Types of hormone therapy. When is hormonal treatment used? Replacement therapy in gynecology

Such treatment is recommended: a) for patients with massive lesions of regional lymph nodes (histologically proven invasion of three or four nodes of one of the collectors or metastases are found simultaneously in several groups of nodes, such as axillary and parasternal or subclavian, etc.); b) patients who are in the premenopausal period and menopause. Hormone therapy in young women, especially younger than 30 years old, and in advanced age (over 70 years old) is not recommended. The latter is associated more with the risk of complications when using hormonal drugs than with low sensitivity to them.

As shown above, with multiple metastases in the lymph nodes found in the preparation after mastectomy, in more than half of the patients the tumor is a disseminated process, so hormone therapy is considered as a necessary therapeutic measure aimed at combating carcinoma and tumor foci in distant organs. Although the mechanism of action of hormones is still unclear, the detection of specific hormone receptors in tumor cells suggests the possibility of their direct inhibition along with changes in the central regulatory systems during prolonged exposure to synthetic hormonal drugs. True, if latent dissemination of the tumor is suspected, chemotherapy is preferred, however, as experience has shown, the combination of chemotherapeutic and hormonal drugs leads to better long-term results due not only to mutual potentiation, but also to the anabolic effects of hormones, which to a certain extent remove the immunosuppressive effects of chemotherapy.

Hormone therapy for primary breast cancer usually begins with a bilateral oophorectomy, which allows both classical and non-classical estrogens to be removed from the body. Removal of the ovaries is especially indicated for patients of the pathogenetic group III (hypertensive-adrenal, see p. 36), it is less beneficial in patients of the pathogenetic group II (ovarian) and is not indicated for patients with groups I (young) and IV ("senile" form of cancer) groups. The literature provides numerous data on the correlation between adrenal steroidogenesis, in particular, an increase in the level of cortisol, an increase in the secretion of ACTH, an increase in the content of the metabolic and the appearance of cancer metastases (Deshpande, 1977). Long-term administration of corticosteroids is widely used to suppress adrenal function after oophorectomy. In other cases, after ovariectomy, androgenic hormones are used, which have a predominantly peripheral effect. The therapeutic effect of androgens is not strictly related to masculinization. The duration of administration cannot be estimated. For young women (up to 40 years of age), drugs are administered for several years after oophorectomy. Androgens are contraindicated in patients with a chromatin-negative characteristic of the tumor due to the worsening of the results by more than 2 times (Bavli Ya. L., Neishtadt E. L., 1968), therefore, most specialists prefer to carry out corticosteroid therapy after oophorectomy.

Experience has shown that the implementation of ovariectomy and hormone therapy after mastectomy causes a delay in the development of metastases only in the first 2 years of follow-up (table 11). In subsequent years, the results of treatment of this group of patients differ little from the results in the group of patients who did not receive hormone therapy.

Table 11. The frequency of occurrence of recurrence and distant metastases in advanced form of primary cancer (4 or more metastatically affected axillary nodes detected during mastectomy) in patients in the premenopausal period and early menopause (randomized trial of 311 patients; Ravdin et al., 1970)

Endocrinological control after ovariectomy and hormonal therapy in patients with primary operable breast cancer is very difficult, since in a significant part of patients before treatment there are no significant differences in the content of gonadotropins, prolactin, 17-p-estradiol, total estrogens, cholesterol, glucose, alkaline phosphatase and other biochemical components compared with healthy women. True, the concentration of estrogens and prolactin is significantly higher in patients in the premenopausal period than in the postmenopausal period (Malarkey et al., 1977). After ovariectomy, there is a significant increase in the level of non-classical phenol steroids (by 20%), a decrease in the level of excretion of classical estrogens and an increase in the content of 17-ketosteroids due to an increase in the activity of the adrenal glands.

Achieved in the future under the influence of androgens or corticosteroids, the decrease in the content of phenol steroids and the normalization of the ratio of concentrations of various estrogen fractions are important for assessing the effect of hormonal drugs, but cannot serve as a criterion for the usefulness of treatment, since there is no parallelism between the clinical course of the disease and endocrinological parameters (Stoll, 1977). It should be emphasized that there is a consensus on the advantages of surgical removal of the ovaries over radiation castration with additional hormone therapy for operable forms of breast cancer. Firstly, oophorectomy makes it possible to achieve a decrease in estrogenic activity in a shorter time, since the main source of the latter is the theca tissue and follicular ovarian cysts. Secondly, during laparotomy it is possible to clarify whether there is a metastatic lesion of the liver, retroperitoneal nodes and the ovaries themselves, the invasion of which by the tumor is observed in 3-15% and 5-9% of patients with stage III cancer, respectively. Finally, practice shows that the abandonment of the ovaries significantly reduces the therapeutic effect of the subsequent use of androgens and corticosteroids, and in some women leads to an increase in the level of gonadotropins under the influence of corticosteroids. The use of the latter to suppress adrenal function after radiation castration is not only ineffective, but also unsafe.

The detection of steroid hormone receptors in tumor cells (they can be found in almost 2/3 of patients, more often in premenopausal and menopausal women) is also an indication for targeted hormone therapy, although this is not enough to predict a favorable response to treatment. The absence of receptors, in particular estrogen (ER), in a primary breast tumor can be combined with earlier and more frequent occurrence of local recurrences and metastases, regardless of other prognostic factors (tumor size, its location, metastases in regional lymph nodes, the patient's age, the use of additional hormonal or chemotherapy). For example, according to Knaight et al. (1977), out of 145 patients with primary breast cancer, ER in the tumor was absent in 54; of the latter, 18 (34%) had metastases within 18 months of mastectomy compared with 13 of 91 patients (14%) who had ER. In patients with metastases in regional nodes in the absence of ER, the interval between mastectomy and the appearance of distant metastases was half as long. The greatest difference was observed in patients younger than 50 years (35 and 8%, respectively). There are reliable observations indicating that not only ER in carcinomas of patients in the postmenopausal period are much more common than in the premenopausal period, but their content in tumors in 2 -4 times higher. The latter is explained by endogenous estrogens, "occupying" receptors and thereby preventing the addition of exogenous estradiol (Yeltsina N.V., 1978). In addition, the concentration of ER varies from 5 to 2000 femtomol per 1 mg of protein (in menopause, an ER concentration of 0.15 femtomol per 1 mg of dry mass of the tumor is considered negative, more than 0.25 is positive, and in patients who have undergone ovariectomy, less than 0, 4 - negative, more than 0.75 - positive).

