Temporary ovarian suppression with a gonadotropin-releasing hormone agonist is an effective strategy for preserving fertility in women receiving chemotherapy.
Ovarian suppression of estrogen production reduces the recurrence rate in hormone receptor positive early breast cancer patients who are pre-menopausal.
Ovarian suppression uses drug therapy or surgery to prevent the ovaries from making estrogen.
Ovarian suppression stops menstrual periods and lowers hormone levels in the body similar to a natural menopause.
Ovarian suppression can slow the growth of hormone receptor-positive breast cancer in premenopausal women.
Ovarian suppression is always given in combination with tamoxifen or an aromatase inhibitor.
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.
In premenopausal women randomized to receive chemotherapy or non-chemotherapy and five years of tamoxifen or tamoxifen plus ovarian suppression or aromatase inhibitor plus ovarian suppression: heading ovarian suppression to tamoxifen does not provide a significant benefit and women who receive chemotherapy and who remained premenopausal the addition ovarian suppression improved disease outcome (SOFT Investigators).
Gonatropin releasing hormone agonists given concurrently with chemotherapy can effectively prevent early menopause in premenopausal patients receiving therapy for early breast cancer.
Chemotherapy is associated with a risk of ovarian dysfunction, permanent or transit amenorrhea, infertility, and symptoms of menopause with a premature onset.
Associated with the premature onset of menopause includes osteoporosis, loss of libido, increased cardiovascular risk, and atrophic vaginitis.
Exemestane/ovarian suppression group versus a tamoxifen/ovarian suppression group revealed the former had a higher overall survival is early breast cancer.
The greatest benefit from ovarian suppression plus endocrine therapy in early breast cancer is seen in women younger than 35 years.
Chemotherapy agents, particularly alkylating agents and topoisomerase inhibitors, induce DNA double strand breaks in primordial follicle oocytes triggering apoptotic death.
Ovarian failure is the last manifestation of chemotherapy induced infertility.
Ovarian suppression plus endocrine therapy is generally administered for at least five years for early breast cancer.
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 when the drug therapy is stopped, the ovaries begin making estrogen again.
Surgery
An oophorectomy stops the production of estrogen and progesterone.
This ends menstrual periods for good and leads to early menopause.
Ovarian suppression is combined with tamoxifen or an aromatase inhibitor in hormone receptor positive breast cancer,
Some younger, premenopausal women at high risk of breast cancer recurrence may benefit from treatment with ovarian suppression plus tamoxifen or an aromatase inhibitor.
Ovarian suppression alone is not a standard substitute for tamoxifen or an aromatase inhibitor.
Standard treatment for premenopausal women with hormone receptor-positive breast cancer is tamoxifen for 5-10 years, with or without ovarian suppression.
Ovarian suppression shuts down the ovaries, premenopausal women can take an aromatase inhibitor when combined with ovarian suppression.
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.
Ovarian suppression plus an aromatase inhibitor may reduce breast cancer recurrence better than ovarian suppression plus tamoxifen.