If you have not been through the menopause, your cancer doctor may advise having one of these treatments with another hormonal therapy:
- Ovarian suppression, which stops the ovaries making oestrogen and causes a temporary menopause.
- Ovarian ablation, which removes the ovaries and causes a permanent menopause.
These treatments lower oestrogen levels, which reduces the risk of breast cancer coming back. But they can also affect your bone health. Before treatment starts, you have a DEXA scan to check your bone health (density). Your doctor will advise you on how to look after your bones.
Drugs to stop the ovaries making oestrogen (ovarian suppression)
Goserelin (Zoladex®) is a drug that stops the ovaries making oestrogen and causes a temporary menopause. You may have goserelin on its own or with tamoxifen or an AI.
Goserelin stops the pituitary gland in the brain from sending messages to the ovaries to produce oestrogen. The side effects are similar to menopausal symptoms and include:
- hot flushes and sweats
- joint pain
- low sex drive.
Your specialist nurse will give you goserelin as a monthly injection under the skin of the tummy (abdomen). When you finish treatment, your ovaries usually start to produce oestrogen again. This means your periods will come back. But this may not happen if you were close to your natural menopause when you started taking goserelin.
Removing the ovaries (ovarian ablation)
This may be an option for women who do not want to take goserelin injections. You will usually have tamoxifen or an AI as well as ovarian ablation.
Removing the ovaries involves a small operation. It can often be done during a short stay in hospital using keyhole surgery. The surgeon makes a small cut in the tummy area and inserts a thin tube with a tiny light and camera on the end (laparoscope). The surgeon removes the ovaries through the cut using the laparoscope, which has a small surgical instrument attached to it. Women usually recover quickly from this operation.
If you have this surgery, your periods will stop straight away and you will have your menopause. It also means you will no longer be able to have children. Becoming infertile because of cancer treatment can be hard to cope with, but there is support available.
Hormonal therapy before menopause
Your doctor may recommend one of the following:
- tamoxifen, an anti-oestrogen drug
- goserelin on its own or with tamoxifen or an AI
- surgery to remove the ovaries on its own or with tamoxifen or an AI.
Hormonal therapy after menopause
Your doctor may prescribe one of the following drugs: