A-Z

Breast Cancer in women

Ovarian ablation (removing or shutting down the ovaries)

Hormonal therapies are treatments which either reduce the levels of hormones in the body or block their effects on cancer cells. They are often given after surgery, radiotherapy and chemotherapy for breast cancer to reduce the chance of the cancer coming back.
 
Hormonal therapies are only effective in women whose cancer cells have receptors for oestrogen and/or progesterone on their surface. This is known as being oestrogen-receptor positive (ER+) or progesterone-receptor positive (PR+). It means that the breast cancer cells are affected by oestrogen or progesterone. These are female hormones that the body produces naturally and that can stimulate breast cancer cells to grow. When a cancer is removed and the tissue is studied in the laboratory, testing for whether these hormonal receptors are present is one of the checks that are normally done.
 
There are many different types of hormonal therapy and they work in slightly different ways. Hormonal therapies for breast cancer include the drug tamoxifen which is from a group of medicines known as a SERM (selective oestrogen receptor modulator). These block the effect of oestrogen on tissue receptors. Another family of drugs which act to reduce hormone levels are the medicines known as aromatase inhibitors (these drugs work by blocking the aromatase enzyme which converts androgen hormones into oestrogen and so they reduce the amount of oestrogen in the body). These do not block the effect of oestrogen from your ovaries, and so are only effective in women whose ovaries have stopped making oestrogen – someone has gone through their menopause either naturally or after surgery to remove the ovaries. Other hormonal treatments work by stopping the ovaries from producing hormones. This can either be through medical therapy, for example having a medicine called zoladex (goserelin) which switches off the ovary, or through surgical therapy, which would involve removing the ovaries.
 
Which hormonal therapy is best for each woman depends on several factors, including:
 
•          A woman’s age
•          whether a woman has had her menopause (change of life)
•          the stage and grade of the cancer
•          which other treatments are being used

Ovarian ablation is treatment that stops or lowers the amount of the hormone estrogen made by the ovaries. This includes surgery to remove both ovaries, radiation therapy, and the use of certain drugs to ‘shut down’ the ovaries such as Zoladex (goserelin). In some breast cancers, known as oestrogen receptor positive breast cancer, oestrogen can stimulate the breast cancer cells to grow. In women who haven’t yet reached their menopause, the ovaries are the main source of oestrogen. Stopping the ovaries from producing oestrogen means there is less of the hormone available in the body. For premenopausal women, research has shown that ovarian ablation after surgery can:
 
  • reduce the risk of the cancer coming back
  • increase chances of survival
  • reduce the risk of getting another new breast cancer.
 
After having ovarian ablation, women are usually prescribed aromatase inhibitors
 
A few younger women we spoke with had had their ovaries removed.
 

Penny chose to have her ovaries removed to reduce her chances of getting breast cancer again. She...

Penny chose to have her ovaries removed to reduce her chances of getting breast cancer again. She...

Age at interview: 47
Sex: Female
Age at diagnosis: 37
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He [doctor] said my treatments would be radiotherapy and I’d be put onto tamoxifen for five years. But that’s all he could really tell me, oh but the oncologist really explained more to be about how that was all going to work. He said, but in addition to that, as an extra precaution because of it being oestrogen positive they wanted to remove my ovaries as well. So straightaway I just said, “Yeah, just do whatever.”  Now I was in a fortunate position, we don’t have children but we had already made our minds up that we weren’t having any children. So to lose my ovaries wasn’t a big thing, which I appreciate it would be too many people.

So I said, “Okay, when will this happen?” So they said, “We’ll be having you back in a week on Monday.” I went, “Oh, okay.” I said, “Well on the Friday of that week,” which was the end of September, I said, “I’m due to go on holiday to Tenerife for two weeks,” and I said, “I can go can’t I?” And he said, “There’s absolutely no reason why you’re not able to go. I said, “Well but if you’re taking my ovaries out, am I going to have stitches? And I’ve got to come back?” And he said, “No.” He said, “Just make sure when you come in, remind the consultant and the doctor that we’re not to stitch you,” he said, “Because it’ll be done through keyhole anyway, and you’re going on holiday.” “Okay.”

 

Having a double mastectomy and her ovaries removed helped Tess feel that she was doing something...

