Living with and beyond cancer

Hormone changes

People living with cancer may experience long-term changes in their hormonal functioning because they are treated with either:
  • radiotherapy to the pelvis, certain types of chemotherapy, or surgical removal of reproductive organs has damaged normal hormone production,
  • hormone-based therapies aimed at slowing cancer growth, thereby protecting against recurrence.
Altered hormonal functioning can have many effects on the body, including hot flushes, mood swings or reduced libido (sex drive). Surgical removal of both ovaries or both testicles causes permanent infertility, and women who have both ovaries removed will immediately feel the effects of hormone changes if they haven't already experienced a natural menopause.
Damaged hormone production due to surgery, chemotherapy or radiotherapy

Several women we spoke to had treatment-related damage to their ovaries or had them surgically removed. Those who were already postmenopausal noticed little or no hormonal changes, although some said it had been impossible to distinguish these from treatment side effects. One had already taken hormone replacement therapy (HRT) before her ovarian cancer diagnosis to counter menopausal symptoms and to treat osteoporosis; while others started after their cancer treatment.

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There was a wide range of reactions among women who had been premenopausal before cancer treatment affected their hormone production. Some had been given HRT immediately after treatment and didn’t notice any menopause symptoms, others said they had found this sudden and enforced menopause the most difficult thing to deal with. Women couldn’t always recall having been warned that they would become menopausal as well as infertile, or said they hadn’t realised the full implications of having their ovaries removed or damaged by treatment. Ken (Interview 40) also suffered hot flushes after having radiotherapy for prostate cancer.
From the 1970s to the early 2000s HRT was heavily promoted for the relief of menopausal symptoms and the prevention of age-related osteoporosis and heart disease, and most women who experienced an early menopause because of cancer treatment would be recommended it. In the early 2000s, when some medical research began to suggest that it caused harm, attitudes to HRT changed. However this medical research has recently been reviewed and “National Institute for Health and Care Excellence's (NICE) new guidelines say that the risks of HRT are small and are usually outweighed by the benefits” (NHS Choices 2016).
Some of the experiences we have reported here are from interviews that took place before the change in attitudes towards HRT and many women we spoke to were happy taking HRT long-term at that time. However, others had problems or decided it wasn’t the right thing for them. After taking HRT for two years after treatment for ovarian cancer, one woman stopped because she was concerned about the risks; she used a dietary supplement instead. Another found that taking her HRT exacerbated her irritable bowel syndrome, so she changed to a different type of HRT. Interview 90 (quoted above) had difficulty finding a suitable dose; she suffered heavy vaginal bleeding while taking it, causing anaemia, so she stopped after 18 months; the bleeding ceased and she was surprised that she had no menopausal symptoms.

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Occasionally, men with testicular cancer may need hormone replacement, in this case the male hormone testosterone. In men who have one testicle removed due to cancer the remaining testicle usually works normally, so their hormone production is unaffected. However, rarely there is a problem with the other testicle or it has to be removed, so that they cannot make enough testosterone. Low testosterone can cause difficulties achieving an erection, reduced libido, tiredness, low mood, and osteoporosis. Testosterone replacement can be administered in a range of forms such as tablets, patches, implants or injections.
One man we spoke to had his right testicle removed because of testicular cancer. Two years later his other testicle was found to have died and was removed; he was given hormone replacement therapy.  
The same man had a lot of difficulties in finding a type of testosterone replacement that suited him, and has now settled on self-administered injections.
Hormone therapies for breast or prostate cancer

Tamoxifen (Nolvadex) is used to treat women with oestrogen receptor-positive breast cancer. Tamoxifen tablets are prescribed after surgery and treatment usually lasts five years. It works by preventing the naturally occurring female hormone oestrogen from attaching to cancer cells, thereby blocking their growth. Oestrogen is also present in small quantities in men. Men can therefore also develop breast cancer and, although this is rare, most breast cancers that occur in men rely on oestrogen to grow, therefore men may also be treated with tamoxifen.

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Some people stopped hormone therapy after taking tamoxifen for 5 years, while others were switched to a different one, such as anastrozole (Arimidex) or goserelin (Zoladex), each of which blocks the production of oestrogen in different ways. Zoladex blocks production of oestrogen and testosterone and may also be used in men to treat prostate cancer or prevent its recurrence (see more about men's experiences of breast cancer and hormone treatments).
Some people experienced side effects from tamoxifen that they found difficult to tolerate, or had other complications, so they stopped taking it or tried other hormone therapies. One man took only Arimidex for 5 years. Tim stopped tamoxifen after 7 years when he had a blood clot in his leg (deep vein thrombosis) following a hip operation. Another man took tamoxifen for 3 years until he too had a deep vein thrombosis. Switching to Arimidex gave him side effects; he now takes Zoladex. Bill stopped Arimidex after 5 years then discovered he was lacking testosterone; he now has testosterone injections alongside Arimidex.
Symptoms of hormone changes

Hormone therapy side effects are the same as those of the natural female menopause. People we spoke to who had either received hormone therapy or had experienced early menopause due to cancer treatments reported a range of hormonal symptoms. These included hot flushes and night sweats, fluid retention causing swollen ankles or weight gain, memory problems, mood disturbances, reduced libido, and fatigue. Some postmenopausal women said that taking tamoxifen brought back their menopausal symptoms.

In addition to these symptoms, some men who'd had a mastectomy for breast cancer said that their remaining breast had changed size while taking Arimidex: Michael A’s had grown; another man’s had shrunk. Some people developed osteoporosis (bone thinning) as a side effect of menopause or hormone therapy (see ‘Other long-term physical effects’).  

For more about natural menopause and female hormone replacement therapy see our Menopause section.

For more about male hormone replacement therapy in testicular cancer see our Testicular cancer section.

For more about hormone therapies for breast cancer see our Breast cancer in women and Breast cancer in men section.

For more about hormone therapies for prostate cancer see our Prostate cancer section.

Last reviewed October 2018.
Last updated October 2018.

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