Treatments To Stop Ovarian Function In Premenopausal Women
Women who haven’t undergone menopause â either naturally or as a result of cancer treatment â may opt to undergo treatment to stop their ovaries from producing hormones.
Options may include:
- Surgery to remove the ovaries
- Radiation therapy aimed at the ovaries
- Medications, such as goserelin
Treatments to stop ovarian function may allow premenopausal women to take medications only available to postmenopausal women.
Inflammatory Breast Cancer Treatment
Inflammatory breast cancer is an uncommon and aggressive type of breast cancer caused by cancer cells blocking lymph vessels in the skin.
All IBC cases are classified as at least stage 3 breast cancer. If the cancer is metastatic , its considered stage 4.
Treatments for IBC depend on what stage the cancer is in.
Why Does Hormone Therapy 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.
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Looking After Your Bones While Taking An Aromatase Inhibitor
Aromatase inhibitors can reduce bone density. This may increase the risk of breaks in the bones. To keep your bones healthy while you are taking this medication, your doctor may recommend that you:
- have a bone density test before and during treatment
- do regular weight-bearing exercise
- maintain a healthy intake of calcium
- ensure a healthy intake of vitamin D
- take other prescription medications to build up your bones if your bone density is already low
If you do show signs of bone thinning or weakening you may need to see your GP or specialist for special treatment for your bones.
Estrogen Receptor Blockers Estrogen Receptor Blocker Drugs Attach Directly To And Block The Estrogen Receptors On Cancer Cells So That The Cancer Cells Cant Use Estrogen They Do Not Affect The Level Of Estrogen In The Body Estrogen Receptor Blockers Are Also Called Selective Estrogen Receptor Modulators
Tamoxifen is the most commonly used anti-estrogen drug. It is used in post-menopausal and premenopausal women. Tamoxifen is given by mouth as a pill.
Tamoxifen is the hormonal therapy drug used most often to lower the risk that DCIS or LCIS will lead to an invasive breast cancer.
Tamoxifen very slightly increases the risk for uterine cancer, deep vein thrombosis and stroke. Doctors will carefully weigh these risks against the benefits of giving this drug before they offer it to women who have a personal or a strong family history of these conditions. Usually the benefits of taking tamoxifen outweigh these risks.
Fulvestrant is an anti-estrogen drug that reduces the number of estrogen receptors on breast cancer cells. It is given as an injection into the muscles of the buttocks.
Fulvestrant is used in post-menopausal women if the breast cancer has grown after they were treated with tamoxifen. It is also used in postmenopausal women with locally advanced or metastatic breast cancer that have never been treated with hormonal therapy.
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Ovarian Ablation Or Suppression
For women who havent gone through menopause, ovarian ablation may be an option. This can be done medically or surgically. Either method stops estrogen production, which can help inhibit the growth of cancer.
Surgical ablation is done by removing the ovaries. Without production of estrogen from the ovaries, you will enter permanent menopause.
Symptoms of menopause may include:
- vaginal dryness
- changes in sex drive
Serious complications after surgical ablation are , but you may be more prone to complications if you have diabetes or obesity, or smoke cigarettes.
Stopping The Ovaries Working
In premenopausal women, doctors might use a type of hormone treatment to stop the ovaries from producing oestrogen. This type of drug is called a luteinising hormone releasing hormone . For example, goserelin and leuprorelin . You might have this on its own or with other hormone therapy drugs.
LHRH drugs work by blocking a hormone made in the pituitary gland that stimulates your ovaries to make and release oestrogen. This stops your ovaries from working. So you won’t have periods or release eggs while you are having the injections.
When you stop taking the drug, your ovaries should start working again. But, if you’re close to the age at which your menopause would naturally start, your periods might not start again.
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What Is The Best Medicine For Estrogen
Medications that stop the body from making estrogen after menopause. Aromatase inhibitors are a class of medicines that reduce the amount of estrogen in your body, depriving breast cancer cells of the hormones they need to grow. Aromatase inhibitors are only used in women who have undergone menopause.
Cancers Treated With Hormone Therapy
Hormone therapy is used to treat prostate and breast cancers that use hormones to grow. Hormone therapy is most often used along with other cancer treatments. The types of treatment that you need depend on the type of cancer, if it has spread and how far, if it uses hormones to grow, and if you have other health problems.
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What Is Hormonal Therapy
Hormones help control how cells grow and what they do in the body. The hormones oestrogen and progesterone, particularly oestrogen, can encourage some breast cancers to grow.
Hormonal therapies reduce the amount of oestrogen in the body or stop it attaching to the cancer cells. They only work for women with oestrogen-receptor positive cancers.
Your cancer doctor will advise you to take hormonal therapy to reduce the risk of the breast cancer coming back. It also helps reduce the risk of getting a new breast cancer in your other breast. Sometimes hormonal therapy drugs are given before surgery to shrink a cancer and avoid a mastectomy.
You usually take hormonal therapy drugs for a number of years. For some women, this could be up to 10 years. You usually start taking them after surgery or chemotherapy.
