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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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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.
In women with oestrogen receptor positive (ER+) breast cancer, the hormone oestrogen can stimulate breast cancer cells to grow. Hormones are produced by the body and act as chemical messengers to help control the activity of cells and organs. In women who haven't been through the menopause, most of the oestrogen is made by the ovaries.
Ovarian ablation is a way of stopping the ovaries| from producing oestrogen and lowering oestrogen levels in the body. There are different types of ovarian ablation.
For pre-menopausal women, research has shown that ovarian ablation after surgery and radiotherapy can:
The ovaries and their surrounding structures
View a large copy of the ovaries and their surrounding structures image|
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|. Some women may have ovarian ablation in combination with other hormonal therapies|.
There are three different ways to stop the ovaries from producing oestrogen:
Surgery to remove the ovaries is known as an oophorectomy. Doctors may also recommend removing the fallopian tubes (salpingo-oophorectomy). The operation is usually done using laparoscopic or keyhole techniques. This involves using a laparoscope, which is a thin, flexible tube with a light and magnifying lens at the tip. It enables the surgeon to look into the abdomen.
The surgery is usually done under a general anaesthetic. Two or three small cuts are made into the skin and muscle of the abdomen to allow the laparoscope and other instruments to be inserted.
Most women will be in hospital for one or two days.
For some women it may not be possible to remove the ovaries using laparoscopic surgery. In this situation, a short incision is made below the bikini line. Again, a general anaesthetic is used, but this procedure usually requires a slightly longer stay in hospital.
Removing the ovaries with surgery produces an immediate and permanent menopause. This means that your periods will stop straight away.
Hormonal therapies for breast cancer 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.
The treatment temporarily shuts down or suppresses 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 stay down as long as treatment continues.
The drug that's most commonly used is called goserelin| (Zoladex®). Another drug called leuprorelin| (Prostap®) may also be used.
Zoladex is given as an injection given under the skin (subcutaneously) into the tummy every 28 days. You'll usually have the first injection in the hospital's outpatients department. After this, your practice nurse, community nurse, or GP can usually give you the injections.
You may have one or occasionally two more periods after your treatment starts before it takes effect.
Zoladex or Prostap are given for 2–5 years. Your doctor will talk to you about the length of treatment that's right for you.
When the drugs are stopped 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. Women who were closer to their menopause may find that their periods don't 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 to stop the ovaries from working. This technique is not commonly used.
Radiotherapy can be given over a period of a few days as an outpatient. The side effects can include tiredness|, diarrhoea|, feeling sick| and abdominal discomfort. These side effects are temporary and will clear up quickly. Your doctor can prescribe medicine to treat any that are troublesome.
Sometimes radiotherapy can cause late side effects months or years after treatment. This is rare in ovarian ablation because the dose of radiotherapy used is very low.
Radiotherapy permanently stops the ovaries producing oestrogen. But this doesn’t happen straight away as it does with surgery. You may carry on having periods for up to about three months after radiotherapy.
It’s important to use reliable contraception until your periods stop completely, as you may still become pregnant. Your breast care nurse or doctor can give you further advice.
Hormonal therapy with Zoladex or Prostap may only have a temporary effect on your fertility|. After treatment your ovaries may start working again and your periods may come back, usually within six months. But, as mentioned earlier, this depends on how close to your menopause you were when treatment started.
Ovarian ablation by surgery or radiotherapy will mean that you can no longer have children.
Infertility can be very distressing especially if you were hoping to have children or add to your family. It can seem especially hard when you already have to cope with cancer.
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 a support organisation listed below.
Women whose ovaries are removed will have an early menopause straight away. The symptoms of this can start suddenly and may be more intense the symptoms of one that happens naturally.
Ovarian ablation using hormonal therapy or radiotherapy happens over a period of 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. The most common symptoms, and ways of dealing with them, are described below.
You can watch a video of Diane's experience of breast cancer and menopausal symptoms.|
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.
Many women find their sex drive is lower while having treatment with Zoladex. This normally continues for as long as the treatment is given.
Early menopause as a result of surgery or radiotherapy to stop the ovaries from working can also affect a woman’s sex drive.
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.
Taking regular exercise|, eating a healthy diet| 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 more 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| is a support group for women who experience a premature menopause.
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.
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.
This section has been compiled using information from a number of reliable sources, including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.