Having a double mastectomy and her ovaries removed helped Tess feel that she was doing something...

Age at interview: 38
Sex: Female
Age at diagnosis: 33
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The two operations, both the mastectomy and then the oophorectomy, the taking the ovaries out, they felt very different because they felt prophylactic. You know I suppose I felt a little bit more in control, like I was doing something, I wasn’t just getting rid of disease, I was doing something kind of to help myself in the future. And so I felt, you know, I think that sort of feeling in control made me feel quite, it wasn’t so scary. And I guess inevitably it’s not so scary because you just feel like you’re just, you’re sort of dealing with possibility rather than actual certainty, having to have it done. So I think it, and again I felt for both those operations.

Surgery to remove the ovaries is known as an oophorectomy. The operation is usually done using laparoscopic or keyhole techniques. This involves using a laparoscope – a thin, flexible tube with a light and magnifying lens at the tip. It enables the surgeon to look into the abdomen (tummy). The surgery usually involves a general anaesthetic. Two or three small cuts are made into the skin and muscle of the abdomen to allow the laparoscope and other instruments to be inserted. Most women will be in hospital one or two days.

 

Penny described what happened when she went to hospital to have her ovaries removed. She felt a...

Penny described what happened when she went to hospital to have her ovaries removed. She felt a...

Age at interview: 47
Sex: Female
Age at diagnosis: 37
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I was asked to go in in the morning to have the ovaries removed. And just went in, and my husband came in with me and sat with me. And they told me I was going to be going down to theatre in the afternoon, which you think, through hanging around. And they explained that they would just be making an incision below my belly button and then sort of one either side, just by my hip bones so to speak. And they would put a camera in and then they would be removing them in whatever way they do through the keyhole. And they said afterwards you may or may not have a drain in, it all depends what was, depending on your surgeon as well I think. And you will, might have some discomfort. But it won’t last anyway, and should be out either on the same day or the following day.

But because I didn’t go down till late afternoon as it turned out, by the time I came back from theatre it was about six or seven o’clock in the evening. And I remember I came to pretty quickly and, nothing like the mastectomy. Came through very quickly. I do remember being in the recovery room and as I came, I can remember them bringing me round and they said, “Oh how do you feel?” And I was in some discomfort. And I can remember the nurse going off and getting me some pain relief.

Anyway I was back on the ward and my parents came to visit, as did my husband. And anyway I can remember just laying there, but every time I moved there was a lot of discomfort. And it was just like a really, really, really bad tummy ache and period pains really. And I just thought, “Oh gosh, Oh gosh, how long is this going to last for?” And the nurse came over and she said, “Are you okay?” And I said, “I am in some discomfort.” And because they had already given me some pain relief from theatre, she said the only thing they could do was give me like a, I can never say the word, oh not depositary. I can’t say the word, oh, but it’d be, it’d be inserted into, if you like your back passage. I went, “No thank you. I’ll deal with the pain [laughs]. I’m fine thank you.” And I can just remember laughing, everybody was just laughing at me.

I can remember then when every, after visiting, and trying to move and I did have a drain in as well. And I thought, “Oh great.” But okay it was for a reason. Then I can remember the nurse coming round and saying you know, “Once you’re up and about walking, we’ve got to get you walking. So tomorrow we can get you home.” That was the cue for me. “Right, what do you want me to do?”

And then my legs weren’t you know, anyway, it absolutely killed me to get, and I put my legs on the side of the bed and got up and walked. Walked around and got back into bed. And then I can remember during the night, I needed to go down and use the bathroom. So I called the nurse over to say I needed to go up to the bathroom, so she said, “Oh,” she said, “We’ll get you a bedpan if you wish?” “No thank you, I’ll walk.” Because I thought the more I walk, oh, and I shuffled my way along, and anyway and made my way up there and made my way back.

And in the morning they came round and thankfully I’d done that because, when they did the ward round, they said that I had got up during the night, and I’d walked. And so they were really pleased about that. My drain was brilliant; there was hardly anything in that. So yeah, I could go home that afternoon.

So later they phoned my husband up so they could bring me some clothes. Because that was the other thing, my tummy was very extended and very sore. And so I went in stupidly in a pair of jeans, and I had to come out in a more of a smocky type dress. And that was great, because it was a dress of my Mum’s that’s she’d

 

Tess had her ovaries removed in the morning and was out of hospital the same day. She found the...

