Hormone therapy for breast cancer
Treating oestrogen-receptor positive cancer
Some breast cancers have extra receptors on their cells’ surface that attach to the female hormone oestrogen (and progesterone). This is called hormone-receptor-positive cancer. The hormones help the cancer cells to grow. Hormone treatments lower the levels of oestrogen or progesterone in the body, or block their effects to slow the growth of the cancer.
Is hormone therapy suitable for me?
If you have hormone-receptor positive cancer, hormone therapy will probably be helpful for you.
If your breast cancer is not sensitive to hormones, hormone therapy will not be of benefit. You may be offered chemotherapy, or no further treatment may be needed.
Hormone therapy drugs work in different ways...
By blocking the receptors on the cancer cells
This means oestrogen cannot attach to the cells. An example of a hormone therapy drug that works in this way is tamoxifen.
By blocking the production of oestrogen in your body fat
Drugs called aromatase inhibitors stop the enzyme aromatase from changing the hormone androgen into oestrogen. These drugs are for women after the menopause (postmenopausal), who don’t produce oestrogen in their ovaries any more. Examples of aromatase inhibitors include anastrozole (Arimidex®), letrozole (Femara®) and exemestane (Aromasin®).
By stopping your ovaries from making oestrogen in prememopausal women
Hormone therapy drugs that work in this way are called luteinising hormone-releasing hormone (LHrH) analogues. They change the levels of hormones released in your brain that control how your ovaries work. The effects of these drugs are usually reversible once the drug is stopped. It usually depends on your age. An example of an LHrH analogue is goselerin (Zoladex®).
Ovarian suppression. Ovarian suppression means reducing the amount of oestrogen made by the ovaries or stopping the ovaries from making oestrogen. Hormone therapy drugs are the main way to do this.
When will I have hormone therapy?
You might have hormone therapy:
After breast surgery to help prevent cancer spreading or coming back.
Before surgery to try to make the tumour smaller.
Instead of breast surgery, where surgery is not possible.
To treat cancer that has come back, alone or with other treatments.
How is hormone therapy given?
Hormone therapy is often given as tablets, or you may have an injection under your skin. It depends on the type of drug.
Other ways to reduce oestrogen levels in your body
Most women will have hormone therapy drugs, but surgery and radiotherapy can also reduce oestrogen levels:
- Surgery. This is where your ovaries are removed so no oestrogen will be produced. This is called oophorectomy.
- Radiotherapy. This uses high-energy rays to stop the ovaries from working.
Surgery and radiotherapy stop your ovaries from working permanently. If you have surgery or radiotherapy to your ovaries you will go through the menopause, if you haven’t already. This is likely to cause menopausal symptoms.
Side-effects of hormone therapy
Hormone therapy may cause short- or long-term side-effects:
Menopausal symptoms after hormone therapy
Hormone therapy can put you into an early or temporary menopause or cause menopausal-like symptoms, like hot flushes. A menopause caused by breast cancer treatment can be quite sudden.
Symptoms are often more intense than when the menopause occurs naturally. Read more about managing menopausal symptoms.
Bone loss and pain after hormone therapy
A lack of oestrogen over a long period increases the risk of osteoporosis (thinning of the bones). Some hormone therapy drugs may increase bone loss and cause pains and aches in your muscle or bone joints.
You may have bone density (DEXA) scans before starting treatment and regularly while on hormone therapy. Drugs may be prescribed if there is serious bone loss (osteopenia).
Read more about bone strengthening drugs and ways to improve bone health.
Blood clotting after hormone therapy
Some treatments slightly increase the risk of blood clotting. Tell your doctor if you have any vaginal bleeding, chest pain, swelling, or tenderness in your legs or arms.
Some drugs can cause the lining of your womb (uterus) to become thickened or put you at small risk of developing cancer of the womb. Tell your doctor if you have any vaginal bleeding while you are having treatment.
If you have drug treatment to switch off oestrogen production you won’t be able to get pregnant while you are being treated and for a time afterwards. Once therapy is stopped, the ovaries should start working again within five to six months for most women.
If you have surgery to remove your ovaries, you will not be able to have children afterwards. Read more about fertility.
Pregnancy and hormone therapy
Hormone therapy drugs can affect a developing baby, so it’s important to avoid pregnancy during and for a time after treatment. Ask your doctor about this.
Coping with hormone therapy side-effects
Coping with a diagnosis of breast cancer is never easy, and the added stress of an early menopause brought on by treatment can make this particularly difficult.
You may find that going through the menopause prematurely can create feelings of loss, and you may even feel isolated from women your own age.
Some women may find it difficult to come to terms with the fact that they will not be able to start a family or have more children. Whatever your feelings, remember that you do not have to cope on your own. Your cancer specialist and breast care nurse are there to provide information and support to you and your family.
You might find it easier to share your feelings with someone who has had a similar experience to you.
Our Survivor Support programme can put you in touch with a trained volunteer who has been through a breast cancer diagnosis. Our trained volunteers are available to provide emotional and practical support to anyone going through or finished with their treatment.
For more information
1800 200 700