Hormone therapy for uterine cancer

Hormones are substances that control some body functions, including how cells act and grow. Hormone therapy adds, blocks or removes hormones to slow or stop the growth of cancer cells that need hormones to grow. Hormone levels can be changed or blocked by drugs, surgery or radiation therapy.

Hormone therapy is sometimes offered to treat endometrial carcinoma and uterine sarcoma, the 2 most common types of uterine cancer. If you have hormone therapy, your healthcare team will use what they know about the cancer and about your health to plan your treatment.

Hormone therapy may be the only treatment you have or it may be used along with other cancer treatments. You may have hormonal therapy to:

• treat advanced-stage (stage 3 or stage 4) uterine cancer or cancer that comes back (recurs) after treatment
• relieve pain or control the symptoms of advanced or metastatic uterine cancer (called palliative therapy)
• treat some types of low-grade, stage 1 uterine cancer that won’t be removed with surgery to preserve fertility (called fertility-sparing treatment)
• treat uterine cancer in some premenopausal people who didn’t have their ovaries removed or have radiation therapy
• destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back (recur) (called adjuvant chemotherapy)
• treat uterine cancer in people who can’t have surgery

Different types of hormone therapy are used for uterine cancer.

Progestins are drugs that are a synthetic form of the hormone progesterone. They act on progesterone receptors to slow the growth of cancer cells. Progestins are the most common type of hormone therapy given for uterine cancer.

The following progestins may be offered for endometrial carcinoma and uterine sarcoma:

• medroxyprogesterone (Provera)
• megestrol

Both drugs are taken daily by mouth as a pill.

If you have advanced-stage or recurrent endometrial carcinoma, you may have medroxyprogesterone or megestrol alternating with tamoxifen, another hormone therapy that is a type of anti-estrogen drug. Each drug is given for 3 weeks at a time.

For premenopausal people who wish to have children after their diagnosis with early-stage endometrial carcinoma, a levonorgestrel intrauterine device (Kyleena, Mirena) may instead be offered as a fertility-sparing treatment. The levonorgestrel intrauterine device, sometimes called a hormonal IUD, releases progestins continuously while it is in place in your uterus.

Anti-estrogens are drugs that block estrogen from getting to the cancer cell. This ensures that the cancer cells can't use estrogen to grow and spread.

Tamoxifen is a type of anti-estrogen drug called a selective estrogen receptor modulator (SERM). You may have tamoxifen as hormone therapy for advanced or recurrent endometrial carcinoma on its own or alternating with a progestin like megestrol.

Tamoxifen is taken daily by mouth as a pill.

Before menopause, the ovaries are the body’s main source of estrogen. Luteinizing hormone–releasing hormone (LHRH) agonists are drugs that stop the ovaries from making estrogen. This reduces the amount of estrogen available for cancer cells to use to grow and spread. LHRH agonists are sometimes called gonadotropin-releasing hormone (GnRH) agonists.

You may be offered LHRH agonists for uterine sarcoma if all the following are true:

• you are premenopausal
• your ovaries weren’t removed during surgery
• you didn’t have radiation therapy that would have damaged your ovaries
• you have uterine cancer that is estrogen receptor or progesterone receptor–positive

Goserelin (Zoladex) or leuprolide (Lupron, Lupron Depot, Eligard) are the most common LHRH agonists given for uterine cancer. Both drugs are given by needle into a muscle (injection).

After menopause, the body's main supply of estrogen comes from the adrenal glands and fat, rather than the ovaries. Aromatase is an enzyme that helps the adrenal glands and fat make estrogen. Aromatase inhibitors are drugs that block this enzyme so that estrogen isn't made. Without estrogen, cancer cells can’t access the hormones they need to grow and spread.

If you are post-menopausal or had your ovaries removed during surgery, you may be offered the following aromatase inhibitors to treat advanced endometrial carcinoma and some types of uterine sarcoma:

• anastrozole (Arimidex)
• exemestane (Aromasin)
• letrozole (Femara)

All these drugs are taken daily by mouth as a pill.

Side effects of hormone therapy will depend mainly on the type of hormone therapy, the dose of a drug or combination of drugs, and your overall health. Tell your healthcare team if you have these side effects or others you think might be from hormone therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

These are common side effects of hormone therapy for uterine cancer:

• treatment-induced menopause and its symptoms, such as hot flashes and night sweats
• sexual problems, such as a loss of desire for sex and vaginal dryness
• weight gain
• increased appetite
• depression
• muscle and joint pain
• nausea and vomiting
• breast swelling or tenderness
• headache
• bone density loss (osteoporosis)
• blood clots

Find out more about hormone therapy and side effects of hormone therapy. To make the decisions that are right for you, ask your healthcare team questions about hormone therapy.

Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.