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Vaginal Dryness

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Category: TNBC Forums
Forum Name: TNBC Talk
Forum Description: A place to chat
URL: http://forum.tnbcfoundation.org/forum_posts.asp?TID=13353
Printed Date: Mar 18 2019 at 8:25am
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Topic: Vaginal Dryness
Posted By: KatFinn
Subject: Vaginal Dryness
Date Posted: May 22 2018 at 9:42pm
I am wondering if anyone has been told that it is OK to use Estrogen based products for vaginal dryness.  I have tried both Rephresh and Replens but nothing really works.  
I'm afraid to use estrogen products because they all have warnings about not using them if you've had breast cancer.  I've been through menopause and this seems to get worse with time.  My gynecologist just suggested using Intrarosa.  It's a steroid and says that it contains Praserone which changes to Estrogen in your body.  It says not to use it if you have or had breast cancer.  

My question is: Since I had Triple Negative (not estrogen based) shouldn't I be able to use an estrogen product safely? (or is this not related?)

My gynecologist isn't sure. I'm 7 years NED (yay!) so I don't see my oncologist any longer.  I will call him but thought I'd start here to see if others have dealt with this successfully.  I certainly wouldn't want to do anything that might cause my breast cancer to return.  I was Stage 1, had a lumpectomy, chemo and radiation.  

Thank you.



Replies:
Posted By: Kellyless
Date Posted: May 22 2018 at 11:23pm
All the oncologists I've had say NO to any of the estrogen products. Chemo put me into instant menopause the first time - man do I miss my estrogen! I nag my gynecologist about hormones every year, lol. No health food herbal estrogen either - and I'm to go light on eating soy :( Your gynecologist should consult a breast oncologist on your behalf, because this is important. I doubt you're her only survivor patient, so she should educate herself. But the consensus is NO, TNBC diagnosis does not make it any safer for us to use any hormone replacement products.
Fyi - lube products that are great: Astroglide is an oldie but goodie (the water based or silicone) and quite affordable, but my new fave is uberlube. Silky super slippery stuff - silicone based - but a lil pricey. Amazon has them both.

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IDC, 2.2 cm, Stage IIb,lumpectomy 1/30/09 ACx4,Tx4 36 rads
6/1/16 Local recurrence same breast, same spot 1.8cm Carb.4x every 3 wks, Taxol 12x once wk. Dbl Mast. PCR!! Reconstruction fail, NED!


Posted By: KatFinn
Date Posted: May 23 2018 at 12:13pm
Thank you Kellyless.  I've had this problem for years now and while I really knew the answer, I was hoping that maybe someone had research to indicate that triple negative survivors were different and could be exposed to estrogen.
My gynecologist said I'm in really bad shape.  I really can't even consider sex even with lubricants.  I'm almost 60 and my lining is very thin. I guess this just happens to some women.  Cry


Posted By: Meadow
Date Posted: May 23 2018 at 4:35pm
My oncologist and cousin's oncologist, both at top 10 cancer centers have said they are very comfortable with use of estrace (vaginal cream) or estring (vaginal insert) to help with vaginal symptoms, because it is low concentration and localized (not systemic). My GP and GYN agree. I've been using estrace for many years. It helps a lot.


Posted By: 123Donna
Date Posted: May 25 2018 at 10:15am
Both my oncologist and gynecologist oncologist are comfortable with me using Estrace vaginal cream.  They don't want you using any type of oral estrogen.  Studies have shown than the use of vaginal cream does not increase breast cancer risk.  

Have you tried coconut oil?  It helps too and much better than the over the counter lubricants.




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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15



Posted By: 123Donna
Date Posted: May 25 2018 at 10:29am
Here's another thread talking about this subject:

http://forum.tnbcfoundation.org/problems-with-sex-after-chemo_topic11105_page1.html" rel="nofollow - http://forum.tnbcfoundation.org/problems-with-sex-after-chemo_topic11105_page1.html


Another study:

Using Vaginal Estrogen Not Linked to High Breast Cancer Risk

An analysis of data collected as part of the Womenís Health Initiative (WHI) trial has found that postmenopausal women who use vaginal estrogen have the same risk of invasive breast cancer, stroke, blood clots, endometrial cancer, and colorectal cancer as women who donít use vaginal estrogen.

