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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.
Ovarian ablation is a way of stopping the ovaries from producing the hormone oestrogen.
In some breast cancers, known as oestrogen receptor positive (ER+) breast cancer, oestrogen can stimulate the breast cancer cells to grow. In women who haven’t yet reached their menopause, the ovaries are the main source of oestrogen. Stopping the ovaries from producing oestrogen means there is less of the hormone available in the body.
For premenopausal women, research has shown that ovarian ablation after surgery| and radiotherapy| can:
Ovarian ablation is only suitable for women who have an oestrogen receptor positive (ER+) breast cancer and who haven’t reached their menopause (change of life). It can be used to treat women with primary or secondary breast cancer| .
There are three different ways to stop the ovaries from producing oestrogen:
Unfortunately, ovarian ablation by surgery or radiotherapy brings on an early menopause| , which can be upsetting, especially for a woman who was hoping to have children or complete her family. It also causes menopausal side effects such as hot flushes, dry skin, vaginal dryness and mood changes. However, these symptoms can be effectively treated. The effects of hormonal therapy are usually temporary.
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 –a thin, flexible tube with a light and magnifying lens at the tip. It enables the surgeon to look into the abdomen (tummy).
The surgery usually involves 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 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 periods will stop straight away.
Your doctor may suggest that you take drugs or injections (types of hormonal therapy), which temporarily ‘switch-off’ the signals from your brain that tell your ovaries to make oestrogen.
In women who have not reached menopause, a hormone produced in the pituitary gland in the brain, called leuteinising hormone (LH), stimulates the ovaries to produce oestrogen. Drugs known as pituitary down-regulators or LHRH analogues reduce the production of LH. This leads to a drop in oestrogen similar to that which happens after surgical removal of the ovaries. The level of oestrogen usually drops within about three weeks of starting treatment and stays down as long as treatment is continued.
The main drug that is used to shut down (suppress) the ovaries is called goserelin (Zoladex®)| . Alternatively leuprorelin (Prostap®) may be used.
Zoladex is an injection given under the skin (subcutaneous) into the tummy. It is given every 28 days. The first injection is usually given in the outpatients department of the hospital. After that, your practice or community nurse, or your GP, can give you the injections.
Zoladex is often given for between two and five years. Your doctor will discuss the length of treatment that they feel is right for you.
The treatment temporarily stops the ovaries from working. Once treatment is stopped, the ovaries will start working again – usually within six months, depending on how near a woman is to her natural menopause. For example, if a woman is near the menopause when she begins Zoladex, her periods may not return when the treatment stops.
Although periods usually stop while you are having treatment, it's not a contraceptive, and women need to ensure that they use effective contraception until their periods stop. It might be helpful to discuss this with your doctor.
Radiotherapy uses high energy x-rays to stop the ovaries from working. This technique is not often used in the UK any more.
Radiotherapy is given over a period of a few days as an outpatient. The side effects can include tiredness| , diarrhoea| , feeling sick| and abdominal discomfort. These 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, but this is rare because the dose of radiotherapy used in ovarian ablation is very low.
Radiation therapy permanently shuts down the production of oestrogen in the ovaries. This doesn’t happen straight away, however, as it does with surgery. Periods usually stop about three months after the radiotherapy is given.
It’s important, if appropriate, that you use reliable contraception until your periods stop completely, as you may still become pregnant.
Hormonal therapy with Zoladex or Prostap temporarily stops the ovaries from working. Your ovaries may start working again and your monthly cycles (periods) may return after treatment is finished. This usually happens within six months of finishing treatment, depending on how near a woman is to her natural menopause.
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. You might mourn the loss of your fertility – even if you didn't plan on having children in the future. Some women feel a strong sense of femininity connected to their ovaries and other reproductive organs. You might fear that you'll somehow be less of a woman if your ovaries are no longer there. It can really help to talk about your feelings. Your breast care nurse can give support and advice, or you can contact a support organisation| .
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 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. Women can have one or more of these symptoms, and they can range 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. Early menopause may increase the risk of developing long-term complications| such as osteoporosis and heart disease, but there are ways to reduce these risks. Your doctor and breast care nurse can give you more information and advice.
You can learn more about common menopausal symptoms, and ways of dealing with them, in our guide to ‘Breast cancer treatment and menopausal symptoms| '.
This section has been compiled using information from a number of reliable sources, including:
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