Side effects of hormone therapy
Hormone therapy works by blocking the effects of certain hormones on the body or blocking cancer cells from making or using the hormones. Normally, hormones play an important role in a person's health and wellbeing. Blocking the effects of hormones can cause side effects.
Each person experiences hormone therapy differently. Not all people experience side effects, but those who do may have options for minimizing or eliminating some of them. It's important to talk with your doctor about possible treatment for side effects and how they can be managed. Consider participating in a clinical trial that is looking at new ways to manage hormone therapy side effects.
Some of the more common side effects of hormone therapy in men and women may include:
- bone weakening or osteoporosis
- hot flashes
- sexual side effects
- difficulty focusing and cognitive changes
- joint pain
- weight gain and body changes
Some of these effects may improve with medication or other medical interventions. It's important that you report any symptoms or changes in your health to your doctor. You may also report any suspected side effects directly to the FDA online or by calling 1-800-FDA-1088.
Experts use the terms “normal,” “osteopenia,” or “osteoporosis” to describe bone health and weakening. Osteopenia refers to low bone mass or density. Osteoporosis is more serious loss of bone density, which weakens the bones. Aromatase inhibitors (used to treat breast cancer), and androgen deprivation therapy (used to treat prostate cancer) can weaken the bones.
Guidelines for all patients on aromatase inhibitors recommend:
- assessment for fracture risk
- exercise and calcium/vitamin D supplementation
- treatment for osteopenia or osteoporosis based on bone density test results
- prescribing denosumab or zoledronate while on an aromatase inhibitor
- prescribing bisphosphonates for all postmenopausal women who have significant risk of their cancer coming back
Guidelines for men on androgen deprivation therapy (ADT) recommend:
- bone density testing before and during treatment
- calcium/vitamin D supplementation.
- treatment for osteopenia or osteoporosis based on bone density test results
- prescribing denosumab or zoledronate for men who have risk for fractures
Hormone therapy can lead to sexual side effects, including:
- Genito-urinary symptoms due to decreased hormones.
- In women, vaginal dryness is a common and frustrating side effect that can limit sexual activity. Medications are available to treat vaginal symptoms.
- In men, erectile dysfunction may be a side effect. Sometimes this can be treated with medications known as PDE5 inhibitors, such as Viagra and Cialis. There are other possible treatments for erection problems if these medications are ineffective.
- For both men and women, a special type of physical therapy known as pelvic PT may help alleviate symptoms and improve sexual function.
- Loss of libido. Libido refers to a person's level of sexual desire. Hormone therapy can reduce libido in both men and women. Other factors may contribute to libido, so it's important to let your doctor know if you are experiencing this symptom, so that you can be evaluated for possible causes.
- In women, medications such as bupropion or flibanserin may improve libido.
- For both men and women, medications that affect libido or sexual function can sometimes be changed or doses adjusted. Lifestyle changes, such as weight loss, increasing physical activity, smoking cessation and avoiding alcohol can improve libido. Integrative therapies, such as yoga or meditation, may also help. Healthcare providers who are trained in couples counseling, intimacy or sexuality may help you work through some of these challenges.
Hormone therapy can cause hot flashes in both men and women. During a hot flash a person typically experiences mild to extreme heat throughout the body, which may also be accompanied by sweating, flushing, and a rapid heartbeat. Certain antidepressants, called selective serotonin reuptake inhibitors (SSRIs), may relieve hot flashes. Men with prostate cancer may be able to take a type of hormone replacement known as progesterone to treat hot flashes. Progesterone is not safe for women or men with breast cancer.
Supplements do not effectively treat hot flashes, and some supplements may be harmful. Some people who experience hot flashes find handheld fans and "chillows" that reduce body temperature to be helpful. Others have also reported that exercise, hypnosis, yoga or acupuncture relieves their hot flashes.
Some hormone therapy may interfere with the ability to have children in both men and women. This may be temporary or permanent, depending on the medication and the length of time you are on it. If you are interested in having children, speak with your doctor about your fertility options before starting hormone therapy.
Certain hormone therapies—especially aromatase inhibitors—may cause joint pain. Nonsteroidal anti-inflammatories, such as ibuprofen and antidepressants such as duloxetine (Cymbalta) may improve joint pain caused by these therapies. Exercise, yoga and acupuncture may also help relieve joint pain.
Fatigue may be caused by cancer or treatment, including hormone therapy. Fatigue is common in cancer survivors and can persist years after treatment.
It's important to tell your doctor about any changes in your energy level during your regular visits. Your doctor can check and treat you for any underlying causes, including depression, sleep disturbances and medication side effects.
Although no medications can counteract fatigue caused by hormone therapy, you can take steps to try to improve your energy level, including:
- making sure that your diet is balanced and provides you with adequate nutrition. Ask your doctor for a referral to a nutritionist if you need help meeting your nutritional needs.
- making sure that you get adequate sleep.
- trying to stay physically active, which can help improve your energy level.
Hormone therapy may affect your memory and cognitive function. You should report cognitive changes to your doctor, so that they can check and treat you for underlying causes, including depression, sleep disturbance, fatigue and medication side effects. Limiting alcohol and drugs may improve your memory. Some research has shown a benefit from yoga, exercise, mindfulness, meditation, cognitive training and modafinil (Provigil), a drug used to treat sleep disorders.
The following clinical trials are looking at ways to improve side effects from hormone therapy:
- NCT03592771: THRIVE Breast Cancer App Study (THRIVE). This study will test an app to improve patient-provider communication to improve symptom management and hormonal therapy adherence among diverse patients with hormone receptor-positive breast cancer.
- NCT02707471: Improving Well-Being for Breast Cancer Patients. In the proposed study, women who are taking hormone therapy for breast cancer will be assigned to one of two groups: 1) a self-management intervention for improving adherence and symptom management, or 2) a general health education control group.
- NCT03697200: Auricular Point Acupressure to Self-Manage Aromatase Inhibitor Musculoskeletal Symptoms in Breast Cancer Survivors. The study tests point acupressure, a non-invasive intervention, to manage aromatase inhibitor musculoskeletal symptoms in breast cancer survivors.
- NCT03489057: Efficacy of a Couple-Focused mHealth Symptom Self-management Program. This study will test the efficacy of a couple-focused, web-based tailored prostate cancer symptom management program, Prostate Cancer Education and Resources for Couples (PERC) in a randomized clinical trial of patients completing initial treatment for localized prostate cancer and their intimate partners.
- NCT03971591: Men Moving Forward: A Lifestyle Program for African-American Prostate Cancer Survivors (MMF). This study will examine the efficacy of Men Moving Forward (MMF), a four-month community-based lifestyle intervention aimed at supporting adherence to nutrition and physical activity guidelines to promote improved body composition and lessen side effects of treatment.