Less Common Types Of Hormone Therapy
Some other types of hormone therapy that were used more often in the past, but are rarely given now include:
- Megestrol acetate , a progesterone-like drug
- Androgens , like testosterone
These might be options if other forms of hormone therapy are no longer working, but they can often cause side effects.
Keep As Active As Possible
Fatigue is such a prevalent side effect of many cancer treatments that patients may find it difficult to get off the couch on some days, much less head outside for a walk. But staying physically active is important for weight management regardless of whether weight loss or gain is desired because regular movement helps maintain lean muscle mass.
We really want patients to hold on to their muscle mass because research has told us there are poorer prognoses for patients who lose their lean body mass at a very rapid rate, Ms. Stella says.
Do You Need To Count Calories
Many people believe that if you eat fewer calories than you burn each day, youll lose weight, and if you eat the same number of calories that youll burn, youll maintain a healthy weight. This plan works for many people, but not all.
If youre counting calories, its important to think about what youre eating. Say Jane eats 1,200 calories a day of cake, cookies and white bread. Shes probably not going to lose any weight. Betty eats 1,200 calories a day of fresh vegetables and fruit and lean protein. Shes probably going to lose some weight and get a lot more nutrients from her food. Counting calories is only part of the weight loss equation.
And counting calories is only one way to lose weight. Because the hormone insulin plays a major role in how your body uses and stores fat, some research suggests that eating foods that keep insulin levels steady throughout the day lean meat and fish, poultry, vegetables, and fruit rather than foods like sugar, candy, white bread, and crackers can help you maintain a healthy weight.
The first thing to do if you want to lose weight is to talk to your doctors and a registered dietitian about a safe and sensible plan designed specifically for you and your needs. Your doctors may want you to wait until you have completely recovered from treatment or any other health issues you may have.
These steps can help you lose weight after treatment:
Association Of Prediagnostic Weight Change With Survival
Premenopausal Diagnosis. To examine whether prediagnostic weight gain during early adulthood might influence survival after a premenopausal breast cancer diagnosis, we evaluated the change in weight from age 20 years until 1 year before diagnosis with adjustments made for age at diagnosis, history of hypertension, and weight at age 20 years . There was little effect for weight gain below 15.9 kg however, gains of 15.9 kg or more increased risk of both breast cancerspecific and all-cause death over 2-fold, although the confidence intervals were wide.
HRs and 95% CIs for overall and breast cancerspecific mortality for tertiles of weight change in kilograms among women who were premenopausal at diagnosis
HRs and 95% CIs for overall and breast cancerspecific mortality for tertiles of weight change in kilograms among women who were postmenopausal at diagnosis
HR and 95% CI for overall and breast cancerspecific mortality for weight change in kilograms by decade among postmenopausal women
Possible Side Effects Of Ais
The most common side effects of AIs are:
- Hot flashes
- Bone and joint pain
- Muscle 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.
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Breast Cancer & Weight Gain: What You Need To Know
Nearly 80% of people who are diagnosed with breast cancer will experience weight gain,1 reported to range between two pounds and 18 pounds. Not only is this an alarming trend for general health and self-image, but also some evidence suggests that pre-menopausal women who gain weight have a 1.5 fold increase risk of cancer recurrence.2 Other studies have shown that some types of treatment, such as anastrozole , are less effective at treating breast cancer in patients who are obese.3
Stephanie Graff, MD, Director of the Breast Cancer Program at Sarah Cannon Cancer Institute at HCA Midwest Health and Associate Director of the Breast Cancer Research Program at Sarah Cannon Research Institute shares what people should know about the risk factors for weight gain after a breast cancer diagnosis.
Simultaneously hitting menopause
Women who become post-menopausal within the year they are diagnosed with breast cancer are the most likely to gain weight. An average woman without breast cancer gains three pounds with menopause.4 The risk of weight gain with menopause is highest in women who were at a healthy weight when reaching menopause. There does not seem to be a significant weight gain in women who quit hormone replacement at the time of a breast cancer diagnosis.
Emotional wellness & coping skills
What Is Hormone Replacement Therapy
Women typically undergo menopause between the ages of 45 and 55. It occurs around one year after a womans last menstrual cycle. The menopausal transition affects the production of hormones produced by the ovaries. This leads to changes that may affect your health. Hormone replacement therapy including prescribed medication that boosts the levels of hormones lost during menopause.
