How does ovarian suppression work?
If you have hormone-positive secondary breast cancer (ER+ breast cancer), this will be encouraged to grow by a natural hormone called oestrogen that your body makes. If you haven’t been through the menopause, most of this oestrogen is made by your ovaries.
Ovarian suppression (also known as ovarian ablation), removes your ovaries or stops them from producing oestrogen.
This vastly reduces the amount of oestrogen in your body that can cause your cancer to grow. Ovarian suppression is only usually used in women who have not been through the menopause yet. It can be used alongside treatment with tamoxifen or an aromatase inhibitor.
Common ways of stopping the ovaries from producing oestrogen are:
- To remove your ovaries surgically – this is called an oophorectomy and can often be done using key-hole surgery (laparoscopy)
- Using a medication called a luteinising-hormone releasing hormone (LHRH) analogue, such as goserelin (Zoladex). This is given as an injection every four weeks.
Less commonly, radiotherapy can be used to stop the ovaries working.
Which method of ovarian suppression is right for me?
Oophorectomy and LHRH analogues are thought to be equally good for treating breast cancer. Your treatment team can help you to decide which type of ovarian suppression is right for you based on the risks and benefits.
Some women choose to use an LHRH analogue, while others choose to have surgery. It is possible to start by using an LHRH analogue and then to have surgery later.
Oophorectomy is a low-risk operation and you can usually go home the same day. It does have some risks associated with having a general anaesthetic and surgery though. LHRH analogies don’t have those risks, but you will need injections.
Are there any serious risks with ovarian suppression?
Oophorectomy comes with a low risk of complications from surgery including:
- Damage to nearby organs or nerves
- Blood clots
Ovarian suppression could put you at risk of fracturing a bone or osteoporosis.
You might be offered a scan of your bones before you start treatment. This is to see whether it might be helpful to give you a bone-strengthening treatment to reduce your risk of having a fracture.
A bisphosphonate or a drug called denosumab can strengthen your bones. It can also increase your risk of having a heart beat abnormality.
Make sure your oncologist explains the risks of ovarian suppression to you, so you’re informed and can balance this up against the potential benefits.
What are the main side effects of ovarian suppression?
Ovarian suppression causes menopausal symptoms, such as:
- hot flushes
- difficulty sleeping
- vaginal dryness and itching
- mood changes
- decreased sex drive
What help is available for side effects?
Treatments can relieve some of your side effects. Hormone replacement therapy is not recommended for women with breast cancer. However, other drugs can help relieve menopausal symptoms, such as some antidepressants called selective serotonin reuptake inhibitors (SSRIs).
There are other therapies and lifestyle changes that may help with hot flushes, such as acupuncture, exercising and avoiding triggers (e.g. caffeine and alcohol).
There is no proof that natural remedies or particular diets help with menopausal symptoms. If you’d like to try them, speak to your oncologist first, as they could interfere with your hormone therapy and stop it working properly.
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