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Ovarian Ablation

By

Megan Freedman

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.

Medication

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.

Oophorectomy

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:

The specific risks of oophorectomy surgery include: