Medical Oncologist
Medicines
Fulvestrant (Faslodex) for breast cancer: the complete patient guide
Fulvestrant is a hormone treatment given as injections for hormone receptor positive breast cancer that has spread or come back. It is often combined with a targeted tablet. This guide explains how it works, who it is for, how the injections are given, the checks before you start, common side effects and what daily life on treatment is usually like.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
On this page
- What is fulvestrant, and what should you know before starting?
- Fulvestrant at a glance
- What your team checks first
- The vocabulary, in plain language
- What to realistically expect from fulvestrant
- Living with fulvestrant treatment
- How your team checks fulvestrant is working
- What people assume about fulvestrant
- Common questions about fulvestrant
The short answer
What is fulvestrant, and what should you know before starting?
Fulvestrant, also known by the brand name Faslodex, is a hormone treatment for breast cancer that grows in response to oestrogen. It is used mainly when hormone receptor positive, HER2-negative breast cancer has spread to other parts of the body or has come back and cannot be removed with surgery. Fulvestrant attaches to the oestrogen receptor on cancer cells, blocks it and causes the cell to break the receptor down, which takes away an important growth signal. It is given as two injections into the buttock muscles, with an extra dose in the first month and then one visit every four weeks. It is used after menopause, or before menopause alongside treatment that stops the ovaries working. Fulvestrant may be given alone or with a targeted tablet, such as a CDK4/6 inhibitor, alpelisib or capivasertib. Many people find it easier to live with than chemotherapy. The most common side effects are soreness where the injections go, hot flushes, tiredness, nausea, headaches and joint aches. Treatment usually continues for as long as it keeps the cancer controlled and side effects are acceptable. Before starting, your team checks your liver function, your other medicines, especially blood thinners, and whether pregnancy is possible.
A hormone treatment, not chemotherapy
Fulvestrant targets oestrogen signals in cancer cells and does not usually cause heavy hair loss.
Given by injection every four weeks
After a starting phase, you visit the clinic once a month for two injections.
Usually part of a longer plan
For advanced cancer, fulvestrant is one of several treatments that may be used in turn over time.
This page gives general information only. Your oncology team can advise on your own treatment.Key facts
Fulvestrant at a glance
The essentials to understand before your first injection.
What it treats
Hormone receptor positive, HER2-negative breast cancer that is advanced, has spread or has come back.
How it is given
Two slow injections into the buttock muscles by a nurse, on the first day, after two weeks, after four weeks and then every four weeks.
It is not available as a tablet.What it is given with
Often a CDK4/6 inhibitor tablet, or alpelisib or capivasertib when tumour tests show certain gene changes.
Common side effects
Injection soreness, hot flushes, tiredness, nausea, headaches and aches in joints and muscles.
Report straight away
- A painful, swollen leg or sudden breathlessness
- Yellow skin or eyes
- Swelling of the face or a severe rash
Before you start
What your team checks first
Check
Why it matters
Receptor results
Fulvestrant only helps cancers with oestrogen receptors, so biopsy results are confirmed
Menopause status
Before menopause, the ovaries must be switched off with other treatment for fulvestrant to work
Liver blood tests
The liver clears fulvestrant, and severe liver problems may make it unsuitable
Blood thinners and platelets
Injections into muscle can bleed more if blood clots poorly
Pregnancy
Fulvestrant can harm a developing baby, so reliable contraception is needed if pregnancy is possible
Words you may hear
The vocabulary, in plain language
- Faslodex
- The original brand name of fulvestrant. Other versions contain the same medicine.
- Metastatic breast cancer
- Breast cancer that has spread beyond the breast and nearby lymph nodes.
- SERD
- Selective oestrogen receptor degrader, the group of medicines fulvestrant belongs to.
- Loading dose
- The extra injection two weeks after the first, which builds up medicine levels faster.
- Progression
- When scans or symptoms show the cancer is growing despite treatment.
- Line of treatment
- Each treatment used in turn for advanced cancer, such as first-line or second-line.
Talk to our team
Have a question about your situation?
Call the helpline or leave your details, and someone will help you arrange a consultation at the CION centre nearest you. One helpline serves every CION centre.
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Being straight with you
What to realistically expect from fulvestrant
Fulvestrant helps many people live well with advanced breast cancer, but it has limits worth knowing.
The aim is control
For cancer that has spread, fulvestrant aims to keep it in check and ease symptoms for as long as possible. It does not remove advanced cancer for good.