Assessing the role of various hormonal receptors still encounters numerous difficulties, not only because of defects in the technique for their detection, but also because of the unclear data on their activity. There are a number of key factors to consider. For example, to understand the interaction between a tumor cell and a hormone, it is important to evaluate the totality of biosynthetic elements, nuclear translocation. Seasonal biological fluctuations in the amount of ER and their dependence on the menstrual cycle were revealed. It is still difficult to make a final conclusion about the role of ER and PR (progestin receptors). Nevertheless, treatment with physiologically inactive antiestrogen drugs (nonsteroidal antihormones) that directly affect the tumor cell and do not affect the central mechanisms of hormone genesis is already being successfully developed. According to Leis (1977), the use after mastectomy of one of the antiestrogenic drugs - tamoxifen (nafoxidine, clomiphene are also used) at a dose of 10 mg 2 times a day (first month), 10 mg 3 times a day (second and third months) and 10 mg 2 times a day (fourth month) upon detection of ER and PR in patients of premenopausal and menopausal age with a tumor classified as stage III (T3N2M0), led in 90% of patients to a relapse-free course in the first 2 years after mastectomy. Sufficient efficacy of antiestrogen therapy in the treatment of cancer metastases has been proven, according to Stoll (1977), which has a great future.

Attempts are being made to create compounds that have both cytostatic and antisteroidal properties (similar drugs are already used, for example, estramustine phosphate, prednimustine).

Thus, indications for additional hormone therapy after mastectomy are based on the following principles:
1. Indications for oophorectomy followed by androgen and (or) corticosteroid therapy are:
a) local spread of the tumor (diameter 5 cm or more, infiltrative nature, rapid growth, inflammatory changes, ulceration) and multiple lesions of regional lymph nodes (3 nodes or more on histological examination after mastectomy);
b) predominantly premenopausal period and menopause;
c) chromatin-positive (detection of Barr bodies in more than 20% of 500 tumor cells) characteristic of the primary node or "metastases in the lymph nodes.
2. There are the following indications for the use of estrogens and progestins:
a) the presence of ER and PR in tumor cells in patients in the premenopausal period and menopause;
b) deep menopause (over 5 years, preferably over 10 years);
As mentioned above, in all cases, additional hormone therapy should be combined with the introduction of chemotherapeutic drugs.

A lack or excess of hormones indicates that the organ that produces them is not working properly. With a lack of hormones or their excess, hormone therapy is performed to restore the balance of hormones in the human blood.

What is Hormone Therapy?

Hormones are involved in all physiological processes of the human body - they coordinate growth, metabolism, reproduction.

The use of hormone therapy means the use of hormones and their analogues for therapeutic purposes. The synthesis of hormones in the human body occurs according to the principle of deficiency: when the level of a hormone becomes below normal, its active production begins. The lack of the hormone indicates a decrease in the efficiency of the gland, and its excess indicates that the organ is working very actively.

To dispel misconceptions, it is necessary to understand the principle of the effect of hormone therapy on the body.

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Types of hormone therapy

There are three types of hormone therapy:

hormone replacement therapy (HRT) used for pathologies of the endocrine glands. The patient takes drugs that contain either the hormone itself or its substitutes (synthetic analogues). This type of therapy gives a result when the hormone enters the body. Therefore, the patient usually takes such drugs for life (insulin in diabetes, thyroid hormone in hypothyroidism). The mode of taking the drug must necessarily be close to the physiological processes in the body;
stimulation therapy is prescribed when there is a need to activate the activity of the endocrine gland. In this case, neurohormones of the hypothalamus and the anterior pituitary gland are taken. This type of therapy does not last long, usually in courses;
inhibitory, or blocking (antihormonal) type hormone therapy is carried out when some endocrine gland is too active, and for the treatment of certain types of neoplasms (hormone-dependent). Then a hormone is injected - an antagonist of an excess hormone or a substance that inhibits the activity of an active gland. Blocking type of hormone therapy is used as part of the treatment in conjunction with radiation or surgery in the treatment of hormone-dependent tumors. As an independent form of therapy, it is not very effective.

Hormone therapy as a type of treatment is used in gynecology, urology, endocrinology, andrology, and oncology.

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In gynecology, hormone replacement therapy is used in menopause, early ovarian failure, infertility, hypogonadotropic amenorrhea, chronic endometritis, gonadal dysgenesis, drug-induced menopause.

With infertility, this therapy is used to stimulate ovulation during in vitro fertilization. The use of hormones in the treatment of infertility creates conditions close to normal.

During menopause in a woman's body, the production of estrogen (female sexual hubbub) decreases. Using replacement therapy during this period, you can normalize the level of estrogen, which will have a beneficial effect on the general condition of the body.

If the ovaries have been removed in young patients, they begin to experience sensations that usually occur in menopausal women. Although some part of the hormones is produced by the adrenal glands, but their work is not enough, therefore, replacement therapy is prescribed. Hormonal drugs are allowed to drink until the end of life, which will prevent the appearance of an early menopause. When removing the ovaries due to a malignant neoplasm, hormonal treatment is prohibited.

But in addition to the positive aspects of the use of hormonal therapy in the field of gynecology, there are also contraindications:

advanced forms of diabetes;
uterine cancer;
oncology of the breast;
malfunctions in the activity of the liver;
vaginal bleeding of unknown etiology.

