What is ovarian ablation?
Ovarian ablation is the shutdown of ovarian function in order to suppress the production of hormones. Doctors most commonly recommend ovarian ablation to help treat hormone-dependent breast cancer in women who have not yet reached menopause. Because estrogen makes hormone-dependent breast cancers grow, eliminating estrogen production in the body can help shrink breast cancer tumors, prevent spread of breast cancer, and lower the chances of its recurrence.
Ovarian ablation may temporarily or permanently shut down your ovaries, depending on the technique your doctor recommends. If your doctor removes your ovaries or permanently shuts down ovarian production with radiation, you will enter menopause and stop having reproductive functions. This means you will no longer have a menstrual period or be able to get pregnant.
Ovarian ablation is a common but serious medical technique with significant risks and potential complications. It is only one method used to treat breast cancer. Ask your doctor about your options to understand which option is best for you.
Types of ovarian ablation
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There are three methods of ovarian ablation:
Medication therapy chemically suppresses the production of estrogen and other hormones from the ovaries. The most common medications used for this purpose are goserelin (Zoladex) and leuprolide (Lupron). Your ovaries may resume hormone production a few weeks to a few months after you stop taking the medication.
Surgery to remove the ovaries is called an oophorectomy. After this irreversible procedure, you will enter menopause, stop having periods, and lose the ability to become pregnant.
Radiation therapy permanently shuts down ovarian function. Doctors rarely use radiation to destroy ovarian function.
Why is ovarian ablation performed?
Your doctor may recommend ovarian ablation to treat certain types of breast cancers that grow in response to the hormone estrogen. Doctors use ovarian ablation most commonly to help treat hormone-dependent breast cancer in premenopausal women with normal ovarian function. Shutting down the ovaries drastically reduces estrogen production in the body. This can help shrink breast cancer tumors, prevent the spread of breast cancer, and lower the chances of its reoccurrence.
Other types of breast cancer treatment include mastectomy and chemotherapy, as well as hormone therapy. Hormone therapy blocks the action of estrogen—drugs include tamoxifen (Nolvadex) and fulvestrant (Faslodex).
Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on ovarian ablation.
Who performs ovarian ablation?
A number of different types of doctors can perform ovarian ablation in a hospital, surgical center, or medical office. The location and doctor involved in your ovarian ablation depends on the treatment method that you and your doctor choose.
One of the following specialists will perform your ovarian ablation:
Obstetrician-gynecologists specialize in women’s reproductive health and pregnancy.
Oncologists and gynecologic oncologists specialize in diagnosing, treating and preventing cancer. Gynecologic oncologists are surgeons who further specialize in treating cancers of the female reproductive system.
General surgeons specialize in the surgical treatment of a wide variety of diseases, disorders and conditions.
Radiologists specialize in using radiation and other imaging techniques to diagnose and treat a wide variety of conditions from broken bones and birth defects to cancer.
How is ovarian ablation performed?
There are three methods of ovarian ablation. Discuss the different treatments with your doctor or healthcare provider to understand which option is right for you.
Hormone therapy temporarily suppresses estrogen production from the ovaries. Goserelin (Zoladex) and leuprolide (Lupron) are the most common medications used for this. Both medications are injections given once a month for several months. Leuprolide is also available as a long-lasting depot injection that only needs to be given every few months. Your ovaries may resume producing estrogen a few weeks to a few months after you stop receiving the injections. This may be an advantage for women who still want to bear children after treatment.
An Ob/Gyn, gynecologic oncologist, or general surgeon leads a surgical team to perform an oophorectomy in a hospital. Your surgeon performs the procedure by making an incision in your lower abdomen. Your ovaries and possibly your fallopian tubes are removed.
You will most likely receive general anesthesia for your surgery. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
You may have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion involves an injection or a continuous drip of a liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Your doctor will use one of the following surgical approaches:
- Minimally invasive surgery is performed by inserting special instruments and a laparoscope through small incisions in the abdomen. The laparoscope is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a video screen. Your surgeon sees the inside of your abdomen on the video screen as he or she performs the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery because it causes less trauma to tissues and organs. Your surgeon will make two or three small cuts instead of a larger one used in open surgery. Your surgeon threads surgical tools around many structures, such as muscle and tissues, instead of cutting through or displacing them as in open surgery.
- Open surgery is performed by making a larger incision in the lower abdomen. An open surgery incision allows your surgeon to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. This is because it causes more trauma to muscle and tissues. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.
Your surgeon may decide after beginning a minimally invasive procedure that you require an open surgery to safely and most effectively complete your surgery. Your surgeon will determine which type of surgery is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different oophorectomy procedures. Ask why your surgeon will use a particular type of procedure for you.
Radiation (Ovarian Irradiation)
For radiation therapy, or radiotherapy, a radiologist or radiologic technician applies concentrated X-rays to your ovaries. This permanently stops their production of estrogen. It is the least common technique for ovarian ablation. Radiation therapy is typically given in a hospital. It does not involve staying overnight. It takes several days of treatments to complete the ablation.
What are the risks and potential complications of ovarian ablation?
Ovarian ablation involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during the procedure or treatment, or throughout your recovery.
