Hormone therapy not well known by many individuals is employed to treat various health conditions by manipulating the hormones in an individual’s body. It refers to the usage of hormones in medical treatment. Hormone therapy is used in a variety of ways, for instance in cancer to block a specific hormone to prevent a disease or to slow down the progression of an illness. It has become extremely prevalent in recent times.

History

  • Hormone Therapy came into existence in 1960s but gained popularity only in 1990’s
  • Initially, it was employed to treat menopausal symptoms but later it was used to treat cardiovascular diseases
  • In 1988 FDA approved the use of Hormonal Therapy in case of Osteoporosis
  • Over the years HRT utilization has shown two peak periods one during 1960’s and other during 1990’s to 2000’s
  • Due to certain observational evidence of ischemic stroke in hormone therapy , it’s usage declined
  • Risks of HT outweighed the benefits hence new guidelines had to be followed.

Applications of Hormone Therapy

Menopause

The widest usage of hormonal therapy lies in treatment of Menopause in women  which dates back to 1960’s. Menopause is the time period that begins after cessation of menstrual bleeding for 12 consecutive months. At the onset of menopause circulating levels of estrogen and progesterone are diminished leading to discomfort like hot flushes and vaginal dryness.

Menopausal Hormone Therapy (MHT) or Hormone Replacement Therapy (HRT) refers to the prescription of either estrogen, progesterone, a combination of estrogen and progesterone, and occasionally testosterone, to treat menopausal symptoms.

Principles to be considered

While prescribing HRT (Hormonal Therapy) including lifestyle recommendations regarding diet, exercise, smoking cessation, and safe levels of alcohol consumption for maintaining the health of peri- and postmenopausal women and framing an overall strategy becomes imperative.

HRT should not be recommended without any clear idea of its use, i.e., significant symptoms or physical effects of estrogen deficiency.

There is no specific postmenopausal hormone replacement therapy plan administered to a typical woman. HRT must be designed specifically according to symptoms and the need for prevention, as well as personal and family history, results of relevant investigations, the woman’s preferences and expectations.

Route of administration is mostly oral, taken in the form of a pill majority are natural progestins

To determine HRT needs to be given or not multiple factors have to be taken into consideration like age of patient, menopausal symptoms, health conditions, allergies, duration of therapy, route of administration.

Some side effects are also associated with HRT:

  • Bloating
  • Breast tenderness
  • Vaginal Bleeding
  • Nausea
  • Headaches

Hormone Therapy In Cancer

Certain types of cancers use hormones to proliferate viz. Breast Cancer, Ovarian Cancer, Endometrial Cancer and Prostate Cancer. To combat these Hormone Therapy can be an appropriate treatment.

It acts in two ways either by stopping the growth/ slowing the growth of cancer or by reducing the symptoms for patients who can’t undergo radiation therapy or surgery.

How it works?

  • By reducing the size of tumor before surgery or radiation therapy termed neoadjuvant therapy
  • Lowering the risk of return of cancer after main treatment is given termed adjuvant therapy
  • Destroying the cancer cells that might have spread to other parts of body

Route of Administration can be

  • Oral: In the form of pills to be swallowed
  • Injection: A shot of injection given in hip, thigh, or arm
  • Surgery: Removal of ovary in women and testicle in men
  • Prostate Cancer: Androgens cause proliferation of cancer cells hence the treatment employed here is Androgen deprivation so that the cancer cells do not receive enough androgens and would not proliferate
  • Breast Cancer: It works by blocking hormones from binding to cancer cell receptors. It can be combined with surgery to reduce the size of cancer cells before performing surgery. It also might prevent cancer from returning back
  • Endometrial Cancer: Often used to treat cancer of advanced stage or cancer that has returned back after treatment. Progesterone or drugs like Progestin are mainly used for treatment by slowing down the growth of cancer cells.
  • Ovarian Cancer: Hormone blocking drugs are generally used to treat ovarian stromal tumors. The drugs might help in reducing estrogen levels.

Thyroid Regulation

Hormone therapy in thyroid regulation

An underactive thyroid gland that secretes very little or no hormones needs to be supplemented by external source.Commonly thyroid hormone is given in the form of a pill.Pure synthetic thyroxine is the most commonly prescribed therapy for hypothyroidism.

When is it prescribed?

  • In case of an enlarged thyroid gland to control the growth.
  • For controlling growth of nodules.
  • In case treatment is required after removal of a benign or malignant tumour.
  • After radioactive treatment of hypothyroidism.

Growth Hormone Deficiency

Growth hormone therapy—injections of growth hormone into the body—is the most common treatment for growth hormone deficiency in both children and adults. The patient or a family member (if it’s a child with growth hormone deficiency) can inject the growth hormone (also known as somatotropin). The pituitary gland produces this hormone, which activates the body’s development and cell reproduction.

When an individual is under hormone therapy, the blood glucose levels, cholesterol levels, bone density will require periodic monitoring.

Benefits Of Hormone Therapy

  • Lower your chances of problems
  • Can be specifically designed according to your physiological requirements
  • Might be more effective when combined with other therapies
  • Would help sleep better
  • Ease the disease symptoms

Side Effects Of Hormone Therapy

  • Hot flashes
  • Nausea
  • Vaginal discharge
  • Joint and muscle pain
  • Infertility
  • Depression
  • Digestive system problems
  • Tiredness
  • Menopausal symptoms
  • Muscle loss

References

https://www.cancer.gov/about-cancer/treatment/types/hormone-therapy

https://www.cancercenter.com/treatment-options/chemotherapy/hormone-therapy

https://www.endocrineweb.com/conditions/growth-disorders/growth-hormone-therapy