Preparations for hormone replacement therapy

Of all the drugs used, the most convenient are oral in the form of tablets.. They are considered very effective, but the disadvantages of their use include: their ability to retain fluid in the tissues of the body, provoke migraine attacks and promote engorgement of breast tissue. In addition, it is necessary to control the intake of drugs, since the only missed pill can cause uterine bleeding.

Another convenient remedy is a gel that is rubbed into the back (lower part). It is also user-friendly and gives good results.

The patch has a similar effect, but it is less convenient. This method of supplying the body with the missing hormones does not adversely affect the liver, the hormones enter the bloodstream. The negative aspects can be considered the possibility of inflammation at the site of gluing the patch (especially in the hot season) and the risk of the patch coming off.

Another way to use replacement therapy is subcutaneous administration. Every six months, a microampule is inserted under the skin with the exact amount of estrogen in it, which is gradually absorbed into the blood. This method of administering the hormone is usually used by those women whose uterus has been removed.

After 60 years, general estrogen preparations are not taken, local hormone therapy is used - suppositories and creams. These drugs relieve the unpleasant symptoms of menopause - they prevent urinary incontinence, vaginal dryness, and normalize sexual relations.

Preparations with conjugated equine estrogens: Hormoplex, Estrofeminal.

Naturally occurring estrogens are also used in similar preparations, which are either oral or injectable. Means where there is a combination of estrogen with progestin are 1-2-3-phase.

1-phase drugs are prescribed a year after the onset of menopause and will have to be taken constantly:

"Kliogest" - lowers the level of cholesterol in the blood by 20%, prevents the occurrence of osteoporosis;
"Proginova";

Intramuscular, subcutaneous, cutaneous preparations are not processed by the liver, therefore they have a lower content of hormones:

"Ginodian Depot" - an injection is made once a month;
"Klimara", "Menorest" - patches;
"Estrogel", "Divigel" - gel for the skin.

Biphasic remedies: "Divina" - has three types of tablets in a package that contain a different combination of different hormones, which should be taken 1 tablet per day until the pack is over, then a week break.

Other drugs of this action are: "Klimonorm", "Cyclo-proginova", "Klimen", "Divitren", "Femoston".

"Femoston" regulates the metabolism of fats, which means that it better fights against atherosclerosis, other diseases of the heart and blood vessels, and does not provoke the appearance of blood clots. In addition, the drug reduces the symptoms of menopause and improves the condition of the endometrium.

Three-phase drugs contain a combination of norethisterone and estradiol, which helps women not suffer from increased sweating and hot flashes (signs of menopause). These include Trisequens, Trisequens Forte.

Cyclic therapy and treatment for uterine fibroids

Methods of cyclic (intermittent) hormone therapy are used to normalize the menstrual cycle in infertility, amenorrhea, dysmenorrhea and menopause.

In case of infertility, a special test is applied using cyclic hormonal therapy. For this, the patient receives doses of estrogen daily for 1.5 weeks, until the cervical number reaches 10 in the analysis. After that, hormonal preparations based on gestagens begin to be used. If after that the patient has bleeding similar to menstruation, this indicates a normal reaction of the receptors of the uterine mucosa to the administration of hormones. If there is no bleeding, the cervical canal is closed or there are extensive pathologies of the endometrium.

Hormone therapy is considered one of the most gentle ways to treat fibroids, but also the most ineffective. The use of hormones makes it possible to reduce the size of the tumor, reduce the symptoms of the disease, and slow down the development of the neoplasm. But hormonal treatment is used for uterine fibroids as part of therapy. It is impossible to completely get rid of the tumor only with the help of hormones.

Hormone therapy is used for fibroids up to 13 weeks in size, without spotting. It is carried out in the absence of symptoms, with menstrual irregularities that are not accompanied by anemia.

Hormone therapy in the presence of fibroids has its own contraindications. It is not carried out in case of:

if the tumor is located under the mucous membrane;
when the fibroid grows rapidly;
if there is bleeding;
when fibroids are diagnosed during pregnancy;
if there are general severe diseases - liver disorders, otosclerosis, hypertension, diabetes, rheumatism, blood clots.

Drugs that are used in the treatment: containing gestagens or progestogens, gonadotropin-releasing hormone agonists, antiprogestins, antigonadotropins. These medicines (hormones) are given as injections or sprays.

Treatment may be accompanied by side effects in the form of:

emotional instability;
activation of sweat glands;
osteoporosis;
flushes of blood to the face;
migraine attacks;
dryness of the mucous membrane of the vulva.

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Hormone therapy for cancer

Some types of tumors use hormones such as testosterone and estrogen. These tumors include neoplasms of the prostate and breast. Hormone therapy is the way that helps eliminate these hormone-dependent neoplasms in the following ways:

reducing the amount of hormones in the body, thereby depriving cancer cells of nutrition;
altering the cancer's ability to use hormones.

By reducing the supply of hormones to cancer, hormone therapy can help shrink the tumor. This type of treatment can only be successful in hormone-sensitive cancers.

Hormone sensitivity of cancer is determined by samples taken during biopsy.

The most common hormone-sensitive cancers are:

endometrial cancer;
ovaries;
mammary gland;
prostate.

Hormone therapy is rarely used as a primary or main type of treatment, more often it is combined with other types of therapy: surgery, radiation and chemotherapy. The use of hormone therapy is possible before the start of the main type of treatment, such as surgery to remove the tumor. This is called neoadjuvant therapy. With the help of hormones, the tumor can be reduced to a smaller size, which makes it easier to remove.

When prescribing hormone therapy after the main one aims to prevent the development of secondary cancer, this type of hormone therapy is called adjuvant therapy.

As the main treatment, it is possible to use hormones for metastatic cancer, when late stages of prostate or breast cancer are diagnosed.

