Ovarian ablation and breast cancer
This information is for women who have been offered ovarian ablation as part of their breast cancer treatment. Ovarian ablation or ovarian suppression are terms used to describe different ways of stopping the ovaries from working. We use the term ovarian ablation to cover all the different methods.
Ovarian ablation is only suitable for women with ER+ breast cancer who haven't reached their menopause. It can be used to treat women with primary or secondary breast cancer.
This information is for women who have been offered ovarian ablation or ovarian suppression as part of their breast cancer treatment. These are medical terms used to describe different ways of stopping the ovaries from working. We use the term ovarian ablation to cover all the different methods.
You’ll only have this treatment if you have the type of breast cancer that responds to treatment with hormonal therapies and have not been through your menopause.
This information explains what ovarian ablation is, how it's done, some of the side effects and ways of coping with them. It should ideally be read with our general information about breast cancer.
We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you're having treatment.
In women with oestrogen receptor positive (ER+) breast cancer, the hormone oestrogen can stimulate breast cancer cells to grow. Hormones are made by the body and help control how cells grow and what they do in the body.
Before menopause, most of the oestrogen in the body is made by the ovaries. Ovarian ablation stops the ovaries producing oestrogen and, as a result, lowers oestrogen levels in the body. It may be used to treat women who have primary breast cancer or breast cancer that has spread to other parts of the body (secondary breast cancer).
Ovarian ablation can be used:
after surgery to reduce the risk of the cancer coming back
to reduce the risk of developing a new breast cancer
to shrink and control breast cancer that has spread.
Some women have ovarian ablation in combination with the anti-oestrogen drug tamoxifen. Ovarian ablation may be offered as an option for some women who don’t want to have chemotherapy after surgery. Chemotherapy, which may be given after surgery to reduce the risk of breast cancer coming back, can also bring on an early menopause
Types of ovarian ablation
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There are three different ways to stop the ovaries producing oestrogen:
surgery to remove the ovaries
hormonal therapy to 'shut down' the ovaries (ovarian suppression)
radiotherapy to stop the ovaries working.
An operation to remove the ovaries is called an oophorectomy. It’s usually carried out under a general anaesthetic. The fallopian tubes, which are close to the ovaries, are usually removed at the same time.
The operation is often done using keyhole (laparoscopic) surgery. The surgeon makes up to four small cuts (incisions) in the skin and muscle in the tummy area. They then insert a long, thin, flexible tube called a laparoscope, which has a tiny light and camera on the end, through one of the cuts. The laparoscope is connected to a video camera and television so the inside of your abdomen can be seen on the screen. Gas is introduced into one of the cuts to make the tummy swell so that it’s easier for the surgeon to see the ovaries through the camera. The gas is released through the cuts at the end of the operation.
To remove the ovaries your surgeon uses instruments that are attached to the laparoscope and inserted into the other cuts. Afterwards, the cuts are closed with stitches (usually self-dissolving) and covered with a small dressing. You may be in hospital for a day or two, and your recovery is usually quick.
Sometimes it is not possible to remove the ovaries with keyhole surgery. Instead, you’ll have one long incision made below the bikini line and the ovaries are removed through this (open surgery). You’ll usually be in hospital for a few days after this operation as it takes longer to recover from than keyhole surgery.
Removing the ovaries produces an immediate and permanent menopause. This means you won’t have any more periods and you may get menopausal symptoms very shortly after the operation
Hormonal therapy to 'shut down' the ovaries
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Hormonal therapies are drugs that work by lowering or blocking the effects of oestrogen on breast cancer cells.
Your doctor may recommend drugs (LHRH analogues) that stop the brain producing the luteinising hormone, which stimulates the ovaries to make oestrogen. They cause a temporary menopause by shutting down or suppressing the ovaries (ovarian suppression) from producing oestrogen. The drop in oestrogen levels is similar to when the ovaries are removed by surgery. Oestrogen levels usually drop within three weeks of starting treatment and remain like this as long as treatment continues.
The drug most commonly used is called goserelin (Zoladex®). Another drug called leuprorelin (Prostap®) may also be used. Zoladex® is given as an injection under the skin (subcutaneously) into the tummy every 28 days. You'll usually have the first injection given to you at a clinic appointment. After this it can usually be given to you by your practice nurse, community nurse or GP.
You may have one, or occasionally two, more periods after your treatment starts before it takes effect.
Zoladex® or Prostap® are usually given for 2 years but can be given for longer in some situations. Your doctor will talk to you about the length of treatment that's right for you.
When you stop taking the drugs your ovaries may start to work again, usually within six months. This depends on how close you were to your natural menopause when you started treatment. If you were close to your menopause your periods may not come back afterwards.
Although your periods usually stop during treatment, the drugs are not a contraceptive, so you'll need to use effective contraception to make sure you don't get pregnant. Your breast care nurse or doctor can give you further advice.
