Uterine Sarcoma: Hormone Therapy 

What is hormone therapy?

Hormone therapy is a type of cancer treatment that works to change certain hormone levels in your body. It may be used to treat some types of uterine sarcoma. It's not the same as the hormone therapy used to help manage the symptoms of menopause.

Hormone therapy is usually done by a gynecologic oncologist. This specialist diagnoses and treats female cancer. It may also be done by a medical oncologist, a specialist in the treatment of cancer using medicine. You may get hormone therapy along with radiation or chemotherapy.

How hormone therapy works 

Hormones are chemicals in your blood. They control how cells grow. Hormones like estrogen and progesterone can cause cancer cells in the uterus to grow. The goal of hormone therapy for cancer is to keep the cancer cells from getting the hormones or blocking the actions of the hormones that the cancer cells need to grow. Then the cancer cells shrink and die.

Estrogen and progesterone are the two main types of female hormones that affect uterine cancer. Different types of cancer cells respond to them. Your healthcare provider will test your cancer cells (from your biopsy or surgery) to see how they are likely to respond.

The type of uterine sarcoma called endometrial stromal sarcoma (ESS) tends to respond to hormone therapy. ESS is a cancer that starts in the stromal tissue. This tissue connects the lining of the uterus (endometrium) to the wall of the uterus. Hormone therapy can help shrink or kill ESS.

Some kinds of uterine leiomyosarcoma (ULMS) might also be treated with hormone therapy. These cancers start in the muscle wall of the uterus.

If you have one of these uterine sarcomas, you may get hormone therapy: 

• After surgery. In this case, the goal is to kill any cancer cells that may have been missed. This may be called adjuvant hormone therapy.

• If the cancer has spread or can't be removed with surgery. Hormone therapy may be used to control or shrink the cancer.

• If the cancer comes back. Hormone therapy may be used if uterine sarcoma comes back after treatment.

• If surgery and radiation can't be done. This may be the case if your health is not good.

Hormone therapy medicines for uterine sarcoma

You may take a progesterone-like medicine to help work against the effects of estrogen. Or you may take a medicine with antiestrogen effects. Your gynecologic oncologist will talk with you about the kind of hormone therapy that would be best for you. Options can include:

• Progestins. These include megestrol acetate and medroxyprogesterone. These progesterone-like medicines are pills you take every day.

• Aromatase inhibitors. These include letrozole, anastrozole, and exemestane. They keep estrogen from forming in the fatty tissues of people who have already gone through menopause. They may be used to treat ESS in people who have had their ovaries removed. They're pills you take every day.

• Gonadotropin-releasing hormone agonists. These include goserelin and leuprolide. These medicines are used to lower estrogen levels in people who have not gone through menopause. They're given as injections (shots) every 1 to 3 months.

Common side effects of hormone therapy 

You need to know what hormone therapy medicine you're taking and the common side effects you should watch for. Side effects depend on which medicine is used and how it's given. Your healthcare team will give you the details about your treatment.

The most common side effects are a lot like the symptoms of menopause and may include:

• Hot flashes

• Vaginal dryness

• Night sweats

• Increased appetite

• Weight gain

• Fluid retention

• Joint or muscle pain

• Blood clots (progestins can rarely cause this side effect)

• Weakened bones (osteoporosis), if certain types of hormone therapy are used for many years

Coping with side effects

Talk with your healthcare provider about what to expect from your type of hormone treatment. Some side effects can be prevented or treated. For instance:

• Weight-bearing exercise and medicine can help decrease bone loss.

• Vaginal moisturizers and lubricants can help overall vaginal health and comfort during sex.

• Regular exercise can help prevent weight gain and muscle loss.

• Hot flashes can be eased by wearing layers of clothing that you can easily take off. Also take care not to overheat yourself and stay away from your hot flash triggers.

Working with your healthcare team

It's important to know which medicines you're taking. Write down the names of your hormone therapy medicine. Find out if there are any special precautions you need to take with it. Ask your healthcare team how it works and what side effects it might cause. Make sure you know what number to call with questions or concerns. Is there a different number for evenings and weekends? Tell your healthcare team about any side effects, even those that seem minor. Your treatment may be changed to reduce these effects.

It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.

Also talk with your healthcare provider about any other therapies you may want to try. Some alternative therapies can affect hormone therapy, so talk with your healthcare provider first.