Ovarian suppression

To try to:

• Stop your estrogen receptor positive (ER+) breast cancer from returning OR
• Shrink your breast cancer and stop it from spreading to other parts of the body.

Two ovarian suppressants are available: leuprolide (Lupron®) and goserelin (Zoladex®).

Ovarian suppressants put you into an artificial menopause. Depending on your age and whether you had chemotherapy, your periods may come back when this medication is stopped.

Leuprolide is a gel injected into the buttock, and goserelin is a small pellet injected under the skin of the abdomen ('tummy area'). Both are given by a trained nurse or doctor.

This medication is usually prescribed at a dose that is injected every 4 weeks. It is important that you get your injection on time to stop your ovaries from making estrogen again.

Pain and irritation at the injection site

• You may get red, itchy and bruised at the injection site. This will get better over time.
• You can put a heating pad on the injection site to help with pain.

Hot flashes

• Wear light clothes and avoid alcohol, caffeine, and sugar to reduce symptoms.
• Exercise helps decrease these symptoms.

Joint stiffness and aches

• You may get body aches but these usually do not need to be treated.
• Exercise helps reduce these symptoms.

Bone thinning

• Bone density can decrease on this treatment.
• Low bone density raises your risk of breaking a bone later in life.
• It is important to take in enough calcium (1200 mg) and vitamin D (1,000–2,000 IU) every day to reduce bone loss. This can be taken through your diet and/or supplements.
• Weight bearing exercise and medications can help maintain bone density.
• Your doctor may order a test to check your bone density.

Vaginal bleeding

• It is common to have vaginal bleeding or spotting when you start on ovarian suppression.
• You may get 1 to 2 menstrual periods after you start treatment.

Some natural health products contain estrogen and should not be used with estrogen-lowering medications. Speak with a pharmacist and/or your doctor before you take other prescription medications, supplements, or natural health products.

Severe side effects are rare with fulvestrant. If you are worried that your symptoms might be caused by this medication, tell your nurse or doctor right away.

Severe side effects are rare with ovarian suppression. If you are worried that your symptoms might be caused by this medication, tell your nurse or doctor right away.

Approximately 80 per cent of breast cancers have 'estrogen receptors' (ER) on the cancer cells. These ER+ cancers are fed by the female hormone estrogen, which attaches to the ER. The ovaries are the main source of estrogen in women who still have menstrual periods. This medication lowers estrogen levels by signalling the ovaries to stop making it. This helps stop the growth of breast cancer cells. Menstrual periods will also stop.