Hormone therapy for cancer in women

Hormone therapy for cancerous tumors is never used alone. As a rule, it is combined with chemotherapy or radiotherapy, surgical treatment.

All cancerous tumors are divided into 3 types:

hormonally active;
hormone-conditioned;
hormone-dependent.

Hormonally active tumors are tumors that secrete hormones. These are: cancer of the pituitary gland, pancreas and thyroid glands, adrenal glands. They may also appear in other organs that normally do not produce hormones (intestines, lungs).

Hormone-mediated are neoplasms that have arisen due to a malfunction in the endocrine system. Such a tumor is breast cancer, which develops when the activity of the ovaries or thyroid gland is disrupted. The occurrence of such a tumor does not always require hormone treatment.

Hormone-dependent formations include formations, the presence of which is impossible without the presence of certain types of hormones. If there is a change in the hormonal background, the production of the hormone necessary for the tumor stops, then the development of the tumor stops. These include some tumors of the breast, kidneys, testicles, prostate, ovaries, thyroid, uterus, the presence of metastases. Hormone therapy is required to treat these tumors.

The effect of treatment depends on the sensitivity of the tumor to hormones. Sometimes this method is prescribed in the early stages in combination with other methods.

Estrogen is often an activator of the development of malignant tumors of the breast.

The use of hormones in breast tumors leads to:

decrease in the amount of estrogen;
slowing down the activity of breast receptors for hormones;
decrease in the synthesis of estrogen by the adrenal glands;
slowing down the activity of the hormone itself by increasing the amount of male hormones.

Hormone therapy for men

Among the total number of andrological diseases, more than half are occupied by diseases associated with the failure of the endocrine glands and lack of testosterone:

male infertility;
endocrinopathy;
erectile disfunction;
climax.

In these cases, the main treatment is a hormone analog, which is taken as hormone replacement (or stimulating) therapy.

Hormone therapy for prostate cancer

Testosterone stimulates the development of abnormal (malignant) cells along with the growth of healthy ones. During hormone therapy, prostate tumors reduce the effect of the hormone on the prostate or reduce the synthesis of this hormone.

But not all cancer cells are hormone dependent. The more actively the affected cells develop, the less impact the treatment has. Because of this, hormonal treatment in the treatment of prostate cancer is not used as the only way.

Hormone therapy for prostate cancer

For prostate cancer, various therapies are used:

orchiectomy- removal of testicles, has been used for a long time. If the cancer is not hormone-dependent (this happens in 20% of cases), removal is a useless procedure. The disadvantages of such treatment include the fact that removal is an irreversible process.
use of lutein-releasing hormone agonists. Under the influence of these drugs, the synthesis of luteinizing hormone by the pituitary gland, which is necessary for the production of testosterone, decreases. Medicines that act according to this scheme: Zoladex, Trelstar, Lupron.
use of antiandrogens. These hormones reduce the activity of testosterone. These funds include: "Bicalutamide", "Nilutamide", "Flutamide".
estrogen use effective in 75% of cases, so it is widely used. But it causes many side effects.

Consequences of taking hormones in men

Hormone therapy with female hormones causes:

decreased attraction to the opposite sex;
bone fractures and osteoporosis;
growth of mammary glands;
increase in body weight due to fat and decrease in muscle mass;
lethargy, fatigue, depressed mood;
rise in blood cholesterol levels.

Hormone therapy in children

Reception by children of hormonal drugs is possible only in exceptional situations and are taken quickly destroyed in the body - "Hydrocortisone", "Prednisolone". It is better for a child to take medicine with hormones during or before breakfast.

Carefully prescribe insulin preparations to the child, since the presence of glucose in the urine does not always indicate diabetes mellitus.

Any hormonal drugs are given to children only after consulting an endocrinologist and in strict accordance with the dosage. During treatment, careful monitoring of the child's condition, his body weight, and the work of the digestive system is required.

Relationship between cancer and hormone replacement therapy (HRT)

Cancer of the genital organs is usually found in women 60 - 69 years old.

According to studies, hormone replacement therapy during menopause lasting up to five years does not contribute to the likelihood of breast cancer. A small risk (1.31%) occurs in women who take hormones longer, no matter what estrogen the patient takes.

Women using replacement therapy are more likely to develop small tumors without metastases. Endometrial cancer appears 1.5% more often in women taking hormone treatment for less than 1 year, and 10% in those who take it for more than 10 years. In patients who took hormonal treatment, endometrial cancer is not as aggressive, and mortality from it is less than in women who did not use replacement therapy. The appearance of ovarian and cervical cancer is not associated with the use of hormonal drugs, the impetus for their formation is the presence of the human papillomavirus (HPV). Among women taking replacement therapy, the risk of bowel cancer is reduced by 40%.

Treatment without hormones. A minimum of chemistry - a maximum of benefit Anna Vladimirovna Bogdanova

Hormone therapy: pros and cons

Recently, a new direction has appeared in medicine - anti-aging. Having seen enough of the peppy Western women of Balzac's age, the Russians decided to keep up, they also took up the rejuvenation of the body. Moreover, the notorious hormone replacement therapy plays an important role in the fight against aging. However, with its classic version, it has a very distant resemblance. Here the doctor's task is to help the patient restore hormonal balance, and with it strength, good appearance and, of course, well-being. Therefore, the doses of hormones are minimal. They do not treat, but stabilize the hormonal background, bringing its numbers to the upper limit of the corresponding age norm. Doses should not be taken from the ceiling, but should be calculated individually, based on the results of a comprehensive examination of the patient. The optimal time to prescribe anti-aging therapy is 5 years before the onset of menopause. It is used at the request of the patients, and it can last as long as you like. The main thing is to avoid side effects, so self-medication is strictly prohibited.

