Drugs That Stop Androgens From Working
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.
Enzalutamide , apalutamide and darolutamide are newer types of anti-androgens.
These drugs are taken as pills each day.
What Is Hormone Replacement Therapy
Hormone replacement therapy is the process of taking hormones when your natural hormone levels are low.
Hormone replacement therapy can help to reduce symptoms associated with low hormones and help to balance your hormone levels and body functions.
Hormone replacement therapy can be used for a variety of hormones, most commonly low insulin, estrogen , testosterone, human growth hormone, and thyroid hormones. Hormone replacement therapy can be used for both men and women.
Hormone replacement therapy comes in different types of applications including topicals like creams, gels, and patches, ingestibles like pill or capsule supplements, injections, and implants.
Not all hormones come in every form, so your doctor will help you to decide which form is best for you based on the hormone that you are taking. Each application type has its own pros and cons and must be weighed to decide if it fits your lifestyle and needs appropriately.
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Hormone therapy may also be called endocrine therapy or hormone-blocking therapy.
Some cancers grow in response to particular hormones. These cancers are known as hormone-dependent cancers. They include some types of breast, uterine and prostate cancers. The aim of hormone therapy is the slow or stop the growth of hormone receptor positive cells.
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Surgery To Stop The Ovaries From Working
This is also a type of ovarian ablation. You might choose to have an operation to remove your ovaries instead of having drug treatment to stop them working. You have this operation as keyhole surgery. It is called laparoscopic oophorectomy and you have it under general anaesthetic . You usually stay in hospital overnight.
The surgeon makes a number of small cuts into your tummy . They put a long bendy tube called a laparoscope into one of the cuts. The laparoscope connects to a video screen.
The surgeon puts small instruments through the other cuts to carry out the operation and remove the ovaries. They close the cuts with stitches and cover them with small dressings.
Removing your ovaries causes you to have a sudden menopause. The symptoms include hot flushes, sweating and mood swings.
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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The Link Between Hormones And Cancer
Many glands throughout the body produce hormones, each of which has one or more jobs.
In women, the ovaries as well as fat and skin cells produce hormones called estrogen and progesterone.
These hormones contribute to a woman’s sexual characteristics and reproductive functions. They can also promote the growth of some breast cancer.
In men, the testicles and, to a smaller extent, the adrenal glands produce testosterone and dihydrotestosterone.
These hormones regulate a man’s sexual development and function. When the body makes too many of these hormones, they can cause cancer of the prostate.
In both sexes, hormonal abnormalities can cause kidney cancer.
Other Treatments For Menopausal Symptoms
Studies have shown that some prescription medications can reduce hot flushes and sweats. These treatments may be an option if HRT cannot be used for health or other reasons, and should be discussed with a doctor.
The herbal medicine, black cohosh, may take the edge off hot flushes and sweats, but there is no data to support long-term use. There is also a rare liver condition that may be associated with the use of black cohosh.
Other complementary and alternative medicines have not been shown to be effective for menopausal symptoms when compared with dummy or placebo treatment in research studies.
Commercially available vaginal moisturisers may reduce vaginal dryness if used regularly. Consult your doctor about what will work best for you.
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When Is Hormone Therapy Recommended
Women who begin hormone therapy at age 60 or older or more than 10 years from the onset of menopause are at greater risk of the above conditions. But if hormone therapy is started before the age of 60 or within 10 years of menopause, the benefits appear to outweigh the risks. Type of hormone therapy.
When To Stop Taking Hrt
Most women are able to stop taking HRT after their menopausal symptoms finish, which is usually two to five years after they start .
Gradually decreasing your HRT dose is usually recommended, rather than stopping suddenly. You may find that your menopausal symptoms come back after you stop HRT, but these should pass within a few months.
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What Are Some Commonly Used Postmenopausal Hormones
The following list provides the names of some, but not all, postmenopausal hormones.
- Pills, Brand names: Cenestin®, Estinyl®, Estrace®, Menest®, Ogen®, Premarin®, Femtrace®.
- Creams, Brand names: Estrace®, Ogen®, Premarin®.
- Vaginal ring, Brand names: Estring®, Femring® .
- Vaginal tablet, Brand names: Vagifem®. Imvexxy®
- Patch, Brand names: Alora®, Climara®, Minivelle®, Estraderm®, Vivelle®, Vivelle-Dot®, Menostar®.