Tess had her ovaries removed in the morning and was out of hospital the same day. She found the...

Age at interview: 38
Sex: Female
Age at diagnosis: 33
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Having the ovaries out was just a laparoscopic surgery, so it was just done by a camera and it was yeah, it was done one morning. I was home, I was sort of sat in a bed that afternoon. They said I could go home at 3, but I said could I not wait until the children were in bed because I didn’t feel, I felt great but I didn’t feel strong enough to sort of put my children to bed. So actually my husband came to get me about 7.30. It was a beautiful sunny evening and I think that was the sort of a high point of my treatment that I felt it was, yeah it was very straightforward. And I didn’t have really very many side effects at all. And it felt very easy.

And how long did it take to be up and running, back to normal?

So I think I took two weeks off work, and that was fine. Because sort of, almost, just it was more to getting over the anaesthetic, and you did, do definitely have a sort of feeling very good for a few days after the anaesthetic, and then you slump. It’s sort of like someone’s sort of taken all the juice out of you and you’re just like, but I think a lot of that’s the anaesthetic. And the operation itself was, and I think it’s straightforward and the scars were just tiny. I had one on my belly button and one about half an inch long lower down. So it wasn’t , it didn’t seem, and I suppose when you’ve had quite a bit of messing around inside you, I didn’t feel very, it didn’t feel bad at all actually.

Removing the ovaries with surgery produces an immediate and permanent menopause. This means that periods stop straight away and women may experience typical menopausal symptoms.

 

Penny didn’t know if the symptoms she had were because of the menopause or side effects of...

Penny didn’t know if the symptoms she had were because of the menopause or side effects of...

Age at interview: 47
Sex: Female
Age at diagnosis: 37
SHOW TEXT VERSION
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For tamoxifen I felt maybe quite lethargic. Because I was going through the menopause anyway, so I couldn’t say whether it was the menopause giving me the hot flushes or the tamoxifen. Or if I just had a double whammy, but I did have the hot flushes, and to the extent I still do. But it was explained to me that, because of my ovaries being surgically, obviously being removed, I was going to have a surgically induced menopause really. So it did come on very quickly. So I and also, what else? I sort of had achy bones, achy limbs as well, which caused me a bit of concern at one point. Which I had some tests done but everything was absolutely fine.

And then the Arimidex I think has been better for me personally. Yes, so hot flushes, but that’s the menopause. And also as part of the menopause you go through the vaginal dryness, and so I can’t really say whether it’s the Arimidex that’s caused it or because of my menopause. But overall I think I’ve been one of the luckier ones, that I haven’t had major side effects. I know I have got friends that get very bad headaches and suffer extremely badly and, I have to say, I can’t really think of anything that’s really, really bad. I think for me it’s more been the hot flushes and yeah your body, and weight gain.

When I was diagnosed I was a very small size 10, and now I’m more of a sort of a 14 top and a size 12 bottom. But it’s the tummy and the hips which are harder to move. And again that can be a side effect, but I think mine has been a combination of both. So it would be interesting to see if I come off the Arimidex if it, how I would feel after that.

And you’ll find out about that next week?

Next week. Yes. Yeah.

How would you feel about coming off the Arimidex?

It’s interesting isn’t it? Because about a couple of years ago I thought, when I thought I was going to be taken off it, I was still unsure because it was my safety net. But now I think I’ve been just thinking it through and working my way through to the fact that, at ten years, that’s a fantastic mile stone. And if anything was going to go wrong, it was going to go wrong before now. And I feel, and I think we don’t know if the Arimidex is doing me any good or whether it’s not. It could be doing me more harm because there’s nothing to say at the moment.

And so I’ve really sort of resigned myself now, that if I come off it that is really good news I think. And I hope that perhaps I might lose a little bit of weight. I don’t know. Maybe the hot flushes may not be as bad, I don’t know. Or I might not see any difference at all. But I was just very positive that here I am, and I’ve, yeah, I’ve worked myself through now that ten years, so it’s a bit like the milestone really.


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Last reviewed August 2018.
Last updated August 2018.

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