Hormone Therapy for Uterine Sarcomas

Hormone therapy is the use of hormones or hormone-blocking drugs to treat cancer. Part of diagnosing uterine sarcoma includes tests that check the cancer cells to see if they have receptors (proteins) where hormones can attach. If they do have these receptors (estrogen and/or progesterone ), hormone treatment might be a good option. Hormone therapy is mainly used to treat low-grade endometrial stromal sarcomas (ESS) and is rarely used for the other types of uterine sarcomas.

Aromatase inhibitors

After the ovaries are removed, or aren't working (after menopause), some estrogen is still made in fat tissue. This becomes the body's main source of estrogen. Drugs called aromatase inhibitors can stop this estrogen from being made. Examples of aromatase inhibitors include letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin). These drugs are most often used to treat breast cancer, but they are also helpful in treating low-grade endometrial stromal sarcoma, adenosarcoma, or other sarcomas that have estrogen and/or progesterone receptors.These drugs are only useful for those whose ovaries have been removed or no longer work (like after menopause).

Side effects can include any of the symptoms of menopause, such as hot flashes and vaginal dryness, as well as joint/muscle pain. If they are taken for a long time (years), these drugs can weaken bones, sometimes leading to osteopenia or osteoporosis.

Progestins

Progestins are drugs that act like the hormone progesterone. The progestins used most often to treat estrogen-positive and/or progesterone-positive uterine sarcomas are megestrol (Megace) and medroxyprogesterone (Provera). Both of these drugs are pills you take every day.

Side effects can include increased blood sugar levels in patients with diabetes. Hot flashes, night sweats, and weight gain (from fluid retention and an increased appetite) also occur. Rarely, serious blood clots can happen in people taking progestins.

Gonadotropin-releasing hormone agonists

Gonadotropin-releasing hormone (GNRH) agonists are drugs used to lower estrogen levels in women who are premenopausal (are still having periods or have not gone through menopause). Before menopause, almost all of a woman's estrogen is made by the ovaries. These drugs keep the ovaries from making estrogen. Examples of GNRH agonists include goserelin (Zoladex) and leuprolide (Lupron). These drugs are given as a shot into a muscle every 1 to 3 months.

Side effects can include any of the symptoms of menopause, such as hot flashes and vaginal dryness. If they are taken for a long time, these drugs can weaken bones, sometimes leading to osteoporosis.

More information about hormone therapy

To learn more about how hormone therapy is used to treat cancer, see Hormone Therapy.

To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Alektiar KM, Abu-Rustum NR, and Fleming GF. Chapter 75- Cancer of the Uterine Body. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.

Benson C, Miah AB. Uterine sarcoma -- current perspectives. Int J Womens Health. 2017;9:597-606.

Boggess JF, Kilgore JE, and Tran AQ. Ch. 85 – Uterine Cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa. Elsevier; 2020.

Dizon DS, Birrer MJ. Advances in the diagnosis and treatment of uterine sarcomas. Discov Med. 2014;17(96):339-345.

Gaillard S and Secord AA. Staging, treatment, and prognosis of endometrial stromal sarcoma and related tumors and uterine adenosarcoma. In: Chakrabarti A and Vora SR, eds. UpToDate. Waltham, Mass.: UpToDate, 2021. https://www.uptodate.com. Accessed June 13, 2022.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Uterine Neoplasms, Version 1.2022 – November 4, 2021. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf on June 13, 2022.

References

Alektiar KM, Abu-Rustum NR, and Fleming GF. Chapter 75- Cancer of the Uterine Body. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.

Benson C, Miah AB. Uterine sarcoma -- current perspectives. Int J Womens Health. 2017;9:597-606.

Boggess JF, Kilgore JE, and Tran AQ. Ch. 85 – Uterine Cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa. Elsevier; 2020.

Dizon DS, Birrer MJ. Advances in the diagnosis and treatment of uterine sarcomas. Discov Med. 2014;17(96):339-345.

Gaillard S and Secord AA. Staging, treatment, and prognosis of endometrial stromal sarcoma and related tumors and uterine adenosarcoma. In: Chakrabarti A and Vora SR, eds. UpToDate. Waltham, Mass.: UpToDate, 2021. https://www.uptodate.com. Accessed June 13, 2022.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Uterine Neoplasms, Version 1.2022 – November 4, 2021. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf on June 13, 2022.

Last Revised: September 20, 2022

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