A variety of hormone replacement therapies are available, but they can lead to various side effects. While some believe that HRT causes weight gain, theres no conclusive evidence to prove it. Theres also no proof that HRT encourages weight loss.
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Weight Gain During Chemotherapy
Its not uncommon to experience weight changes when you have cancer or when you receive chemotherapy. Minor weight gain is not a cause for concern. However, significant weight gain is something to monitor because it puts you at higher risk for health problems such as diabetes and heart disease.
Weight gain is more common during chemotherapy treatment for certain kinds of cancer, including breast cancer, ovarian cancer and prostate cancer. This may result from the combination of chemotherapy along with hormone therapy and other medications typically used to treat these cancer types.
Weight gain during cancer treatment is associated with a lower chance of recovery.
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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Menopause And Age Effect
Several studies describe an increased tendency toward weight gain in premenopausal women compared to postmenopausal women. However, inconsistencies in defining menopause in retrospective studies and the issue of chemotherapy-related amenorrhea complicate the interpretation of this effect on weight gain. Goodwin and colleagues identified the greatest weight gains in premenopausal women who experienced chemotherapy-associated amenorrhea and became postmenopausal.
When weight gain is assessed following the use of regimens less likely to cause chemotherapy-induced amenorrhea, younger age rather than menopausal status appears as a significant risk factor. Makari-Judson et al, employing recursive partitioning analysis found women younger than age 59 gained the most weight with no independent effect of menopausal status. Irwin and colleagues determined associations between weight gain and both younger age and postmenopausal status this was further refined as younger post-menopausal women gaining significantly more than older post menopausal women and women who developed treatment-associated menopause after diagnosis. Tredan and associates found no influence of menopausal status on weight gain.
Hormone Replacement Therapy And Risk Of Breast Cancer
This resource was developed, reviewed or revised more than 5 years ago and may no longer reflect current evidence or best practice.
Cancer Australias Breast Cancer the Risk Factors website provides the most up-to-date evidence in relation to breast cancer risk factors including menopausal hormone therapy/hormone replacement therapy and menopausal hormone therapy/hormone replacement therapy
This position statement applies only to Hormone Replacement Therapy and breast cancer risk in women it does not address other risks or benefits to women from HRT usage.
For more information see the Recommendations – HRT & Breast cancer risk below.
For the purposes of this position statement, Cancer Australia defines HRT as the use of exogenous hormones to manage menopausal symptoms.
There are various forms and combinations of HRT. This position statement refers to the following types of HRT: oestrogen-alone , combined HRT , combined oestrogen and testosterone, tibolone and natural therapies.
The 2004-2005 National Health Survey indicates that 11% of Australian women aged 45 years and over were currently using HRT prescribed by a doctor, and that of these women the majority had been using HRT for 5 years or more.1
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Medicines To Avoid While Taking Tamoxifen
In the list below, the medications under the headings Strong Inhibitors and Moderate Inhibitors can inhibit CYP2D6 and interfere with the effectiveness of tamoxifen. The medications under the heading Not Inhibitors do not block the CYP2D6 enzyme and will not interfere with tamoxifen treatment.
This list is incomplete and subject to change over time. Use it as a starting place and ask your doctor if any medications you are taking or that are recommended to you are compatible with tamoxifen.
If You Cant Have Surgery
Surgery is the main treatment for breast cancer, but some women have health problems that mean they cant have surgery. Some women choose not to have surgery.
In this case, if your breast cancer is oestrogen receptor positive, your doctor might recommend hormone therapy. This treatment won’t get rid of the cancer but can stop it growing or shrink it.
The treatment can often control the cancer for some time. Your doctor might change you to a different type of hormone treatment if your cancer starts growing again.
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Why Do Some People With Breast Cancer Gain Weight
Many people gain weight when they are treated with chemotherapy and steroids. Your extra weight may hang around and increase after chemotherapy if you also take hormonal therapy . If your body shifts into menopause because of chemotherapy, there’s a tendency to gain weight.
This weight gain may be because of the enzyme lipoprotein lipase , which is controlled by insulin.
LPL sits on the surface of cells and pulls fat out of the bloodstream and into the cell. If LPL is on a muscle cell, it pulls fat into the cell where its used for fuel. If LPL is on a fat cell, it pulls fat into the cell and makes it fatter.