General complications of ovarian ablation
All three methods of ovarian ablation result in early menopause. Menopause symptoms and complications include:
Anxiety and mood swings, which can interfere with your daily life and become debilitating
Higher risk of heart disease, which is sometimes prevented or minimized while your body produces estrogen
Hot flashes and night sweats, which are often described as a sudden sensation of warmth, flushing and sweating
Osteoporosis, or thinning bones, which is a complication of menopause
Sleep problems, including insomnia or sleeplessness
Vaginal dryness, which cause burning, irritation, and painful sexual intercourse
Complications of oophorectomy
The general risks of any surgical procedure include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
The specific risks of oophorectomy surgery include:
Damage to nearby abdominal organs, such as the uterus or intestines
Development of an intestinal blockage
Complications of medication
The risks of hormonal therapy for ovarian ablation include:
Complications from too little hormonal medication
Infection that develops at an injection site
Pain or discomfort at the injection site
Side effects from too much hormonal medication
Side effects not related to dose. For example, injections can cause skin changes including abnormal bumps, dents or thickening of your skin.
Complications of radiation
The risks of radiation therapy for ovarian ablation include:
Abdominal pain or discomfort
Exposure to ionizing radiation, which may harm normal tissues while treating diseased tissues
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Exercising and eating a healthy diet
Following activity, dietary and lifestyle restrictions and recommendations before, during and after surgery or treatment
Getting bone density testing performed as recommended to help detect early osteoporosis. Your doctor will discuss your treatment options with you. This can include bone-strengthening drugs.
Informing your doctor if you are nursing or there is any possibility that you may be pregnant
Losing weight if you are overweight. This will help keep you as healthy as possible and may reduce your risk of heart disease and of bone fractures.
Notifying your doctor immediately of any concerns after surgery, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Stopping smoking. This can help reduce the risk of osteoporosis and heart disease.
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my ovarian ablation?
You are an important member of your own healthcare team. The steps you take before surgery or treatment can improve your comfort and outcome. You can prepare for ovarian ablation by:
Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative or pretherapeutic testing as directed. Testing will vary depending on your age, health, diagnosis, stage of cancer, and specific procedure. Testing may include a mammogram, chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing weight before surgery or treatment through a healthy diet and exercise plan
Not eating or drinking just prior to an oophorectomy as directed. Your doctor may cancel your surgery if you eat or drink too close to the start of the procedure because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible.
Taking or stopping medications exactly as directed. For oophorectomy, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing any type of ovarian ablation can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with questions or concerns before your procedure or treatment begins and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need ovarian ablation? What are all my options for treating my condition?
What type of ovarian ablation will I need?
What is the likelihood of permanent infertility after my ovarian ablation?
How long will the procedure or treatment take? When can I go home?
What kind of restrictions will I have after the ovarian ablation? When can I expect to return to work and other activities?
What kind of assistance will I need at home?
What medications will I need before and after the surgery?
How will you manage my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my ovarian ablation?
Knowing what to expect can help make your road to recovery after ovarian ablation as smooth as possible.
How long will it take to recover?
Recovery after ovarian ablation is a gradual process. Recovery time varies depending on the specific procedure, your general health, age, and other factors. Full recovery time varies depending on the method involved:
Medication therapy has side effects, such as fatigue and mood changes, which generally go away after treatment is finished. Once your doctor stops the medication, your ovaries may resume producing hormones a few weeks to a few months later if you have not yet reached natural menopause.
Oophorectomy may require a few weeks to a few months to fully recover. After the surgery, you will stay in the recovery room until you are alert, breathing effectively, and your vital signs are stable. Minimally invasive oophorectomy typically involves a one- to two-night stay in the hospital. Open oophorectomy involves staying an additional night or two.
Radiation therapy may have side effects, such as fatigue, abdominal pain, and diarrhea. These generally go away within a few weeks. The ovaries may continue producing hormones for up to a few months after radiation therapy. Your periods may continue until then.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There may be discomfort during your treatment or after your oophorectomy. Your doctor and care team will manage your pain so you are comfortable and can get the rest you need. Contact your doctor if your pain or discomfort gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after ovarian ablation. Call your doctor if you have questions or concerns between appointments. If you had an oophorectomy, call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate, pass gas, or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Numbness or tingling in the affected extremity
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
How might ovarian ablation affect my everyday life?
Ovarian ablation may help cure your breast cancer or lengthen your life with breast cancer. Ovarian ablation can also cause significant changes to your body that may affect your everyday life including:
Early menopause. Symptoms of early menopause can be mild to severe and include vaginal dryness, painful sexual intercourse, sleep problems, hot flashes, and mood swings. Early menopause may be treated with hormone replacement therapy (estrogen therapy).
Loss of childbearing ability. Some women report feeling a deep sense of loss after a oophorectomy, especially if they still planned to bear children. Tell your healthcare provider if you are concerned about these feelings.
Sexual changes. Some women report painful sex or a loss of orgasm during sex after menopause. See your healthcare provider if you experience pain with intercourse or are not enjoying sex.
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- Ovarian ablation and breast cancer. Macmillan Cancer Support. http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Breast/Treatingbreastcancer/Hormonaltherap....
- Ovarian Shutdownor Removal. Breastcancer.org. http://www.breastcancer.org/treatment/hormonal/ovary_removal.jsp.