Ovarian Suppression: Early Menopause and Late Effects

Curr Treat Options Oncol. 2024 Apr;25(4):523-542. doi: 10.1007/s11864-024-01190-8. Epub 2024 Mar 13.

Abstract

Around 90% of breast tumours are diagnosed in the early stage, with approximately 70% being hormone receptor-positive. The cornerstone of adjuvant therapy for early-stage hormone receptor-positive breast cancer is endocrine therapy, tailored according to disease stage, biological characteristics of the tumour, patient's comorbidities, preferences and age. In premenopausal patients with hormone receptor-positive breast cancer, ovarian function suppression is a key component of the adjuvant endocrine treatment in combination with an aromatase inhibitor or tamoxifen. Moreover, it can be used during chemotherapy as a standard strategy for ovarian function preservation in all breast cancer subtypes. In the metastatic setting, ovarian function suppression should be used in all premenopausal patients with hormone receptor-positive breast cancer to achieve a post-menopausal status. Despite its efficacy, ovarian function suppression may lead to several side effects that can have a major negative impact on patients' quality of life if not properly managed (e.g. hot flashes, depression, cognitive impairment, osteoporosis, sexual dysfunction, weight gain). A deep knowledge of the side effects of ovarian function suppression is necessary for clinicians. A correct counselling in this regard and proactive management should be considered a fundamental part of survivorship care to improve treatment adherence and patients' quality of life.

Keywords: Breast cancer; Endocrine treatment; Ovarian suppression; Young patients.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Agents, Hormonal / therapeutic use
  • Breast Neoplasms* / drug therapy
  • Breast Neoplasms* / etiology
  • Breast Neoplasms* / pathology
  • Chemotherapy, Adjuvant / adverse effects
  • Female
  • Humans
  • Ovary / pathology
  • Premenopause
  • Quality of Life*
  • Tamoxifen / therapeutic use

Substances

  • Tamoxifen
  • Antineoplastic Agents, Hormonal