Non-hormonal interruption of incessant ovulation as a potential approach for ovarian cancer prevention.

Ovarian cancer is a silent killer. There is a need to intensify research efforts on prevention strategies. The causative role of incessant ovulation has been supported by the protective effect of oral hormonal contraceptives. The released follicular fluid in the process of ovulation bathes not only the surface of the ovary but also the fimbrial end of the fallopian tube. Evidence has been accumulating about a fimbrial tubal origin for ovarian high-grade serous carcinoma, and for the potential of opportunistic or elective salpingectomy as an intervention strategy. Alternatively, periodic suppression of ovulation could be beneficial among women who have no need or are not using oral hormonal contraceptives. Rupture of the ovarian follicle releasing the ovum and follicular fluid is a prostaglandin-mediated inflammatory process. It can be stopped by nonsteroidal anti-inflammatory drugs, leading to pharmacologic production of a luteinized unruptured follicle, simulating a normal non-conception cycle with unaltered steroid patterns/levels and cycle length. Non-hormonal periodic interruption of incessant ovulation could be recommended for women who are at high risk of ovarian cancer, but further research is needed to validate the potential of this approach.