What Are the Types of Hormonal Therapy?

There are four major kinds of hormonal therapy. Depending on your personal situation, you and your doctor will decide which one is right for you. The decision will depend, in part, on whether you are still menstruating (pre-menopausal) or no longer have periods because you have passed through menopause (post-menopausal). Read a study about aromatase inhibitors and tamoxifen.

Some of the treatments lower the amount of estrogen in the body, some block estrogen's ability to lock onto the estrogen receptor, and some remove or shut down the major source of estrogen production.

1. Aromatase inhibitors reduce the amount of estrogen produced in post-menopausal women. The three aromatase inhibitors are Arimidex (chemical name: anastrozole), Aromasin (chemical name: exemestane), and Femara (chemical name: letrozole).
2. SERMs (selective estrogen-receptor modulators) such as tamoxifen block the estrogen receptor. As in a game of musical chairs, the SERM sits in the place that estrogen would take in the estrogen receptor—so no estrogen can get in to turn on cell growth.
3. ERDs (estrogen-receptor downregulators) destroy the estrogen receptor. With no receptor in the cell, estrogen cannot get in. Faslodex (chemical name: fulvestrant) is the only ERD so far.
4. Ovarian shutdown or removal addresses the fact that the ovaries are the major source of estrogen in women before menopause. For pre-menopausal women, there are three ways to stop the ovaries' production of estrogen:
   • Medicines: Zoladex (chemical name: goserelin) and Lupron (chemical name: leuprolide) are given by injection once a month for several months to stop the ovaries from producing estrogen.
   • Surgery: Oophorectomy, which removes the ovaries, can dramatically lower the amount of estrogen in the body.
   • Radiation to the ovaries: Low-dose radiation to the ovaries, sometimes called ovarian ablation, can also stop estrogen production. This method of shutting down ovarian function is rarely used.

The role of each of these hormonal therapies depends on a woman's stage of disease, menopausal status, overall medical condition, and personal considerations.

Hormonal medications can be given many different ways: alone, in combination, or one after the other. In January 2005, the American Society of Clinical Oncology published new guidelines for hormonal therapy for many different situations. Read more about the different ways that hormonal therapy is given.

Use the information in this section in deciding with your doctor about the right treatment plan for YOU. And keep talking with your doctor over time to be sure you continue to get the best treatment possible.