The type of hormonal therapy you have depends on:
- whether you have been through the menopause or not
- the risk of the cancer coming back
- how the side effects are likely to affect you.
Turning Off Or Removing The Ovaries
Turning off or removing the ovaries lowers the levels of oestrogen in the blood. This is another way of starving cancer cells of oestrogen to stop them growing. This treatment only works before menopause.This treatment is not necessary for women who have already gone through menopause because the ovaries naturally stop making oestrogen after menopause.
Turning off or removing the ovaries:
- reduces the risk of cancer returning or new cancer developing
- can be combined with other treatments for breast cancer like breast surgery, radiotherapy, chemotherapy, aromatase inhibitors and tamoxifen
Surgical removal of the ovaries reduces the risk of breast cancer returning and has the added benefit of reducing the risk of developing cancer of the ovaries, although cancer of the ovaries is uncommon.
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Hormone Therapy For Premenopausal Women
For premenopausal women with metastatic breast cancer, hormone therapy almost always begins with ovarian suppression and either an aromatase inhibitor, tamoxifen or other hormone therapy drug.
Ovarian suppression lowers hormone levels in the body so the tumor cant get the estrogen it needs to grow. This may involve surgery to remove the ovaries or, more often, drugs to stop the ovaries from producing hormones.
Combining ovarian suppression and a hormone therapy drug improves survival over either treatment alone .
If breast cancer progressed during past treatment with a hormone therapy drug, the same hormone therapy drug may not be an option for treatment.
Learn more about ovarian suppression.
Learn more about tamoxifen.
Learn more about aromatase inhibitors.
What Is Targeted Therapy For Breast Cancer
Targeted therapy focuses only on killing cancer cells and minimizing damage to normal, healthy cells. It can provide a better outcome with fewer side effects for certain types of breast cancer.
HER2+ breast cancer is a primary diagnosis that calls for the use of targeted therapy for breast cancer. HER2 is an acronym for Human Epidermal Growth Factor Receptor 2. This type of cancer diagnosis means that the cancerous cells are producing too much of the protein. An overabundance of HER2 protein creates more rapid and aggressive cancer growth. However, targeted therapies specific to HER2 tend to be very effective at stopping cancer from continuing to grow and replicate.
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Who Gets Hormone Therapy For Breast Cancer
When youâre diagnosed with breast cancer, your doctor will test cells from your tumor to see if they have parts on their surfaces called receptors that use estrogen or progesterone. If they do, it means that they depend on these hormones to grow. In that case, your doctor will probably recommend hormone therapy as part of your treatment plan.
If youâve already been treated for breast cancer, you might use hormone therapy to help keep it from coming back. It also helps lower your odds of getting new cancers in the other breast.
Also, if you don’t have the disease but have a family history of it, or genes that raise your risk, your doctor may recommend hormone therapy to lower your chances of getting it.
How Is Hormone Therapy Used To Treat Breast Cancer
There are three main ways that hormone therapy is used to treat hormone-sensitive breast cancer:
Adjuvant therapy for early-stage breast cancer:Tamoxifen is FDA approved for adjuvant hormone treatment of premenopausal and postmenopausal women with ER-positive early-stage breast cancer, and the aromatase inhibitorsanastrozole, letrozole, and exemestane are approved for this use in postmenopausal women.
Research has shown that women who receive at least 5 years of adjuvant therapy with tamoxifen after having surgery for early-stage ER-positive breast cancer have reduced risks of breast cancer recurrence, including a new breast cancer in the other breast, and reduced risk of death at 15 years .
Until recently, most women who received adjuvant hormone therapy to reduce the chance of a breast cancer recurrence took tamoxifen every day for 5 years. However, with the introduction of newer hormone therapies , some of which have been compared with tamoxifen in clinical trials, additional approaches to hormone therapy have become common .
Some premenopausal women with early-stage ER-positive breast cancer may have ovarian suppression plus an aromatase inhibitor, which was found to have higher rates of freedom from recurrence than ovarian suppression plus tamoxifen or tamoxifen alone .
Men with early-stage ER-positive breast cancer who receive adjuvant therapy are usually treated first with tamoxifen. Those treated with an aromatase inhibitor usually also take a GnRH agonist.
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Medications That Block Hormones From Attaching To Cancer Cells
One approach to hormone therapy is to stop the hormones from attaching to the receptors on the cancer cells. When the hormones can’t access the cancer cells, the tumor growth may slow and the cells may die.
Breast cancer medications that have this action include:
Tamoxifen. Tamoxifen is usually taken daily in pill form. It’s often used to reduce the risk of cancer recurrence in women who have been treated for early-stage breast cancer. In this situation, it’s typically taken for five to 10 years.
Tamoxifen may also be used to treat advanced cancer. Tamoxifen is appropriate for both premenopausal women and postmenopausal women.
- Toremifene . Toremifene is taken as a daily pill. It’s used to treat breast cancer that has spread to other areas of the body. Toremifene is approved for use in postmenopausal women.