According to statistics, women who used hormone replacement therapy, that is, sex hormones, for more than five years looked good and felt good, but ... It turned out that the use of estrogens increases the likelihood of developing breast cancer: this type of hormone stimulates cell division, including number of cancers. Again, hormone replacement therapy after menopause triples the risk of thrombosis and embolism, including pulmonary embolism. If we talk about the risk of cancer, in this case it can be reduced only by the use of combined estrogen-gestagenic drugs, that is, again, hormonal.

As a result of preliminary studies of growth hormone (somatotropin, somatropin) in the elderly conducted in the early 1990s, it appeared that the administration of exogenous growth hormone could slow down aging and improve the physical condition of the elderly. After 6 months of the experiment, it turned out that the introduction of this hormone into the blood led to an increase in muscle mass, a decrease in adipose tissue mass and an increase in bone tissue mineralization. Pathological increase in the level of somatotropin or long-term administration at doses characteristic of a growing organism leads to thickening of the bones, coarsening of facial features and an increase in the size of the tongue.

In recent years, the attention of scientists has been drawn to the possibilities of stem cells, which regulate the hormonal background of the body. A number of methods have been developed with the help of which it is realistic not only to restore health, to prolong the active years of life, but also to push back old age. For example, a group of Chinese biologists at a university in Shanghai has found a way to prolong women's fertility. In laboratory mice, special cells responsible for the functioning of the ovaries have been isolated. Scientists have developed a technique to save these cells in order to later transplant them back, pushing back the onset of menopause. According to the researchers, women's ovaries work in a similar way. Therefore, further research on human stem cells gives hope that in the near future a way will be found to delay menopause for a long time, and the problem of infertility will be solved.

However, women struggle with the first manifestations of aging not only with hormones. An important role is played by lifestyle, proper nutrition with individually selected vitamin therapy, exercise and, of course, the rejection of bad habits.

By the way, if you are thinking about how to preserve youth from a young age, do not neglect the general recommendations for improving health, and you may not need any hormone therapy. By the way, this is also advised by biorhythmologists, who connect the activity of all organs and systems of the human body with natural rhythms.

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Hormones are natural substances that are produced by the endocrine glands of our body. Their network is called the endocrine system. Hormones travel in the bloodstream and act as messengers between different parts of the body. They perform many functions, one of the main ones is to control the growth and activity of certain cells and organs. Artificial or synthetic hormones are created in laboratories.

The medical service site offers an individual program of hormone therapy in Israel as the only treatment option and in combination with other methods of cancer therapy.

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Glands and the hormones they produce

The ovaries, small sex organs on either side of the uterus, produce the female hormones estrogen and progesterone, which are involved in reproduction.
The testicles are organs of the male reproductive system that produce testosterone, which is involved in reproduction.
The pituitary gland is a small gland at the base of the brain that produces luteinizing hormone (LH), which stimulates the testicles and ovaries.
Adrenal glands - glands above the kidneys that produce corticosteroids, mineralocorticoids (for example, aldosterone), estrogens (in the postmenopausal period), testosterone (in small quantities).
The pancreas, located behind and below the stomach, produces glucagon (increases blood sugar) and insulin (reduces blood sugar).

What is hormone therapy?

Some types of cancer use hormones to grow. Hormone therapy in oncology uses drugs to block the effects of hormones. For some types of malignant tumors, it is useless. This method is used when the disease is sensitive to this treatment or hormone-dependent. These types of cancer include:

breast oncology;
prostate cancer;
ovarian tumor;
uterine cancer;
malignant tumor of the kidney.

Hormone therapy changes the level of hormones in the body. There are three ways to do this:

Remove the gland that synthesizes hormones.
Treat the gland with radiation therapy to destroy hormone-producing cells.
Take hormones or other drugs that interfere with or stop the production of hormones or their action.

Medicines, surgery, or radiation therapy to specific organs affect hormone levels.

Hormone therapy is often combined with other cancer treatments. Sometimes it is used before or after them.

Principles of Hormone Therapy

Hormone dependent tumors require hormones to grow and develop. Such treatment can slow or stop the disease by:

blocking the synthesis of hormones;
prevent the action of hormones on cancer cells.

Doctors test tumor samples with tests to determine:

type of hormone receptors on the surface of malignant cells;
the number of receptors;
Will hormone therapy be effective?

The higher the level of the hormone receptor (positive test), the more sensitive the tumor will be to this method. If the receptors are absent or very few (negative test), then the treatment will probably not affect the growth of cancer cells, and other therapies will bring more results.

Hormone therapy is used both in the early stages of the disease, and in the later stages, if the tumor is sensitive to changes in hormone levels. Sometimes the disease initially responds to this treatment, but later becomes resistant. In some cases, the neoplasm begins to grow again and does not respond to further hormonal therapy. In other situations, the disease responds to a change in drugs. For example, tamoxifen was first used, then it was changed to anastrozole (Arimidex) or letrozole (Femara).

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Types of hormone therapy in Israel

There are several types of hormone therapy. The choice is determined by certain factors - the type of tumor, stage, personal factors (age, entry of a woman into menopause), the presence of hormone receptors on the surface of cancer cells.

Surgery

Surgical removal of hormone-producing glands to stop hormone synthesis or create an anti-hormonal effect in the body. This may be surgery to resect the ovaries for breast cancer or the removal of the testicles (orchiectomy) for prostate cancer.

Radiation therapy

Irradiation destroys hormone-producing tissues, stopping the production of these substances. For example, radiation therapy can be directed to the ovaries, stopping the synthesis of estrogen. The radiation oncologist calculates the dose, amount, and duration of radiation therapy to tailor the treatment for each cancer patient. Remote radiation therapy is usually performed.

Hormonal drug therapy

Some drugs prevent hormone-producing cells from synthesizing hormones, others affect the effect of this substance in the body. Hormone therapy is used for the following types of malignant tumors:

uterine cancer;
ovarian cancer;
kidney cancer.

