The Who, What, Where, When and Sometimes, Why.

Ovarian Suppression

Ovarian suppression can slow the growth of hormone receptor-positive breast cancer in premenopausal 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. It’s not used instead of these therapies.

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.

This ends menstrual periods for good and leads to early menopause.

Learn more about early menopause and how to manage its symptoms.

Ovarian suppression combined with tamoxifen or an aromatase inhibitor

Some younger, premenopausal women at high risk of breast cancer recurrence may benefit from treatment with ovarian suppression plus tamoxifen or an aromatase inhibitor [6,81].

Ovarian suppression alone is not a standard substitute for tamoxifen or an aromatase inhibitor.

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 [6].

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 5-10 years when combined with ovarian suppression [6].

Side effects of ovarian suppression combined with tamoxifen or an aromatase inhibitor

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 [81,112-113].

Talk with your provider about whether ovarian suppression is right for you.

Under study

Some findings show ovarian suppression plus an aromatase inhibitor may reduce breast cancer recurrence better than ovarian suppression plus tamoxifen [81].

Ovarian suppression and chemotherapy

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 [114]. This may improve survival in some women [114].

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