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Is there an alternative oral medication for ovarian suppression instead of the zoledex implant?


Is there an alternative oral medication for ovarian suppression instead of the zoledex implant?

Hi, I was diagnosed with ER + 8\8, DCIS, stage II, requiring a full mastectomy plus level 3, lymph node clearance in 2017.  I had chemotherapy, radiotherapy and ovarian suppression with exemestane and zoledex and IV zometa every 6 month (this finishing next year).

I was informed by my consultant at the time, to take exemestane and zoledex for 5 years for ovarian suppression. Then last year a new consultant told me i should stay on them for 10 years. However my specialist nurse suggests that I will need zoledex for longer or require a hysterectomy, as this will reduce my estrogen as i am only 38 years old?

Please can you advise me on this?

Obviously my overall goal is to remain cancer free and reduce reoccurance.  However surely there is something kinder i can be offered instead or zoledex every 28 days? My poor abdomen is like leather!  Not sure it can cope with 2 more years Or potentially 7 years?!?!

Or can i stop all after 5 years? What is the current protocol?  Research suggests that this treatment is mainly for secondary breast cancer treatments?

Please help?

Many thanks, Emma x


Hello Emma

Thank you for your post.

Ovarian suppression and hormone therapy does reduce the risk of breast cancer recurrence. Evidence suggests that women who remain premenopausal after chemotherapy may benefit most from ovarian suppression. This is most commonly achieved with Zoladex injections which is often combined with a hormone therapy such as tamoxifen or an aromatase inhibitor (AI) like exemestane. The choice of AI will vary.

Two of the main trials looking at this are TEXT and SOFT. In these trials’ hormone therapy was given for five years. However, clinical trials have demonstrated that some postmenopausal women may benefit from taking an AI for up to 10 years. Guidance from the European School of Oncology suggests we can treat premenopausal women using ovarian suppression as postmenopausal women. There may be some variations in how long treatment is given for according to someone’s individual situation. 

Aromatase inhibitors are not used on their own as hormone treatment in premenopausal women because they are not an effective treatment while the ovaries are still making oestrogen. This means you will need ovarian suppression while you still are premenopausal. This is something that is really best discussed with your own treatment team and you can make the decision whether to continue with treatment.  

I imagine the thought of continuing monthly injections for you is distressing, as you say your abdomen is so sore. There isn’t an oral alternative unfortunately. The alternative would be oophorectomy (surgical removal of the ovaries). This would lead to an immediate and irreversible menopause but for some women would be preferable to many more years of Zoladex injections. 

It might help to connect with other younger women with breast cancer. We are currently planning an online service for younger women. For more information, you can contact our team co-ordinating these events on 0345 077 1893.

You may be interested in the Younger Breast Cancer Network (YBCN) which is a private Facebook group run by young women for young women (under 45) who’ve had breast cancer and you will find a number of women on the same drug combination as you are having.

If you have any further questions or would like to talk things through do give us call. Your call will be confidential, and the number is free from UK landlines and all mobile networks.

The number is 0808 800 6000 (Text relay prefix 18001).

Our opening hours are Monday to Friday 9am - 4pm and 9am -1pm on Saturday. Out of hours you can leave a message and we will call you back when we next open.

Kind regards


Breast Care Nurse

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