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Hormone therapy for breast cancer

Female hormones - estrogen and progesterone - affect malignant tumors of the breast. Doctors describe these cancers as estrogen receptor positive or progesterone receptor positive breast cancer. The treatment prevents the hormones from reaching the breast cancer cells.

In the course of treatment in Israel, various medicines are used:

Tamoxifen.
aromatase inhibitors.

The patient may be prescribed one or more drugs. If diagnosed early, tamoxifen is recommended for 2 or 3 years to prevent recurrence. Depending on the onset of menopause, aromatase inhibitors are prescribed.

Based on the results of the study, it is known that sometimes other hormone therapy drugs work better than tamoxifen alone.

Hormone therapy with tamoxifen

One of the most common drugs used for breast cancer. Women before and after menopause can take tamoxifen. It prevents estrogen from reaching cancer cells. Some of them have areas called receptors. When estrogen binds to receptors, it stimulates tumor cells to divide. Tamoxifen blocks receptors.

Aromatase inhibitors in hormone therapy

These drugs are prescribed if a woman has reached menopause. During this period, the ovaries stop producing estrogen. But the body still creates a small amount of hormones by converting androgens to estrogens. For this to happen, the aromatase enzyme is required. Inhibitors block it, preventing transformation.

There are several preparations of aromatase inhibitors in hormone therapy:

anastrozole (Arimidex);
exemestane (Aromasin);
letrozole (Femara).

luteinizing hormone secretion inhibitors

The pituitary gland is a gland in the brain that regulates the amount of sex hormones that are produced by the ovaries. In women, these blockers prevent the ovaries from producing estrogen or progesterone. This is due to the suppression of the signal transmitted from the pituitary gland to the ovaries.

This treatment is prescribed unless the woman has reached menopause. After that, the ovaries do not produce hormones, so the drug will not help. The only inhibitor used in breast cancer is goserelin (Zoladex).

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Hormone therapy for prostate cancer

Prostate cancer is dependent on the male hormone testosterone. Hormonal treatment of this disease in Israeli clinics is aimed at reducing or stopping the production of this substance. Various drugs are used.

luteinizing hormone secretion inhibitors

The pituitary gland coordinates the synthesis of testosterone produced in the testicles. Inhibitors suppress the production of luteinizing hormone. Accordingly, the testicles stop producing testosterone.

Drugs prescribed for prostate cancer include goserelin (Zoladex), leuprorelin (Prostap), and triptorelin (Decapetyl).

Antiandrogens

Prostate cancer cells are endowed with certain areas - receptors. Testosterone joins them, which stimulates cells to begin the process of division. Antiandrogens attach to the receptors, preventing testosterone from getting to the malignant segments. Several drugs are used in the treatment: bicalutamide (Casodex), cyproterone acetate (Cyprostat), and flutamide (Drogenil).

Blocker (antagonist) of gonadotropin-releasing hormone (GnRH)

These drugs prevent a message from the hypothalamus from reaching the pituitary gland to produce luteinizing hormone. The latter stimulates the testicles to produce testosterone. There is currently only one GnRH blocker, Degarelix (Firmagon).

Hormone therapy for uterine cancer in Israel

Female hormones - estrogen and progesterone - affect the growth and activity of cells lining the body. Doctors prescribe progesterone to shrink large tumors or relapse. Various drugs are used in Israeli clinics, including medroxyprogesterone acetate (Provera) and Megestrol (Megace).

Hormone therapy for ovarian cancer

Some types of ovarian tumors have estrogen receptors. Tamoxifen is thought to be of benefit as a treatment for them. But it is not yet known whether hormone therapy is suitable for combating this disease. Doctors are doing research with tamoxifen and letrozole.

Hormone therapy for kidney cancer

Sometimes, when kidney cancer recurs, the drug medroxyprogesterone (Provera) can control the disease for a while. It is a man-made version of the hormone progesterone. Currently, it is not often used in the treatment of kidney cancer, as newer methods, such as biological therapy, have a better effect. But this drug may be suitable if for some reason other methods of treatment are not applicable.

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Possible complications of hormone therapy and consequences for women

Potential side effects depend on the type of hormone therapy.

Fatigue

The patient may experience increased fatigue during treatment. Doctors give recommendations on how to improve the condition.

Digestive problems

Hormone therapy can cause certain problems with the gastrointestinal tract. It can be nausea, but it's usually mild and goes away after a few days or weeks. The doctor will prescribe antiemetics.

Sometimes there is constipation or diarrhea. The condition is easily controlled with diet or medication. If diarrhea becomes severe, lasts more than 2-3 days, then you need to tell your doctor.

The patient may lose her appetite, or it may increase, causing weight gain.

menopause symptoms

If a woman has not reached menopause, then under the influence of hormone therapy this period may begin. The condition is either temporary or permanent. If a woman takes a luteinizing hormone blocker, her periods will stop. In the case when the patient is prescribed tamoxifen, menstruation is still there, but they may stop or become more scarce.

If a woman has reached menopause, other symptoms may develop that were not there before - vaginal dryness, hot flashes, sweating, decreased libido.

Problems that arise should be reported to the doctor. There is a treatment available that will alleviate the condition.

Hair thinning

Some types of hormone therapy can lead to thinning hair. Doctors will give detailed recommendations on how to deal with this problem.

Changes in bone and muscle tissue

The patient may experience joint pain. It often goes away after a few weeks. Doctors prescribe mild painkillers to control the condition.

Some drugs, such as aromatase inhibitors, can cause bone thinning. Tamoxifen can cause this condition in premenopausal women. In patients after menopause, this drug does not have a similar effect.

Physical exercise, where a person carries his own weight, helps to strengthen and protect bone tissue. This is walking, running, cycling, playing sports in the gym. Swimming in this matter will not do any good. It is important to consult a doctor before embarking on any new type of physical activity, especially if the person has not previously engaged in it.

Thinning bones cause osteoporosis and fractures if the process continues for several years. Doctors treat this condition with bisphosphonates to strengthen bone tissue.

