Ovarian Suppression and Other Alternatives to Ovary Removal

If you’re currently being treated for estrogen receptor-positive breast cancer or were treated for it in the past, your doctor may talk with you about treatments that lower the levels of estrogen in your body. That’s because estrogen receptor-positive breast cancer uses estrogen to grow. With less estrogen in the body, cancer can’t grow as quickly.

Before menopause, the ovaries are the main source of estrogen in the body. While some people with estrogen receptor-positive breast cancer may decide to have ovary removal surgery, you may not be ready for this surgery or feel worried about possible side effects from ovary removal. 

In some cases, medicines may be used to stop the ovaries from functioning temporarily (also called ovarian suppression, ovary ablation, or ovarian shutdown). Unlike ovary removal, ovarian suppression is not permanent.

There are two medicines commonly used for ovarian suppression:

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  Zoladex (chemical name: goserelin)

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  Lupron (chemical name: leuprolide)

These medicines are given as injections once a month or every three months. They can be used alone or in combination with other hormonal therapy medicines to treat people who have not gone through menopause.

There are several reasons why your doctor may recommend you consider ovarian suppression:

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  to reduce the risk that DCIS or early-stage breast cancer comes back (recurs) after initial treatment 

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  to slow the growth of advanced or metastatic breast cancer  

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  to stop ovulation (the release of a mature egg) during chemotherapy

If you’re pre-menopausal and stop receiving ovary suppression medicine, your ovaries usually begin functioning again — producing estrogen and releasing mature eggs from the ovary. The time it takes for the ovaries to recover varies from person to person.

Many of the side effects from ovarian suppression are the same as those from ovary removal surgery. These symptoms include: 

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  hot flashes

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  loss of libido

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  vaginal dryness

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  irregular periods or loss of period

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  mood swings

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  depression

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  osteoporosis

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  weight changes

Aromatase inhibitors (for example, anastrozole and letrozole) can’t stop the ovaries from making estrogen, but they can help lower the amount of estrogen in the body of people whose ovaries no longer produce estrogen. Aromatase inhibitors work by blocking the hormone androgen from turning into small amounts of estrogen in the body. If you haven’t gone through menopause, you can only take an aromatase inhibitor if you’re also prescribed a medicine to stop your ovaries from functioning. 

Selective estrogen receptor modulators (SERMs; for example, tamoxifen) bind to estrogen receptors. If a SERM is in the estrogen receptor of a breast cancer cell, estrogen can’t attach to the receptor, and the cell can’t grow and multiply.

Selective estrogen receptor degraders (SERDs; for example, Faslodex) also block estrogen from attaching to estrogen receptors on breast cancer cells. SERDs also lower the number of estrogen receptors and change the shape of breast cell estrogen receptors so they don’t work as well. If you haven’t gone through menopause, you should only take a SERD if you’ve also been prescribed a medicine to stop your ovaries from functioning.