- Spray, Brand name: Evamist®.
- Modest improvement in joint pains.
- Lower death rate for women who take hormone therapy in their 50s.
How Do I Know If Hormone Replacement Therapy Is Right For Me
Your doctor can help you weigh the pros and cons and suggest choices based on the severity of your symptoms and your medical history.
Here are some questions to ask:
- Based on my medical history, is there any reason I shouldnât use HRT?
- Do you think it could help my symptoms, especially hot flashes, sleep issues, and vaginal dryness?
- Are there other treatments I should consider?
- Do you think Iâll have side effects from HRT?
- Does my family medical history make me a good or bad candidate for HRT?
- What type of HRT might be best for me?
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What Is Natural Hormone Replacement Therapy
Unlike traditional hormone therapy, which uses lab-created synthetic hormones, natural hormone therapy, also known as bioidentical hormone therapy, uses plant-derived hormones. These hormones are then altered in a lab to have the same molecular structure as the hormones your body used to produce before menopause.
The decision to go on hormone therapy and which type, traditional or natural, is a personal one and should be made after talking to your health care provider. Contact us today to schedule an appointment to talk with a knowledgeable provider about your options.
Classes Of Hormone Therapy
An antiestrogen or estrogen blocker works by blocking estrogen receptors in breast tissue. While estrogen may not cause breast cancer, it is needed for the cancer to grow in some breast cancers. With estrogen blocked, the cancer cells that feed off estrogen may not be able to survive.
Estrogen receptor antagonist
Every person reacts differently to medications, so it is hard to predict what side effects each patient will have. However, the most common side effects in this category of medications include hot flashes, night sweats, weight gain, vaginal dryness and nausea. Blood clots and endometrial cancers are rare but can occur with these medications.
In women who have gone through menopause, estrogen is mainly made by converting androgens into estrogens. An enzyme called aromatase makes this conversion happen. Aromatase inhibitors block this conversion, leading to less estrogen in the body.
LHRH agonist, works by stopping production of leutinizing hormone by the pituitary gland. LH causes the ovaries to make estrogen.
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Forms Of Hormone Therapy
HT comes in different forms. You may need to try different types before finding one that works best for you.
Estrogen comes in:
- Pills or tablets, taken by mouth
- Skin gel
- Skin patches, applied to the thigh or belly
- Vaginal creams or vaginal tablets to help with dryness and pain with sexual intercourse
- Vaginal ring
Most women who take estrogen and who still have their uterus also need to take progestin. Taking both hormones together lowers the risk of endometrial cancer. Women who have had their uterus removed cannot get endometrial cancer. So, estrogen alone is recommended for them.
Progesterone or progestin comes in:
- Vaginal suppositories
- Intrauterine device or intrauterine system
The type of HT your doctor prescribes may depend on what menopause symptoms you have. For example, pills or patches can treat night sweats. Vaginal rings, creams, or tablets help relieve vaginal dryness.
Discuss the benefits and risks of HT with your provider.
What Does Hormone Therapy Do
Hormone therapies change the amount of hormones in your body in different ways. You may have tests to see if a cancer is sensitive to hormones. Your doctor may recommend hormone therapy to:
Prevent the body from making a hormone
Change how a hormone acts in the body
Block a hormone from binding to cancer cells
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Radiotherapy And Androgen Deprivation Versus Androgen Deprivation Alone
Endocrine treatment with or without radiation therapy for locally advanced prostate cancer has been examined by two large phase III clinical trials. The NCIC CTG PR3/MRC UK PR07 study reported by Warde et al. and SPCG-7/SFUO-3 study reported by Widmark et al. confirmed that the combination of hormonal therapy and radiation is superior to the use of androgen deprivation therapy alone in terms of disease-specific survival as well as overall survival.50,51 It is well documented, however, that the side effects of the combined treatment is greater than hormonal therapy alone including diarrhea and rectal bleeding as well as dyspnea and fatigue.
Hua Zhou, David W. Dempster, in, 2013
Understanding The Benefits And Risks
Recent findings show that although not completely risk-free, HRT remains the most effective solution for helping with symptoms of menopause and is also effective for the prevention of osteoporosis. It may also provide protection against heart disease.