Weight gain

Sometimes there is an increase in weight. The condition is controlled through diet and exercise. A nutritionist will give qualified recommendations on how to manage your own weight.

Headache

In some cases, this symptom occurs in connection with the intake of certain hormone therapy drugs. The doctor must be aware of this. Mild analgesics, such as paracetamol, may help.

Memory problems

Some women note that the state of memory worsens during hormonal treatment for a while. But there are ways to improve the quality of life, like making lists so you don't forget. It is normal for this side effect to be frustrating. You should talk to your doctor.

Mood swings and depression

Hormone therapy can affect mood. Some patients report drops and even depression during treatment with goserelin. Communication with loved ones or with a qualified doctor can help.

Thrombus formation

Tamoxifen can increase the risk of blood clots in the veins of the lower extremities. This condition is called deep vein thrombosis.

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Possible complications of hormone therapy and consequences for men

Potential side effects depend on the choice of drugs.

Fatigue

Perhaps a state of weakness during treatment.

erection problems

This is a common complication of hormone therapy for prostate cancer. It occurs due to the cessation of testosterone production. As soon as the treatment is stopped, the disturbances will go away. Recovery time - from 3 months to a year or longer. In some men, these problems become permanent, depending on the drug and the duration of its use.

Hot flashes and sweating

Similar symptoms are seen in women going through menopause. They are caused by a decrease in testosterone levels. Gradually, with adaptation to treatment, the condition improves. Most often, hot flashes occur with the use of luteinizing hormone blockers, since they completely stop the production of testosterone. Drinking hot tea, coffee, smoking - worsen the symptoms.

But in some cases, hot flashes persist throughout the treatment. If you have serious problems with sweating, you can discuss them with your doctor. There are procedures that can help.

Soreness of the mammary glands

This condition is caused by high doses of bicalutamide (Casodex). There is pain, breast tissue swells. Tamoxifen reduces pain in 6 out of 10 men taking bacalutamide. Sometimes a small dose of radiation therapy to the area of the breast before starting hormone treatment helps.

Pain associated with the tumor

Pain caused by secondary prostate cancer may temporarily worsen when the patient begins hormonal treatment. Before starting leuprorelin (Prostap) or Zoladex (Goserilin) injections, your doctor will prescribe another hormone medication to help prevent flare-ups of bone pain. If the pain does not subside, bisphosphonates are prescribed.

Weight gain

Body weight may increase. Control the process with diet and exercise. But often in the course of hormone therapy, this struggle is ineffective.

Memory problems

In some cases, the state of memory deteriorates during treatment. It's good to make lists so you don't forget. You should talk to your doctor if this symptom has a significant impact on life.

Depression and mood swings

The treatment acts on the mood, especially with Zoladex. Communication with loved ones or a psychologist will be useful.

Bone disorders

A complication of hormone therapy for prostate cancer is bone thinning (osteoporosis). Studies have shown that the risk of problems such as bone fractures is higher in men who have long-term treatment that aims to block testosterone (for example, with Zoladex). Your doctor may suggest taking vitamin D and calcium to reduce your risk of osteoporosis. Other recommendations:

No smoking.
Reduce the amount of alcohol.
Introduce activities such as walking into your lifestyle.

Risk of early heart attack

Men over the age of 65 are more likely to die from a heart attack when on hormone therapy for 6 months, according to the study. This is because some side effects of treatment, such as weight gain, can make the disease worse.

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This is a group of drugs that are used for hormone therapy. The effect of such drugs on the body has been studied well enough so that it does not cause concern.

Such a broad group as hormonal drugs includes the following categories of drugs:

Contraceptives.
Therapeutic (drugs whose action is aimed at curing a disease caused by a lack of a hormone).
Regulatory (for example, to normalize the menstrual cycle).
Maintenance (insulin for diabetics).

All drugs affect the body and women in different ways. It all depends on the general condition of the body, the presence of serious diseases and the state of the immune system.

Medications

This group is used for hormone therapy and is available in the form of tablets and ointments. Tablets treat serious diseases caused by deviations in the hormonal sphere, and ointments have a local effect.

In girls who lack the production of hormones, the skin suffers from cracks and wounds in the winter, as the synthesis of new cells is disrupted. To deal with such an annoyance. The doctor prescribes creams, ointments and lotions containing hormones. Usually corticosteroids are included in the ointment, which are absorbed into the blood after a few hours.

Such drugs can seriously affect the body. Therefore, it is important to maintain the dosage and, when prescribing, immediately determine the duration of the course, since one wrong step can lead to complications of existing problems.

Regulatory drugs

Due to the peculiarities of the lifestyle of a modern woman, deteriorating nutrition and a polluted environment, many of the fair sex are faced with menstrual irregularities. This can affect not only the sexual sphere of the body, but also the general condition of the body. Hormonal disorders can lead to the development of breast cancer, as well as infertility. The action of hormonal drugs can help solve problems.

However, before admission, it is necessary to conduct examinations and tests. First, a blood test is performed for certain substances. He will be able to identify either their excess. Such tests are quite expensive, but in order to solve problems, it is necessary to start treatment in a timely manner. After detecting a deficiency or excess of hormones, regulation of their content begins. For this, courses of injections or tablets are prescribed. Properly selected oral contraceptives will help normalize the cycle without harm to health.

Any remedy containing hormones requires scrupulousness in determining the dosage, since it is quite simple to cross the line of the required dose. For example, exceeding the norm can lead to hair loss, swelling and pain in the mammary glands.

Hormonal preparations can be made on the basis of hormones of natural origin or they are synthetically produced substances. With a course of hormonal therapy, it is aimed at normalizing the hormonal background and normalizing metabolic processes. Depending on the functional state of a particular gland, hormone therapy is conditionally divided into replacement, stimulating and blocking.