The research was published online on Aug. 14, 2017 by the journal Menopause. Read the abstract of  http://journals.lww.com/menopausejournal/Abstract/publishahead/Breast_cancer,_endometrial_cancer,_and.97708.aspx" rel="nofollow - ďBreast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Womenís Health Initiative Observational Study.Ē

The research is part of the very large Womenís Health Initiative Observational Study, commonly called the WHI. Overall, the study includes information from more than 161,608 postmenopausal women who were ages 50 to 79 when they joined from 1993 to 1998. The WHI wants to find any links between health, diet, and lifestyle factors and health problems such as cancer.

For this study, the researchers looked at information from 45,663 women who were ages 50 to 79. The women had not taken any type of hormone replacement therapy. Information about vaginal estrogen use was self-reported in the regular questionnaires sent out as part of the WHI. Information about the specific dose or type of vaginal estrogen -- ring, cream, or tablet, for example -- wasnít reported.

For women who still had their uterus and used vaginal estrogen, the risk of:

  • invasive breast cancer
  • colorectal cancer
  • endometrial cancer
  • stroke
  • blood clots

was the same as it was for similar women who didnít use vaginal estrogen.

Women who still had their uterus and used vaginal estrogen also had a lower risk of:

  • heart disease
  • breaking a bone
  • dying from any cause

Women who had had a hysterectomy and used vaginal estrogen also had the same risk of:

  • invasive breast cancer
  • colorectal cancer
  • endometrial cancer
  • stroke
  • blood clots

as similar women who didnít use vaginal estrogen.

"Prior studies have never assessed the overall balance of risks and benefits of vaginal estrogen use, including cardiovascular events, cancers, and fractures," said lead author Carolyn Crandall, M.D., of UCLA. "Also, the use of oral forms of estrogen -- with and without progestogen -- have been linked with increased risk of cardiovascular events and cancer, but it was not known whether vaginal estrogen use was associated with these risks.

"The blood levels of estrogen that result from vaginal estrogen use are lower than those resulting from oral estrogen use, so we expected that associations with increased risk of cardiovascular disease and cancer might not be as pronounced with vaginal estrogen as those seen in studies of oral estrogen use. The results are reassuring that vaginal estrogen use is not associated with increased risk of cancer and cardiovascular disease," she added.

Menopausal side effects can dramatically reduce quality of life for some women. This study suggests that vaginal estrogen may be a good alternative to hormone replacement therapy. Many studies have shown a link between higher breast cancer risk and using hormone replacement therapy to treat menopausal symptoms. Women whoíve been diagnosed with breast cancer should NOT take any type of oral hormone replacement therapy.

In 2016, the American Congress of Obstetricians and Gynecologists concluded that women whoíve been diagnosed with breast cancer who are having troubling systems such as pain during sex  https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/The-Use-of-Vaginal-Estrogen-in-Women-With-a-History-of-Estrogen-Dependent-Breast-Cancer" rel="nofollow - may consider using vaginal estrogen at the lowest effective dose if nonhormonal moisturizers or lubricants donít work.

If youíre having severe menopausal side effects, talk to your doctor about ALL your treatment options. Together you can decide if vaginal estrogen is right for your unique situation.

http://www.breastcancer.org/research-news/vaginal-estrogen-not-linked-to-high-risk" rel="nofollow - http://www.breastcancer.org/research-news/vaginal-estrogen-not-linked-to-high-risk


Another article:

http://www.cancertodaymag.org/Pages/Summer2016/Breast-Cancer-Survivors-and-Vaginal-Estrogen.aspx" rel="nofollow - http://www.cancertodaymag.org/Pages/Summer2016/Breast-Cancer-Survivors-and-Vaginal-Estrogen.aspx





-------------
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15



Posted By: Kellyless
Date Posted: May 25 2018 at 11:42am
Why the hell do all my doctors keep telling me no?? I'm sending this to my oncologist and asking if she's singling me out for meaness or what. Thanks for the input ladies!
Seriously, I tell my gynecologist I have dreams of buying black market estrogen, doing it on the down low. I loathe menopause!