- Fulvestrant . Fulvestrant is administered as a shot every month after first getting a dose every two weeks for the first month. It’s used in postmenopausal women to treat advanced breast cancer.
Determining The Right Breast Cancer Treatment For You
Many factors go into determining the right breast cancer treatment for your condition. These include the size of your tumor, the stage and type of breast cancer you have, an assessment of the genes that may be associated with your cancer, your age, whether cancer has spread to other parts of your body, and your risk for recurrence. Tests will determine if your breast cancer is hormone-receptor-positive, HER2-positive , or triple-negative.
The sequence of treatments is determined by your treatment team and can include a lumpectomy or mastectomy, medical treatment, and radiation treatment. Medical treatments can include chemotherapy, hormone therapy which blocks hormones such as estrogen or progesterone that promote the growth of cancer cells and targeted therapies, which tell the bodys immune system to target and destroy certain breast cancer cells.
Your medical oncologist will help you weigh the pros and cons of each treatment option to help guide your decision.
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How Hormone Therapy Is Used Against Cancer
Hormone therapy is used for two main reasons.
- Treat cancer. Hormone therapy can stop or slow cancer’s growth and reduce the chance it will return.
- Ease cancer symptoms. Hormone therapy may be used to reduce or prevent symptoms in men with prostate cancer who are not able to have surgery or radiation therapy.
Genetics And Family History
Treatment for breast cancer may depend partly on having a close relative with a history of breast cancer or testing positive for a gene that increases the risk of developing breast cancer.
Patients with these factors may choose a preventive surgical option, such as a bilateral mastectomy.
Clinical trials are studies in which patients volunteer to try new drugs, combinations of drugs, and methods of treatment under the careful supervision of doctors and researchers. Clinical trials are a crucial step in discovering new breast cancer treatment methods.
Emerging treatments for breast cancer being studied in clinical trials include:
- that block protein used to repair DNA damage that occurs during cell division are being used and tested for TNBC.
- Drugs that or prevent androgen production are being used and tested for TNBC.
If youre interested, ask your oncologist for information about available trials.
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What Is Hormone Replacement Therapy
Hormone replacement therapy uses bio-identical hormones like testosterone, estrogen, and progesterone to naturally re-balance your bodys hormone levels. At our professional office, we use an innovative pellet delivery system. The hormone pellets, which are about the size of a grain of rice, are inserted under the skin with a long, hollow needle.
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Possible Side Effects Of Hormone Therapy
Some side effects are common to all methods of hormone therapy and are due to the reduced levels of oestrogen.
Tamoxifen and aromatase inhibitors also produce some different side effects. You may experience some of the side effects listed, but are unlikely to experience them all.
For most people who are recommended to take hormone therapy for breast cancer, the risks of treatment are outweighed by the benefits.
Here is a list of possible side effects that might be experienced on tamoxifen and aromatase inhibitors:
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What Hormones Are Needed To Grow Breast Cancer
Some breast cancer cells need estrogen and/or progesterone to grow. When these hormones attach to special proteins called hormone receptors, the cancer cells with these receptors grow. Hormone therapies slow or stop the growth of hormone receptor-positive tumors by preventing the cancer cells from getting the hormones they need to grow.
Adjuvant Hormonal Therapy Treatment Time
For many years, women took hormonal therapy for five years after surgery for early-stage, hormone receptor-positive breast cancer. In most cases, the standard of care is five years of tamoxifen, or two to three years of tamoxifen followed by two to three years of an aromatase inhibitor, depending on menopausal status.
Recent research has found that in certain cases, taking tamoxifen for 10 years instead of five years after surgery lowered a womans risk of recurrence and improved survival.
In most cases, a post-menopausal woman diagnosed with early-stage, hormone receptor-positive breast cancer would take an aromatase inhibitor for five years after surgery to reduce the risk of recurrence. After that, if breast cancer had been found in the lymph nodes, called node-positive disease, a woman would take an aromatase inhibitor for an additional five years, for a total of 10 years of hormonal therapy treatment.
Doctors call taking hormonal therapy for 10 years after surgery extended adjuvant hormonal therapy.
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Possible Side Effects Of Ais
The most common side effects of AIs are:
- Bone and joint pain
AIs tend to have side effects different from tamoxifen. They don’t cause uterine cancers and very rarely cause blood clots. They can, however, cause muscle pain and joint stiffness and/or pain. The joint pain may be similar to a feeling of having arthritis in many different joints at one time. Options for treating this side effect include, stopping the AI and then switching to a different AI, taking a medicine called duloxetine , or routine exercise with nonsteroidal anti-inflammatory drugs . But the muscle and joint pain has led some women to stop treatment. If this happens, most doctors recommend using tamoxifen to complete 5 to 10 years of hormone treatment.
Because AIs drastically lower the estrogen level in women after menopause, they can also cause bone thinning, sometimes leading to osteoporosis and even fractures. If you are taking an AI, your bone density may be tested regularly and you may also be given bisphosphonates or denosumab , to strengthen your bones.