Negative effects of hormones

For the body of both men and women, the use of hormonal drugs can cause such unpleasant consequences as:

osteoporosis and ulcers of the mucous membrane of the duodenum and the stomach itself when taking glucocorticoids;
weight loss and cardiac arrhythmia when taking thyroid hormone preparations;
too sharp a decrease in blood sugar when taking insulin.

The effect of hormonal ointments on the body

Preparations containing hormones for external use can vary greatly in the degree of impact on the body. Ointments and creams are considered the most powerful, gels and lotions contain lower concentrations. Hormonal ointments are used to treat skin diseases and allergic manifestations. Their action is aimed at eliminating the causes of inflammation and irritation on the skin.

However, if we compare ointments with tablets or injections, then their harm is minimal, since absorption into the blood occurs in small doses. In some cases, the use of ointments can lead to a decrease in the productivity of the adrenal glands, but after the end of the course of treatment, their functionality is restored on their own.

The effect of hormonal contraceptives on the body of a woman

Features of the influence of hormonal drugs on the human body are that many factors are perceived purely individually. The use of such drugs is not only an interference with natural physiological processes, but also an impact on the functioning of body systems during the day. Therefore, the decision to prescribe hormonal drugs can only be made by an experienced doctor based on the results of a comprehensive examination and analysis.

Hormonal contraceptives can be produced in various forms and dosages:

combined;
mini-drank;
injections;
plasters;
subcutaneous implants;
postcoidal drugs;
hormone rings.

Combination preparations contain substances similar to female hormones produced by the ovaries. To be able to choose the optimal medicine, all groups of drugs can be monophasic, biphasic and triphasic. They differ in the proportions of hormones.

Knowing about the properties of gestagens and estrogens, certain mechanisms of action of oral contraceptives can be distinguished:

decrease in the secretion of gonadotropic hormones due to the effects of progestogen;
increased acidity of the vagina due to the influence of estrogens;
increased viscosity of cervical mucus;
in each instruction there is the phrase "implantation of the egg", which is a veiled abortive effect of drugs.

In the time that has passed since the appearance of the first oral contraceptives, the debate about the safety of the use of drugs does not subside, and research in this area continues.

What hormones are in contraceptives

Typically, hormonal contraceptives use progestogens, which are also called progestins and progestogens. These are hormones that are produced by the corpus luteum of the ovaries, in small amounts by the adrenal cortex, and during pregnancy by the placenta. The main gestagen is progesterone, which helps prepare the uterus in a state favorable for the development of a fertilized egg.

Another component of oral contraceptives is. Estrogens are produced by the ovarian follicles and the adrenal cortex. Estrogens include three main hormones: estriol and estrogen. These hormones are needed in contraceptives to normalize the menstrual cycle, but not to protect against unwanted conception.

Side effects of hormonal drugs

Each drug has a number of side effects that can occur when a decision is made to immediately stop the drug.

The most frequently recorded cases of side effects of hormonal drugs:

Hemolytic-uremic syndrome. It is manifested by such disorders as anemia, thrombocytopenia and acute renal failure.
Porphyria, which is a violation of the synthesis of hemoglobin.
Hearing loss due to otosclerosis.

All manufacturers of hormonal drugs indicate thromboembolism as a side effect, which is extremely rare. This condition is a blockage of the vessel by a thrombus. If the side effects outweigh the benefits of the medication, it should be discontinued.

Side effects of oral contraceptives are:

(lack of menstrual flow);
headache;
blurred vision;
change in blood pressure;
depression;
weight gain;
soreness in the mammary glands.

Studies on the side effects of oral contraceptives

In foreign countries, studies are constantly being conducted on the side effects of hormonal drugs on a woman's body, which revealed the following facts:

Hormonal contraceptives are used by more than 100 million women in different countries.
The number of deaths from venous and arterial diseases is fixed at 2 to 6 per million per year.
The risk of venous thrombosis is important in younger women
Arterial thrombosis is relevant for older women.
Among female smokers taking OCs, the number of deaths is about 100 per million per year.

The effect of hormones on the male body

The male body is also seriously dependent on hormones. The male body also contains female hormones. Violation of the optimal balance of hormones leads to various diseases.

Either estrogen leads to decreased testosterone production. This can cause problems:

in the cardiovascular system;
with memory;
age;
decrease in immunity.

If the balance of hormones is disturbed, a course of hormone therapy is necessary, which will help to avoid further deterioration in health.

Progesterone has a calming effect on the male nervous system and helps men suffering from premature ejaculation to solve sexual problems.

The normal content of estrogens in the male body has a number of useful properties:

maintaining optimal levels of "good cholesterol";
pronounced muscle growth;
regulation of the nervous system;
libido improvement.

When noted:

inhibition of testosterone production;
body fat according to the female type;
gynecomastia.
Erectile dysfunction;
decreased libido;
depression.

Any of the symptoms is extremely unpleasant, so do not hesitate to visit the doctor. A competent specialist will be able to conduct a complete examination and prescribe a course of medications that will significantly improve the condition of the body.

Bibliography

Sudakov K.V., Normal Physiology. - M.: LLC "Medical Information Agency", 2006. - 920 p.;
Kolman Ya., Rem K. - G., Visual biochemistry // Hormones. Hormonal system. - 2000. - pp. 358-359, 368-375.
Berezov T.T., Korovkin B.F., Biological chemistry // Nomenclature and classification of hormones. - 1998. - pp. 250-251, 271-272.
Grebenshchikov Yu.B., Moshkovsky Yu.Sh., Bioorganic chemistry // Physical and chemical properties, structure and functional activity of insulin. - 1986. - p.296.
Orlov R. S., Normal physiology: textbook, 2nd ed., corrected. and additional - M.: GEOTAR-Media, 2010. - 832 p.;
Tepperman J., Tepperman H., Physiology of metabolism and the endocrine system. Introductory course. - Per. from English. - M.: Mir, 1989. - 656 p.; Physiology.