Radiotherapy uses high-energy x-rays and can be given to the ovaries to stop them working and producing oestrogen. This way of stopping the ovaries working isn’t commonly used.
You can have the radiotherapy over a few days as an outpatient. The side effects can include diarrhoea and feeling sick, but your doctor can prescribe medicine to control this. You may also feel tired. The side effects go away shortly after treatment is over.
It is rare for radiotherapy in ovarian ablation to cause any long-term effects because the dose used is very low.
Radiotherapy to the ovaries causes a permanent menopause. This doesn’t happen straight away and your periods may carry on for up to three months after radiotherapy. It’s important to use reliable contraception until you are sure your periods have stopped completely, as you may still become pregnant. Your breast care nurse or doctor can give you further advice.
Hormonal therapy with Zoladex® or Prostap® is used to temporarily stop your ovaries working. After treatment your periods may come back, usually within six months. So this treatment may be suitable for women who want the option of having children after breast cancer. However, if you were close to your natural menopause when treatment started your periods may not come back.
Having your ovaries removed or having radiotherapy to your ovaries means you won’t be able to have children. This can be very distressing, especially if you were hoping to have children or add to your family. Some women may find it helpful to talk through their feelings with a professional counsellor. Your breast care nurse or doctor can give you support and advice, or you can contact one of the organisations listed below.
We have a section on fertility and cancer treatment for women, which has more information.
Coping with menopausal symptoms
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Women whose ovaries are removed will have an early menopause straight away. The symptoms of this can start suddenly and may be more intense than the symptoms of a natural menopause.
Ovarian ablation using hormonal therapy or radiotherapy happens over a period of weeks or months and is a more gradual change.
The menopause can cause symptoms such as hot flushes, dry skin, vaginal dryness, lowered sex drive and psychological effects. These symptoms can vary from being mild to severe. This can be difficult for women to cope with, especially when they’re already dealing with breast cancer and its treatments.
Diane talks about her experience of breast cancer and menopausal symptoms.
The most common symptoms, and ways of dealing with some of them, are described below.
We have a section on breast cancer and menopausal symptoms, which has more detailed information.
Hot flushes and sweats are the most common menopausal symptoms. There are a number of drugs that your doctor can prescribe to reduce the severity and frequency of flushes and sweats.
It can help to wear thin layers of cotton clothing that can easily be removed, and to sleep in a well ventilated room with a window open (or use an electric fan). Some women may find certain breathing techniques helpful.
A low level of oestrogen in the body causes vaginal dryness and sometimes itching. There are different lubricating gels and creams that can help, which you can buy from a chemist or be prescribed by your doctor. Your doctor or nurse can discuss this with you.
Loss of sex drive (libido)
Permanent or temporary menopause as a result of ovarian ablation can reduce your sex drive. If you’re taking Zoladex your sex drive will usually improve when your ovaries start working again. Treating symptoms such as hot flushes and vaginal dryness can help make having sex easier and improve your sex drive. If you are having problems with your sex life, you can talk to your breast care nurse or doctor who can offer more support.
You may feel very emotional or anxious at times. Some women also have mood swings, poor concentration and a lack of confidence. It can often help to talk about how you're feeling. A number of organisations provide support for women going through an early menopause.
Oestrogen helps keep bones strong, and a lack of it over a long period increases the risk of osteoporosis (thinning of the bones). You may need to have your bone health (density) checked by having a special bone scan called a DEXA scan. There are bone strengthening drugs that your doctor can prescribe, if necessary.
We have a section about bone health, which you may also find helpful.
Taking regular exercise, healthy eating and giving up smoking can help keep your bones healthy. These measures also help protect your heart and reduce the risk of other illnesses. Having an early menopause may increase the risk of heart problems later on, although this hasn't been proven. Your doctor and breast care nurse can give you information and advice about the risk of long-term problems after ovarian ablation.
To help you make a decision about ovarian ablation, it's important that you have all the information and support you need, as well as the opportunity to discuss your options in detail.
The Daisy Network
The Daisy Network is a support group for women who experience a premature menopause.
Fertility Friends is a web-based information and support community. Message boards allow you to ask a nurse and other relevant professionals questions, or to chat with other people affected by infertility.
National Osteoporosis Society
The National Osteoporosis Society promotes the prevention and treatment of osteoporosis. Services include a national helpline answered by experienced nurses, publications and a network of support groups.
This section has been compiled using information from a number of reliable sources, including:
Early and localised breast cancer: diagnosis and treatment. National Institute for Health and Clinical Excellence (NICE). February 2009
Advanced breast cancer. National Institute for Health and Clinical Excellence (NICE). February 2009.
Harrison J, et al. Diseases of the Breast. 4th edition. Lippincott Williams and Wilkins. 2010.
Thanks to Professor R Coleman, Professor of Medical Oncology, and the people affected by cancer who reviewed this edition.