Ovarian Suppression
Ovarian suppression can slow the growth of hormone receptor-positive breast cancer in premenopausal (before menopause) women.
Ovarian suppression uses drug therapy or surgery to prevent the ovaries from making estrogen. This stops menstrual periods and lowers hormone levels in the body (similar to a natural menopause), so the tumor can’t get the estrogen it needs to grow.
Ovarian suppression is always given in combination with tamoxifen or an aromatase inhibitor [10]. It’s not used instead of these therapies. So, having ovarian suppression doesn’t mean you can avoid taking tamoxifen or an aromatase inhibitor.
Who can be treated with ovarian suppression?
Ovarian suppression is only an option for premenopausal women.
It’s not helpful in postmenopausal women because the ovaries don’t make much estrogen after menopause.
Types of ovarian suppression
Drug therapy
Ovarian suppression drugs, such as leuprolide (Lupron) or goserelin (Zoladex), can stop the ovaries from making estrogen.
In most cases, once drug therapy is stopped, the ovaries begin making estrogen again.
To learn more about a specific ovarian suppression drug, visit the National Institutes of Health’s Medline Plus website.
Surgery
Surgical removal of the ovaries (oophorectomy) stops the production of estrogen and progesterone, which ends menstrual periods for good and leads to early menopause.
Learn more about early menopause and how to manage its symptoms.
Ovarian suppression, tamoxifen and aromatase inhibitors
Some younger, premenopausal women at high risk of breast cancer recurrence may benefit from treatment with ovarian suppression plus tamoxifen or an aromatase inhibitor [10,92,100,133-135]. Ovarian suppression is always given in combination with one of these drugs.
Talk with your health care provider about whether ovarian suppression is right for you.
Combined with tamoxifen
Standard treatment for premenopausal women with hormone receptor-positive breast cancer is tamoxifen for 5-10 years, with or without ovarian suppression. Ovarian suppression (with drug therapy) is given for 5 years [10].
Combined with an aromatase inhibitor
Aromatase inhibitors don’t normally work in premenopausal women because their ovaries are still making estrogen.
Ovarian suppression shuts down the ovaries. So, premenopausal women can take an aromatase inhibitor for 5 years when combined with ovarian suppression [10]. Ovarian suppression (with drug therapy) is given for 5 years [10].
Side effects of ovarian suppression combined with tamoxifen or an aromatase inhibitor
Watch our MBC Impact Series, Metastatic Breast Cancer and Sexual Health. Although this webinar was created for women who have metastatic breast cancer, it has helpful information about sexual health for women with any stage of breast cancer. We encourage all to watch.
Ovarian suppression combined with tamoxifen or an aromatase inhibitor causes more side effects from the loss of estrogen than the use of tamoxifen or an aromatase inhibitor alone [133-134].
Before you begin treatment with ovarian suppression combined with tamoxifen or an aromatase inhibitor, talk with your health care provider about possible side effects and how to manage them.
Under study
Some findings show ovarian suppression plus an aromatase inhibitor may reduce breast cancer recurrence better than ovarian suppression plus tamoxifen [136].
Ovarian suppression after treatment with chemotherapy
Some women at high risk of breast cancer recurrence who remain premenopausal after chemotherapy may be given ovarian suppression in combination with tamoxifen or an aromatase inhibitor [137-138]. This may improve survival in some women [137-138].
Treatment guidelines
Although the exact treatment for breast cancer varies from person to person, evidence-based guidelines help make sure high-quality care is given. These guidelines are based on the latest research and agreement among experts.
The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) are respected organizations that regularly review and update their guidelines.
In addition, the National Cancer Institute (NCI) has treatment overviews.
Talk with your health care team about which treatment guidelines they follow.
After you get a recommended treatment plan from your health care team, study your treatment options. Together with your health care team, make thoughtful, informed decisions that are best for you. Each treatment has risks and benefits to consider along with your own values and lifestyle.
Updated 04/12/24
