Definition
Ovarian suppression refers to the intentional reduction or cessation of ovarian function to decrease estrogen production, often as part of hormone-sensitive cancer treatment or fertility preservation strategies.
Purpose in Oncology
- Primarily used in pre-menopausal women with hormone receptor–positive breast cancer to reduce estrogen-driven tumor growth.
- Can also be used for fertility preservation during chemotherapy.
Methods of Ovarian Suppression
| Method | Description | Duration | Reversibility |
|---|---|---|---|
| GnRH/LHRH agonists | Drugs like goserelin, leuprolide, triptorelin suppress pituitary stimulation → ↓ ovarian estrogen production | Usually given monthly or quarterly injections | Reversible upon discontinuation |
| Oophorectomy | Surgical removal of ovaries | Permanent | Irreversible |
| Ovarian irradiation | Radiation to ovaries to suppress function | Usually permanent | Irreversible |
Common Agents & Dosing
| Agent | Dose/Administration | Notes |
|---|---|---|
| Goserelin | 3.6 mg SC monthly or 10.8 mg SC q3 months | Used for ovarian suppression in breast cancer |
| Leuprolide | 3.75 mg IM monthly or depot forms available | Similar indications |
| Triptorelin | 3.75 mg IM monthly or 11.25 mg q3 months |
Clinical Indications in Oncology
- Adjuvant treatment for premenopausal hormone receptor-positive breast cancer (often combined with tamoxifen or aromatase inhibitors).
- Neoadjuvant setting in select cases.
- Used in fertility preservation protocols prior to gonadotoxic chemotherapy.
Side Effects
- Menopausal symptoms: hot flashes, night sweats, vaginal dryness
- Bone density loss → increased fracture risk
- Mood changes, fatigue
- Injection site reactions
Monitoring
- Menopausal symptom assessment
- Bone mineral density monitoring (DEXA scan) periodically
- Cardiovascular risk assessment due to hypoestrogenism
- Counseling on contraception as fertility may recover after discontinuation
Practice Pearls
- Ovarian suppression plus endocrine therapy improves outcomes in high-risk premenopausal breast cancer.
- Bone health support (calcium, vitamin D, bisphosphonates or denosumab) is important.
- Patient education on menopausal side effects and supportive care is essential for adherence.
- Reversibility with GnRH agonists allows future fertility potential; surgical methods do not.
Key Takeaway:
Ovarian suppression is a key component of endocrine therapy for premenopausal breast cancer, reducing estrogen production to limit tumor growth, with reversible or irreversible options based on patient preference and clinical scenario.