- What is ovarian suppression?
- How does it work as a treatment for breast cancer?
- Who might be offered ovarian suppression?
- Can ovarian suppression preserve fertility during chemotherapy?
- Different types of ovarian suppression
- What are the possible side effects of ovarian suppression?
- Coping with the effects of ovarian suppression
- Further support
Ovarian suppression is the term used to describe treatments that stop the ovaries from making oestrogen, either permanently or temporarily.
You might hear different terms for ovarian suppression such as ovarian function suppression and ovarian ablation.
Ovarian suppression is used:
- as part of treatment for breast cancer in premenopausal women (have not yet reached the menopause)
- to try to help preserve fertility during chemotherapy, because chemotherapy can cause damage to the ovaries
Some breast cancers are stimulated by the hormone oestrogen. This means that oestrogen in the body helps the cancer to grow. This type of breast cancer is called oestrogen receptor positive (ER+). Invasive breast cancers are tested to see if they are ER+ using tissue from a biopsy or after surgery.
Before the menopause, oestrogen is mainly produced by the ovaries. If the ovaries are removed, or if they are stopped from working, there’s less oestrogen in the body to stimulate the cancer to grow. This is called ovarian suppression. Small amounts of oestrogen will still be produced by fat cells.
You will only benefit from ovarian suppression if your breast cancer is ER+.
Ovarian suppression might be offered to people who have primary or secondary breast cancer.
Primary breast cancer
Ovarian suppression can be used as part of your treatment for primary breast cancer (breast cancer that has not spread beyond the breast or the lymph nodes under the arm). Your specialist team will look at various features of the cancer such as the stage, size and grade to decide whether you would benefit from having ovarian suppression as part of your treatment. Other factors may also be relevant.
It will only be recommended if you are premenopausal and your breast cancer is ER+. It’s not used in women who are already postmenopausal.
Evidence suggests that women who remain premenopausal after chemotherapy may benefit most from ovarian suppression. Older premenopausal women may not get as much benefit from ovarian suppression after chemotherapy. Your specialist will talk to you about whether ovarian suppression may be of benefit in your situation.
Women who are not recommended to have chemotherapy are less likely to be offered ovarian suppression.
It may be an option for some women who choose not to have chemotherapy.
Secondary breast cancer
Ovarian suppression may also be used to treat women with secondary breast cancer (when cancer cells from the breast have spread to other parts of the body such as the bones, lungs, liver or brain).
It will only be prescribed if you are premenopausal and your breast cancer is ER+.
Chemotherapy can affect the functioning of the ovaries, reducing the number and/or quality of eggs and affecting a woman’s ability to become pregnant.
Some studies have shown that ovarian suppression using hormone therapy drugs may protect the ovaries during chemotherapy as it temporarily ‘shuts down’ the ovaries. However, the effectiveness of ovarian suppression for preserving fertility is still debated and cannot replace other fertility preservation methods like egg and embryo freezing.
We need more research to establish the role of ovarian suppression during chemotherapy to preserve fertility.
Your specialist team should discuss what treatment they recommend for you and why.
Ovarian suppression can be achieved by:
- hormone therapy (drugs) – usually monthly injections
Your specialist team should help you decide which is best for you. Using hormone therapy is the only way of achieving ovarian suppression that may not be permanent. This may be something to consider when making your decision, especially if you want to have children.
Some drugs stop the ovaries from making oestrogen. They interfere with hormone signals from the brain that control how the ovaries work.
Goserelin (Zoladex) is the most commonly used drug. It comes as an implant (a very small pellet) in a pre-filled syringe. It’s given as an injection into your abdomen (tummy) once a month. Find out more about how goserelin is given.
Leuprorelin (Prostap) is given as an injection once a month, or sometimes every three months.
Triptorelin is given as an injection once a month.
Ovarian suppression combined with tamoxifen or aromatase inhibitors
If you are having one of the above injection for ovarian supression this is often combined with another hormone therapy such as tamoxifen or drugs known as aromatase inhibitors. Research has suggested this may reduce the risk of the breast cancer coming back for some premenopausal women who have had chemotherapy.
There may be a small extra benefit having an aromatase inhibitor over tamoxifen but there might be different side effects to consider that can affect your quality of life. Your specialist will help you discuss the possible benefits and side effects.
Aromatase inhibitors are not used on their own as hormone treatment in premenopausal women because they are not an effective treatment while the ovaries are still making oestrogen, but they can be given alongside goserelin, leuprorelin or triptorelin.
Your specialist team will discuss with you what they recommend and why.
Surgery to remove the ovaries (oophorectomy)
An operation to remove the ovaries is called an oophorectomy. The fallopian tubes, which are close to the ovaries, are usually removed at the same time.
The operation is usually done as ‘keyhole’ surgery using a laparoscope (a flexible thin tube with a camera lens attached). Three small cuts are made, one near the belly button, one near the bikini line and one on the side of the abdomen. It’s done under general anaesthetic, usually as a day case but some people stay in overnight.
Sometimes it isn’t possible for the ovaries to be removed with keyhole surgery, in this case they will be removed through a short incision made below the bikini line.
Removing the ovaries will mean an immediate and permanent menopause. Your periods will stop straight away.
Everyone reacts differently to drugs and treatments and some women have more side effects than others. If ovarian suppression is given in addition to chemotherapy or other hormone therapies, it’s sometimes difficult to know which side effects are being caused by which treatment.
Ovarian suppression achieved by hormone therapy or surgery is more likely to cause menopausal symptoms than a natural menopause. Menopausal symptoms, especially if sudden and/or intense, can affect your confidence and may have an impact on both you and your partner. As well as the symptoms mentioned above, you may experience weight gain, joint pain and stiffness, fatigue (extreme tiredness) and nausea (feeling sick).
Although these symptoms may be quite intense in the beginning, they usually improve over time and there are ways to try to manage them.
Lack of oestrogen over a long period of time can cause thinning of the bones (osteoporosis). Some women with primary breast cancer having ovarian suppression will be offered a DEXA (dual energy X-ray absorptiometry) scan within the first few months of starting treatment. A DEXA scan measures bone density. Whether you’re offered a DEXA scan will depend on which other treatments you’re having.
If you’re having ovarian suppression for secondary breast cancer, you can talk to your specialist team about whether a DEXA scan is appropriate for you.
For some women coping with the effects of ovarian suppression and possibly an early menopause brought on by treatment can be difficult.
Your specialist team will discuss with you the possible benefits and risks of ovarian suppression. If you have persistent side effects, tell your specialist team so they can suggest how best to manage them. Research has shown that younger women are more likely to stop taking hormone treatment early if they don’t get help with possible side effects so it’s important to get support if you need it. Not taking hormone treatment for the recommended time may increase the risk of breast cancer coming back.
Going through the menopause prematurely can create feelings of loss, and make you feel isolated from women your own age. You don’t have to cope on your own. Some women find it helpful to discuss their feelings and concerns with their breast care nurse or specialist. If you feel you’d like to talk things through in more depth, a counsellor or psychologist may be more appropriate.
Sharing your feelings with someone who has had a similar experience can be helpful. Breast Cancer Now runs specific services especially for younger women.
- Younger Women Together – a free two-day event for women aged 45 or younger who have been diagnosed with primary breast cancer in the past three years, with sessions on topics such as treatment, menopausal symptoms, breast reconstruction, fertility and diet.
- Someone Like Me – be put in touch with someone with a similar experience of breast cancer so you can talk through your worries and share experiences over the phone or by email
Find out more about support for younger women with breast cancer.