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Ovarian Suppression: Early Menopause, Late Effects

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Abstract

Purpose of Review

Pre-menopausal women diagnosed with hormone receptor (HR) breast cancer are candidates for prolonged hypoestrogenism to improve cancer outcomes. However, the disease benefit eclipses the toxicities associated with ovarian function suppression (OFS), which are often under-reported.

Recent Findings

Increased risk of mortality from cardiovascular disease, bone disorders, and metabolic disorders is well reported in women with no history of cancer, after surgical oophorectomy or premature ovarian failure. Vasomotor symptoms, urogenital atrophy, weight gain, sexual dysfunction, cognitive decline, and sleep disturbances contribute to the increased non-compliance associated with OFS, especially in younger women.

Summary

Balancing the toxicities of prolonged OFS with its benefits should be critically analyzed by providers when making recommendations for their patients. Supportive care to manage multi-system toxicities and to counteract the long-term impact on all-cause mortality should be emphasized by every cancer program. Future studies with OFS should incorporate patient outcomes and strategies for symptom management in addition to focusing on improving disease outcomes.

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Authors and Affiliations

  1. Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Chaya Goldberg, Megan R. Greenberg & Alexandra Noveihed

  2. Norton Cancer Institute, Louisville, KY, USA

    Laila Agrawal

  3. Rutgers Cancer Institute of New Jersey, Rutgers, 195 Little Albany Street, New Brunswick, NJ, 08901, USA

    Coral Omene, Deborah Toppmeyer & Mridula A. George

  4. The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA

    Mridula A. George

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  1. Chaya Goldberg
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Correspondence to Mridula A. George.

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Chaya Goldberg MD, Megan R. Greenberg, MD, Alexandra Noveihed, MD, Coral Omene Deborah Toppmeyer, Mridula A George declare no relevant conflict of interest. Laila Agarwal, MD declares consulting fees from Astra-Zeneca/Daiichi, Immunomedics, Breast Cancer Index, Pfizer; Payment or honoraria from Lilly USA; Leadership role in After Cancer–Solutions for Sexual Health (unpaid).

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Goldberg, C., Greenberg, M.R., Noveihed, A. et al. Ovarian Suppression: Early Menopause, Late Effects. Curr Oncol Rep 26, 427–438 (2024). https://doi.org/10.1007/s11912-023-01491-5

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