-------------
IDC, 2.2 cm, Stage IIb,lumpectomy 1/30/09 ACx4,Tx4 36 rads
6/1/16 Local recurrence same breast, same spot 1.8cm Carb.4x every 3 wks, Taxol 12x once wk. Dbl Mast. PCR!! Reconstruction fail, NED!


Posted By: 123Donna
Date Posted: May 25 2018 at 12:13pm
Kelly,

I could see the argument for estrogen positive ladies, but it doesn't make sense to me for TNBC.  I read too that the estrace cream stays locally so it's not the same as taking an oral pill.  I can definitely tell the difference when I don't use it vs when I'm using the cream on a normal basis.  Good luck!

Donna


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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15



Posted By: Meadow
Date Posted: May 25 2018 at 3:49pm
This is Meadow commenting again. I asked my oncologist why estrogen would be a problem if you are "negative" for estrogen-related cancer. She said there are studies showing a small correlation between systemic estrogen and TNBC, though not anywhere near the level as for ER+ breast cancer. She said there is no accepted explanation for this but that the "local" cream is very low risk.

Last week at my annual physical, my GP adamantly refused to renew my prescription for estrace cream but eventually relented after I pointed out my oncologist and GYN/ONC have prescribed it for many years. I think GPs are just not up to date on the research. Anyone denied estrogen cream should push back and go to an oncologist if other doctors won't relent. Don't give up.


Posted By: 123Donna
Date Posted: Jan 07 2019 at 8:22pm
New Study Demonstrates Effectiveness and Safety of Vaginal Estrogen

Despite its proven effectiveness in treating the genital symptoms of menopause, low-dose vaginal estrogen therapy remains underused largely because of misperceptions regarding its safety. However, a new study that followed women from the Nurses' Health Study demonstrates that its use is not associated with a higher risk of cardiovascular disease or cancer. Results were published in the journal Menopause.

Between 25% and 70% of postmenopausal women are affected by an array of genital and urinary issues collectively known as the genitourinary syndrome of menopause (GSM). Common symptoms include vaginal burning and irritation, a lack of lubrication, pain during intercourse, and urinary tract infections. Unlike hot flashes, which often accompany menopause, GSM symptoms do not resolve over time, are chronic, and can become progressively worse without treatment.

Low-dose vaginal estrogen therapy is the preferred and most effective treatment for GSM and is recommended by the North American Menopause Society (NAMS), the American College of Obstetricians and Gynecologists, and the Endocrine Society. Multiple studies document the superior effectiveness of vaginal estrogen over nonhormone therapies and demonstrate that it provides better symptom relief than oral estrogen therapy.

As a result of misperceptions regarding its safety (which partially stem from the FDA-issued black-box warning that relates to systemic hormone therapy), vaginal estrogen therapy is not prescribed as often as it could be, leaving many postmenopausal women to experience a lower quality of life. This new study that followed women from the Nurses' Health Study for more than 18 years, however, concluded that vaginal estrogen was not associated with a higher risk of cardiovascular disease, cancer, or hip fractures. This included risks for myocardial infarction, stroke, and pulmonary embolism, as well as breast, endometrial, ovarian, and colorectal cancers.

"Over-the-counter vaginal lubricants and moisturizers are often used as first-line treatments for women with symptoms of GSM," says Dr. JoAnn Pinkerton, NAMS executive director. "Persistent symptoms often need therapies such as local vaginal estrogen, intravaginal dehydroepiandrosterone, or oral ospemifene. This study adds to a growing body of data showing the long-term efficacy and safety of low-dose vaginal estrogen, which works primarily locally with minimal systemic absorption."

SOURCES:
Menopause, online edition, December 19, 2018
The North American Menopause Society ( http://www.menopause.org" rel="nofollow - http://www.menopause.org )

http://www.hopkinsbreastcenter.org/artemis/201901/12.html




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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15




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