Its important to know that the hormone estrogen suppresses LPL activity on fat cells. This could be one reason why some women gain weight after menopause or after breast cancer treatment that dramatically decreases estrogen levels. With less estrogen in the body, LPL can pull fat into fat cells and store it there.
Losing weight becomes much harder as we grow older, but it can still be done with careful diet changes and exercise. Be nice to yourself don’t punish yourself.
Learn more about Being Overweight as a risk factor for breast cancer in the Lower Your Risk Section.
What Is Hormone Therapy
Hormone therapy slows or stops the growth of hormone-sensitive tumors by blocking the bodys ability to produce hormones or by interfering with effects of hormones on breast cancer cells. Tumors that are hormone insensitive do not have hormone receptors and do not respond to hormone therapy.
Hormone therapy for breast cancer should not be confused with menopausal hormone therapy treatment with estrogen alone or in combination with progesterone to help relieve symptoms of menopause. These two types of therapy produce opposite effects: hormone therapy for breast cancer blocks the growth of HR-positive breast cancer, whereas MHT can stimulate the growth of HR-positive breast cancer. For this reason, when a woman taking MHT is diagnosed with HR-positive breast cancer she is usually asked to stop that therapy.
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More Recent Reports: Modern Chemotherapy Regimens
In more recent reports, covering a period of time during which adjuvant chemotherapy regimens incorporated anthracyclines and/or taxanes, weight gain is reported but generally to a lesser degree than earlier studies. In a prospective study from Turkey, Basaran et al reviewed weight change in 176 women receiving adjuvant chemotherapy between 2003 and 2007, 98% of whom received an anthracycline-based regimen, with or without a taxane 72% had gained weight at end of year one. Age, menopausal status and comorbidities impacted the degree amount of weight gain.
Makari-Judson and associates conducted a retrospective review of 185 patients with early stage breast cancer and evaluated weight change at diagnosis, 1, 2 and 3 years. Ninety percent of this patient population received an anthracycline-containing regimen . Weight gain at 2 years was greater than one year, plateauing at year 3. Recursive partitioning analysis associated weight gain at year 1 with younger age, closer to ideal BMI and adjuvant chemotherapy. In fact, older and overweight patients receiving chemotherapy tended to lose weight, although these patients constituted a smaller subgroup. Length of chemotherapy, specific chemotherapy regimens, and hormonal therapy were not found to be significant predictors of weight gain. Of patients who had gained weight at year 1, only one in five had returned to baseline by year 3.
Types Of Studies Of Hormone Therapy And Cancer Risk
Different types of studies can be used to look at cancer risk from menopausal hormone therapy .
Randomized controlled trials: In this kind of study, a group of patients get the drug being studied , and another group gets a placebo . Results from this kind of study are powerful because which group a patient is in is based on chance. This helps assure that the groups are similar in all ways, such as risk for cancer, except for the drug thats being studied. This is the best way to see the effects of a drug. These types of studies can also be double-blinded, which means neither the people in the study nor their doctors know which group they are in. This lowers the chance that thoughts or opinions about treatment could affect the study results. Unfortunately, these kinds of studies are costly, which limits the number of people in the study, how long the study can continue, and the number of studies done.
A major drawback of observational studies is that the people getting the treatment being studied may have different cancer risk factors than the people who arent. Plus, the treatment can differ between the people being studied. This makes it less clear that the differences seen are only due to the drug being studied and not other factors.
When observational studies and randomized controlled trials have different results, most experts give more weight to the results of the randomized controlled trial.
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After Treatment Be Prepared For Change
The end of treatment brings pivotal changes, both mental and physical, for cancer survivors, including a recommended switch back to a mostly plant-based diet to manage their weight. Just like other healthy people, survivors should follow the MyPlate recommendations to fill half their plates with fruits and vegetables and split the remaining half between grains and protein.
For survivors, its still very important to make sure their weight is a healthy weight, Ms. Gerdes says, explaining that this group may be at higher risk for other health conditions, including type 2 diabetes and heart disease. We want to make sure that once theyve gotten over the hump of treatment that they continue forward with a healthy diet, at a healthy weight, with a healthy lifestyle.
Ms. Stella adds: Recommendations about weight management are patient specific, and there is no meal plan thats right for everyone. Patients undergoing active treatment will always be instructed to maintain or gain weight, while some survivors may be instructed to lose weight. Its always best to check with your primary doctor to determine if weight loss, gain, or maintenance is best.