Managing the side effects of hormone therapy

Because estrogen fuels breast cancer growth, doctors often prescribe hormone therapy to block estrogen or lower estrogen levels. Taking these drugs has been shown to help reduce the risk of cancer recurrence after surgery. They're also used to treat more advanced breast cancers.

For example, taking the estrogen-blocking drug tamoxifen for 5 years after surgery has been shown to reduce the risk that breast cancer will come back. And drugs called aromatase inhibitors – letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin) -- have been approved to treat both early-stage and advanced breast cancer in post-menopausal women. They work by blocking the enzyme aromatase, which is responsible for making small amounts of estrogen in post-menopausal women.

But taking estrogen-blocking drugs can come with some difficult side effects: fatigue, hot flashes, vaginal discharge, and mood swings. To help women cope, doctors often prescribe steroids or antidepressant drugs, which can come with their own set of side effects: weight gain, fatigue, sexual dysfunction, and nausea, among others. Many women don't want to take the drugs because of those effects, or because they simply don't want to take another drug.

For this study, researchers at Henry Ford Hospital Department of Radiation Oncology in Detroit, Michigan, recruited a group of 47 women who were taking either tamoxifen or anastrozole and had at least 14 hot flashes per week. The women were split into 2 groups: over the course of 12 weeks, 24 women received acupuncture and 23 took the antidepressant venlafaxine (Effexor). Both groups then recorded the number and severity of hot flashes during the week before they started treatment, and on each day of treatment. Researchers also measured depression, quality-of-life, and general health, as well as other effects.

Acupuncture vs. Effexor

At 12 weeks, both groups experienced fewer hot flashes and menopausal symptoms, as well as less depression. However, the group taking Effexor also reported some negative effects, including nausea, dry mouth, headache, trouble sleeping, dizziness, double vision, increased blood pressure, constipation, fatigue, anxiety, feeling "spaced out," and body jerking during the night.

Patients who had been treated with acupuncture reported no adverse effects. In fact, there were reports of increased energy, clarity of thought, sexual desire, and compared to before the treatment, an overall sense of well-being.

"Our study shows that physicians and patients have an additional therapy for something that affects the majority of breast cancer survivors and actually has benefits, as opposed to more side effects," said Eleanor Walker, MD, lead author of the study and a radiation oncologist at the Henry Ford Hospital Department of Radiation Oncology.

Acupuncture has been used in the United States for years to treat everything from tobacco addiction to tennis elbow. Some of these uses are backed by scientific studies, but many others have not been tested rigorously.

While the results of this study offer solid evidence in support of using acupuncture as an alternative to antidepressant medication for treating the side effects of hormone therapy, this study was relatively small and has not yet been published in a peer-reviewed journal. More research is needed.

Acupuncture is generally considered safe, but there is a risk that you could be harmed if your acupuncturist is not well trained. Women interested in learning more about the practice should talk to their doctors.

For more information on these topics, see the American Cancer Society's Guidelines for Using Complementary and Alternative Methods and Breast Cancer: Hormone Therapy.

"Acupuncture for the treatment of vasomotor symptoms in breast cancer patients receiving hormone suppression treatment." First author: Eleanor Walker, MD. International Journal of Radiation Oncology - Biology – Physics. Abstract No. 228. Volume 72, Number 1, Supplement, 2008.