How long it works varies widely
Some people stay on fulvestrant for years, while for others the cancer grows sooner. Earlier treatments and the cancer's biology both play a part.
Monthly visits are part of life
Regular trips for injections, blood tests and scans take time and energy, for you and your family.
What this page cannot tell you
It cannot tell you how well fulvestrant will work for you or whether another option would suit you better. Your oncologist can discuss this using your own results.
Everyday life
Living with fulvestrant treatment
Many people on fulvestrant keep up much of their normal routine. A little planning helps.
Work and travel
Most people can work and travel between injections. Plan longer trips around your injection dates, and ask your team before travelling far if you also take a tablet that needs blood tests.
Food and activity
There are no special food rules with fulvestrant. Balanced meals and regular gentle exercise help energy, mood, bone strength and joint stiffness.
Other medicines and supplements
Fulvestrant has few known interactions, but tell your team about every medicine, herbal remedy and supplement, especially blood thinners and anything taken with a partner tablet.
Emotional support
Living with advanced cancer can be hard. Counsellors, support groups and palliative care teams can help with worry, pain and planning.
Monitoring
How your team checks fulvestrant is working
Regular reviews look at both the cancer and how you are coping with treatment.
Scans
CT, bone or PET-CT scans are usually repeated every few months to see whether the cancer is stable, shrinking or growing.
Blood tests
Liver tests are checked from time to time. If you take a partner tablet, blood counts or sugar levels may be checked more often.
How you feel
New pain, breathlessness, weight loss or changes in energy are important clues. Mention them at every visit.
Commonly believed
What people assume about fulvestrant
Fulvestrant is only a last resort.
It is used at several stages, including as part of the first treatment for advanced cancer.
A branded version works better than other versions.
Approved versions contain the same medicine and must meet quality standards. Ask your oncologist if unsure.
Once started, I can never stop.
Treatment is reviewed regularly and can be changed if it stops working or side effects are too hard.
If I feel well, I can skip an injection.
Feeling well is often a sign treatment is helping. Keep to the schedule unless your team advises otherwise.
Questions we are asked
Common questions about fulvestrant
How long will I be on fulvestrant?
There is no fixed length. Fulvestrant for advanced breast cancer usually continues for as long as scans show the cancer is controlled and side effects are manageable. That may be months or several years. Your oncologist reviews it at regular visits and discusses any change with you.
Is fulvestrant better than an aromatase inhibitor?
Neither is simply better. The choice depends on earlier treatments, how long ago they were given, whether a partner tablet is planned and your preferences about tablets or injections. Both are effective hormone treatments, and your oncologist chooses the one that fits your situation.
Will I lose my hair on fulvestrant?
Heavy hair loss is not expected, because fulvestrant is not chemotherapy. A few people notice mild thinning. If you also take a partner tablet, ask whether that medicine affects hair, as some can cause more noticeable thinning.
Can I take fulvestrant if I have liver problems?
Mild liver problems are not usually a barrier. Moderate problems need careful monitoring. With severe liver problems, fulvestrant is generally avoided because the body cannot clear it properly. Your team will check liver blood tests before and during treatment.
Can I get pregnant while on fulvestrant?
Pregnancy should be avoided, as fulvestrant can harm a developing baby. If there is any chance you could become pregnant, use reliable non-hormonal contraception during treatment and for a time afterwards, as your team advises. Breastfeeding is also not advised.
Do I need to avoid any foods?
No specific foods need avoiding with fulvestrant itself. Some partner tablets do have food rules, such as avoiding grapefruit, so check the advice for any tablet you take. Ask before starting high-dose supplements or herbal products.
Can I have vaccines while on fulvestrant?
Most vaccines, including flu vaccines, are usually fine. Your team may time them away from other treatments or low blood counts caused by a partner tablet. Always tell the person giving a vaccine that you are having cancer treatment.
What happens if the cancer grows on fulvestrant?
Your oncologist will review scans and may test the tumour or blood again for gene changes. Options may include another hormone treatment, a different targeted tablet, an antibody-drug conjugate or chemotherapy. Growth on one treatment does not mean nothing else will work.
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Talk to our team
Speak to a breast cancer specialist
Call the helpline or leave your details, and someone will help you arrange a consultation at the CION centre nearest you. One helpline serves every CION centre.
Call 1800 202 8726
Helpline open 24/7
Sources
- National Cancer Institute — Fulvestrant
- Cancer Research UK — Fulvestrant (Faslodex)
- Macmillan Cancer Support — Fulvestrant
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.