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Hormone therapy is the use of hormones or hormone-blocking drugs to fight cancer. This type of systemic therapy is rarely used to treat epithelial ovarian cancer, but is more often used to treat ovarian stromal tumors.

Luteinizing-hormone-releasing hormone (LHRH) agonists

LHRH agonists (sometimes called GnRH agonists) stop the ovaries from making estrogen. They are used to lower estrogen levels in premenopausal women. This can help slow or stop the growth of cancers that depend on estrogen.

Examples of LHRH agonists include goserelin (Zoladex) and leuprolide (Lupron), given as injections every 1 to 3 months.

Side effects can include symptoms of menopause, such as hot flashes and vaginal dryness. Long term use (years) can weaken bones, sometimes leading to osteoporosis.

Tamoxifen

Tamoxifen is often used to treat breast cancer, but it can also treat ovarian stromal tumors and, rarely, advanced epithelial ovarian cancer. Tamoxifen acts as an anti-estrogen in many tissues in the body, but as a weak estrogen in others. The goal of tamoxifen therapy is to prevent estrogen circulating in the body from stimulating cancer cell growth.

The anti-estrogen activity of this drug can lead to side effects like hot flashes and vaginal dryness. Because tamoxifen acts like a weak estrogen in some areas of the body, it does not cause bone loss but can increase the risk of serious blood clots in the legs.

Fulvestrant

Fulvestrant can be used to treat low-grade serous carcinoma. It blocks the effects of estrogen by binding to an estrogen receptor on the cancer cells. The goal of fulvestrant therapy is to keep any estrogens circulating in the body from stimulating cancer cell growth.

Side effects include joint pain, hot flashes, headaches, and fatigue.

Aromatase inhibitors

Aromatase inhibitors are drugs that block an enzyme called aromatase that turns other hormones into estrogen in post-menopausal women. They don’t stop the ovaries from making estrogen, so they are only helpful in lowering estrogen levels in women after menopause. These drugs are mainly used to treat breast cancer but can also be used to treat some ovarian stromal tumors that have come back after treatment as well as low grade serous carcinomas.

Examples include letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin). These drugs are taken as pills once a day.

Common side effects include hot flashes, joint and muscle pain, and bone thinning. The bone thinning can lead to osteoporosis and bones that break easily.