a time.
This is done as an outpatient procedure. It is probably the least expensive and simplest form of hormone therapy. But unlike some of the other treatments, it is permanent, and many men have trouble accepting the removal of their testicles. Because of this, they may choose treatment with drugs that lower hormone levels instead.
Some men having this surgery are concerned about how it will look afterward. If wanted, artificial testicles that look much like normal ones can be inserted into the scrotum.
LHRH agonists
Luteinizing hormone-releasing hormone agonists are drugs that lower the amount of testosterone made by the testicles. Treatment with these drugs is sometimes called medical castration because they lower androgen levels just as well as orchiectomy.
With these drugs, the testicles stay in place, but they will shrink over time, and they may even become too small to feel.
- Leuprolide mesylate
LHRH antagonists
Possible side effects
Many side effects of hormone therapy can be prevented or treated. For example:
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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How To Tell If Hormone Therapy Is Working
If you are taking hormone therapy for prostate cancer, you will have regular PSA tests. If hormone therapy is working, your PSA levels will stay the same or may even go down. But, if your PSA levels go up, this may be a sign that the treatment is no longer working. If this happens, your doctor will discuss treatment options with you.
If you are taking hormone therapy for breast cancer, you will have regular check-ups. Checkups usually include an exam of the neck, underarm, chest, and breast areas. You will have regular mammograms, though you probably wont need a mammogram of a reconstructed breast. Your doctor may also order otherimaging procedures or lab tests.
Missing Element Number : Beliefs Regarding Individual Compared With Collective Risk
Contemporary biomedicine focuses on the management of individual risk, construed as consequence of individual lifestyles combined with genetic predisposition, while effectively ignoring societal risks that shape changing population profiles of disease and social inequalities in health. In the case of HRT, the emphasis on individual risk contributed to research that ignored womens social and ecological context, thereby hindering rigorous analysis of socially patterned confounding and the possible impact of endocrine disruptors.
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Dynamics Of Proliferative Breast Disease
The exact pathogenetic mechanisms of breast cancer initiation and/or promotion are still poorly understood . Therefore, no firm causal conclusions can be established from the associations found between risk factors, including hormone use, and breast cancer.
Hormones may well influence the progression of breast cancer at any time from the primordial mutation to tumour diagnosis several years later . The pathophysiological prerequisite for the appearance of cancer in menopausal and post-menopausal women and its association with hormone use is the presence of active estrogen receptors in the respective target tissues. Unfortunately, none of the studies which form the current view on the risk associated with HRT incorporate biochemical or immunopathological data on tumoral levels of estrogen receptor expression. Such information might have clarified some of the more troublesome observations made in these studies. The main issue these studies fail to resolve is whether the apparent associations are due to the facilitated detection of pre-existing small carcinomas growing more rapidly under HRT stimulation or to de novo malignant breast tumours brought about by an increased frequency of initiating mutations.
Due to their lack of initial diagnostic status, well-documented follow-up and history of prior hormonal therapy, these studies are by design restricted in their ability to address the questions surrounding their rather surprising results.
Hormone Replacement Therapy In Women
In the human female body, estrogen and progesterone are hormones that play a crucial role in the development and regulation of the female reproductive system and secondary sexual characteristics. However, as females age, they begin to experience menopause symptoms, and their bodys ability to produce estrogen and progesterone begins to drop. A decline in estrogen and progesterone levels can lead to females experiencing several discomforting issues like vaginal dryness leading to pain during sex, hot flashes, night sweats, insomnia, mood swings, general irritability, and a number of others.
There are primarily two forms of hormone replacement therapy to address menopausal symptoms. The first is estrogen therapy, in which estrogen is the primary hormone administered and is applied to menopause symptoms that follow a hysterectomy. The second is Estrogen Progesterone therapy, or Progestin Estrogen Therapy, and is administered on women who still have their uterus. It is also known as combination therapy because it combines estrogen with progestin which is actually a synthetic form of the progesterone hormone.
The HRT program has several benefits for women as it helps reduce the risk of osteoporosis, cancer, and diabetes. It also relieves them of hot flashes and vaginal dryness and leads to an improved mood and sense of well-being in women.
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What Is Hormone Replacement Therapy
HRT medicines usually contain the hormones estrogen, progesterone, or both, to replace the hormones a womans body stops making after menopause.
HRT is different than hormonal therapy medicines that block estrogen to treat hormone receptor-positive breast cancer.
There are two main types of HRT:
-
combination HRT, which contains both estrogenand progesterone
Estrogen-only HRT usually is taken only by women who have had a hysterectomy .
Combination HRT usually is taken by women who still have their uterus. Estrogen-only HRT can cause the lining of the uterus to become too thick a condition called estrogen-associated endometrial hyperplasia. This can increase the risk of cancer of the uterus, called endometrial or uterine cancer. The progesterone in combination HRT helps to prevent thiscondition.
In combination HRT, both hormones can either be combined into one medicine or given as separate medicines. The same dose of estrogen and progesterone can be taken daily , or in different amounts on different schedules .
There are several ways to take or use HRT:
Systemic HRT effectively treats many symptoms of menopause, including hot flashes and night sweats. Topical HRT only works on vaginal symptoms, such as dryness and discomfort during sex.