When deciding whether to have hormone replacement therapy , it is also important to understand the risks.
You may have heard about a link between breast cancer and HRT. Guidelines from the National Institute for Health and Care Excellence say that HRT is effective and recommend that it should be offered to women with menopausal symptoms.
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Symptoms And Effects Of Menopause
Menopause is the time in a womans life when menstruation ceases, signaling the end of her reproductive ability. The timing of menopause varies widely, but this event often occurs naturally in women in the fourth or fifth decades of life, at a mean age of 51 years. Certain medical or surgical conditions may induce the cessation of menses before this age. If menopause occurs before the age of 40 years, it is considered premature.
The STRAW classification proposed by the American Society for Reproductive Medicine depicts the natural transition in a female’s life from the reproductive years to the time of menopause.
The reproductive years are divided into early, peak, and late and are characterized by regular menstrual cycles . This is followed by the stage of menopausal transition, which earlier on is characterized by a variable cycle length that is more than 7 days different from normal. During the latter stages of this transition phase, women experience intervals of amenorrhea of more than 60 days. When this duration of amenorrhea lasts for up to 12 months, it is classified as postmenopause. The stage of perimenopause spans from the beginning of the stage of menopause transition up until the completion of 1 year following the final menstrual period.
What Are The Side Effects Of Stopping Hormone Replacement Therapy
Written by Elite HRT on April 15, 2021
Camille Freking, Regulatory Affairs Specialist, MEDICAL ADVISOR
Not everyone will be on hormone replacement therapy for the rest of their lives after they start it. So, when its time to stop, you should know what to expect.
It is common to focus on what it is like to start hormone therapy but you really should look at the whole process so you know exactly what you are getting into.
To determine if stopping hormone replacement is right for you, you should work with your doctor to find the weaning timeline that would be most appropriate, which depends not only on the type of HRT, but also other factors like what other medications you may be taking and how low-dose or high-dose your hormone therapy is.
Keep reading to learn more about what hormone replacement therapy is, who can help you with hormone replacement therapy, how to start hormone replacement therapy, how to stop hormone replacement therapy, and the side effects that can come along with stopping certain hormone replacement therapies.
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What Are The Pros And Cons Of Hormone Replacement Therapy For Menopause
Menopause occurs when a woman’s reproductive hormones naturally decline, and she no longer menstruates, which may result in undesirable or uncomfortable symptoms. Fortunately, hormone replacement treatment has been clinically proven to help decrease these symptoms, allowing you to navigate menopause with ease.
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 .
Blocking estrogens effects: Several types of drugs interfere with estrogens ability to stimulate the growth of breast cancer cells:
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Oestrogen Combined With A Serm
SERMS are a newer treatment option for menopause. They have anti-oestrogen or oestrogen-like effects that vary in different parts of the body.
A tablet containing conjugate equine oestrogen combined with the SERM bazedoxifene improves menopausal symptoms, bone density and reduces breast density. Bazedoxifene, like progestogen, reduces the risk of cancer of the lining of the uterus in women who have not had a hysterectomy.
- SERMs can be combined with oestrogen to improve symptoms, improve bone density and reduce the risk of uterine cancer.
How Is Hormone Therapy Used To Treat Cancer
Doctors often use hormone therapy along with other types of cancer treatment, such as radiation therapy, chemotherapy, or surgery. If a person cannot have those treatments because of other health problems, hormone therapy may be used alone.
Hormone therapy can be used in different ways at different times. These include:
Before surgery or radiation therapy to shrink a tumor. This is called neoadjuvant therapy.
After other cancer treatments to reduce the risk that cancer will come back. This is called adjuvant therapy.
For cancer that comes back after treatment, called recurrent cancer.
For cancer that has spread to other parts of the body, called metastatic cancer.
The goal of hormone therapy depends on the type of cancer and how far it has spread. Sometimes, the goal is to keep cancer from coming back after treatment. Or the goal may be to stop or slow cancer growth.
Hormone therapy may also be used to help prevent or manage cancer symptoms. Relieving side effects is an important part of cancer care and treatment. This is called palliative care or supportive care. Be sure to ask your doctor why a specific hormone therapy is being recommended for you and how the therapy will contribute to your cancer treatment plan.
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