Ovary pausing (ovarian suppression)
Ovary pausing is using medicine to temporarily stop ovaries from working.
Some studies show that chemo may do less harm to ovaries that are suppressed or not working, such as in kids who haven’t yet gone through puberty.
What are ovaries?
Ovaries are two small organs in your lower belly. You were born with tiny eggs stored in your ovaries. Over time, the number of eggs in your ovaries goes down.
When you go through puberty:
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Hormones such as follicle-stimulating hormone (FSH) cause follicles (sacs in the ovaries) that contain a tiny egg to grow it into a larger, mature egg.
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The mature egg is released from one of your ovaries each month.
If an egg is fertilized (joins) with a sperm, it will implant itself into the wall of the uterus and begin to grow into a baby.
If the egg is not fertilized with sperm, you get your period (menstruation).
Where to start?
Who can choose ovary pausing?
You can think about choosing ovary pausing if:
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You have ovaries.
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You have gone through puberty – meaning you have started your period – and you don’t want to or can’t choose another option that we have more information on, such as egg freezing or ovarian tissue freezing.
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You will get chemo to treat your cancer or blood disease.
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You have any risk level of fertility problems: lower, medium, or higher risk.
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What will I need to do if I choose ovary pausing?
Your doctor will give you a shot:
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Of an ovary pausing medicine called GnRH analogues (such as leuprolide or goserelin)
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Into your buttock, thigh, or arm
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8-14 days before you start chemotherapy, but you can begin at any time
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You will get shots every 1-3 months while you get chemotherapy.
You most likely won’t get your period while you’re getting chemotherapy. This may protect you from thrombocytopenia, a condition that can happen from cancer, treatments, or medicines. People with thrombocytopenia can bleed more easily and it can be harder to stop bleeding if you get a cut.
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When your chemo ends, you will stop getting shots of the medicine.Your ovaries may start working again and your period may return - this could take up to a year after stopping the shots.
Depending on the treatment you had for cancer or a blood disease, your period may not return or may not be regular.
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You could still get pregnant even if your periods stop. So you should still use contraception (such as birth control pills and condoms) if you are having sex.
Ovary pausing is not birth control!
When can I do it? How long does it take?
It is best to get the first shot of ovary pausing medicine 8-14 days before starting chemotherapy so your ovaries have time to stop working. But you can start ovary pausing at any time during treatment.
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If you choose ovary pausing, you will get shots every 1-3 months while you get chemotherapy. Each shot will only take a few seconds.
Ovary pausing is available most places.
Where can I do ovary pausing?
The downsides
What are the side effects of ovary pausing?
The shots may cause pain and bruising where you get the shot.
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They may also cause symptoms that feel like menopause, which many older women get when their periods stop, such as:
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Suddenly getting hot (hot flashes)
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Sweating at night
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Mood swings
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Dryness in your vagina
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Your doctor may be able to give you medicines to lessen these side effects.
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Sometimes the shots can cause lower bone strength (density). Ask your doctor or nurse if you have a high risk of osteoporosis, which is a condition where your bones become brittle and fragile.
What are the risks of ovary pausing?
Risks to you
In rare cases, some patients with very low platelets might develop a hematoma (a pool of blood under the skin) where the needle is put into their skin.
Risks to your ovaries
Doctors don’t currently know of any risks to your ovaries from ovary pausing.
How much does ovary pausing cost?
Ovary pausing medicine is usually covered by insurance. Check with your insurance plan about insurance coverage and costs.
In the future
What happens in the future?
If you decide to have biological children someday, you can try to get pregnant without help from a doctor or fertility clinic if:
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Your ovaries are working.
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Your doctor has said it’s safe for you to try and get pregnant.
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You have a partner that makes sperm.
If you try for 6-12 months and don’t get pregnant, you and your partner should see a fertility specialist. Doctors may suggest fertility treatments like taking medicine to encourage your ovaries to mature eggs.
How well does ovary pausing work?
The medicines doctors use to pause the ovaries have been used for many years to treat conditions such as early puberty, endometriosis, prostate cancer, and more.
But we don’t know as much about how well ovary pausing works to preserve fertility in kids and teens with cancer or a blood disease. Some studies show ovary pausing does work for preserving fertility, but other studies show it doesn’t work. We will continue to learn more about ovary pausing over time.
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We have more information on egg freezing and ovarian tissue freezing, if you are able and prefer to choose an option that we have more information on.
Pausing your ovaries during chemotherapy may give you a higher chance of having a biological child, but it does not guarantee you will have a biological child someday.
Important note!
If you are unable to have biological children, there are other ways to become a parent. Visit this page to learn more.
