A number of new effective hormonal therapies have recently become available. These treatments help stop the hormone estrogen from fueling the growth of breast cancer cells. So which one do you try first? Your best option depends on how you've responded in the past to hormonal therapy, and whether you are still menstruating (having periods regularly).

If the cancer grew or otherwise got worse while you were taking one type of hormonal therapy, your doctor may switch you to a different type of hormonal treatment. But if more than two years has passed since you took the hormonal therapy and had a recurrence, you may still respond to that first medication you were taking. To find out all your choices, read the section below that applies to you.

Pre-menopausal options

If you are still having a period each month, you have several choices of hormonal therapy:

• tamoxifen
• treatments that stop your ovaries from making estrogen (ovary shutdown)
• tamoxifen AND ovary shutdown
• Megace (chemical name: megestrol)
• Halotestin (chemical name: fluoxymesterone)

Tamoxifen is usually the first choice, followed by treatments that stop your ovaries from making estrogen:

• surgical removal of the ovaries
• radiation treatment to stop the ovaries from working
• the drugs Zoladex (chemical name: goserelin acetate), Lupron (chemical name: leuprolide), or Trelstar (chemical name: triptorelin), which are injected into the muscle

Get as much information about these options as you can so that you can discuss them with your doctor.

Hormonal therapies that are now used only occasionally are Megace and Halotestin:

• Megace, a progesterone-like hormonal therapy, is generally less effective than tamoxifen, and causes bloating and weight gain. But it still can be highly effective in some women.
• Halotestin is a male hormone that is not as effective as tamoxifen and Megace. It also causes facial hair growth and other masculine traits to develop. Despite its unpleasant side effects, halotestin can be very beneficial for some women because it can increase their numbers of red blood cells.

Pre-menopausal women who have had treatments to shut down their ovaries or who have gone into early menopause as a side effect of chemotherapy have some other options. These women can use hormonal therapies that are only for post-menopausal women:

• Arimidex (chemical name: anastrozole), Femara (chemical name: letrozole) or Aromasin (chemical name: exemestane)
• Faslodex (chemical name: fulvestrant)

Post-menopausal options

Very often, treatments for breast cancer stop the menstrual cycle temporarily. If you have not been menstruating for several months after treatment ends, you may think you have gone into menopause. But that's not necessarily the case. Your doctor must test you to be sure that you are in fact post-menopausal. If you are, you have a greater variety of options for hormonal treatment:

• Arimidex (chemical name: anastrozole)
• Femara (chemical name: letrozole)
• Aromasin (chemical name: exemestane)
• tamoxifen (if you have never before been treated with it)
• Faslodex (chemical name: fulvestrant), an ERD (or estrogen receptor down-regulator)
• Fareston (chemical name: toremifene), which is very closely related to tamoxifen
• Megace (chemical name: megestrol)
• Halotestin (chemical name: fluoxymesterone)
• some combination of the above therapies

All these treatments are medicines that you take as a daily pill except for Faslodex, which is given as a monthly injection.

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