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dlaxague · 07-02-2007, 06:44 AM

Hi, good topic and timely for me. I'm ERPR negative, was perimenopausal at diagnosis and post menopausal after treatment, I assume (no uterus so no periods). About two years after treatment, in desperation after trying all the other options, I began using an Estring. The research that I did on it at that time showed that when one first began using it, there was a small measurable rise in systemic estrogen, but that it caused the least rise compared to the other options (cream, vagifem which is a suppository). Also, after the initial surge, as the tissue became more normal and apparently did not suck up the estrogen so thirstily, levels returned to unmeasurable systemically. Initially, for me, the Estring made a marginal difference - just enough to make things do-able, with lots of moisturizer/lubricant support. But over time (almost four years), the pain worsened and we pretty much gave up.

This year, six years out, as it becomes clear that perhaps I do have a longer term future to consider (age 55), I decided that we didn't really want to spend the rest of our lives without sex. I went to my gynecologist who prescribed estrace vaginal cream. It took a few weeks but what an incredible difference.

I don't think they've done more than measure blood levels r/t use of vaginal estrogen preparations. I have not found anything that looks at survival or disease free survival in women post diagnosis, r/t use of vaginal estrogens, nor to ERPR positivity and same. This information is just not known. What it comes down to is each individual woman must weigh the potential risks against the benefit, make her own decision, and trust that it's right, for her. Maybe someday there will be more clear answers to help us make these decisions, but right now - no one knows.

There's also the question of using vaginal estrogen while on Tamoxifen or an AI. Would that render it systemically safe yet still allow enough local action to make a difference?

Susan Love has always intrigued me with her talk of estrogen being made in the breast itself, thus rendering almost moot any small increase in systemic estrogen. The HRT studies hint at that, when they show much less (or perhaps no) increase in risk when only estrogen is used (as opposed to cyclical estrogen/progesterone - it could have more to do with the fluctuation than the small overall increase systemically).

Susan Love said that this theory could explain why hormonal treatment made such a big difference (it limits hormonal action in the breast tissue) while adding estrogen with HRT makes such a small difference in the other direction. HRT raises systemic estrogen but if levels in the breast are already very high, HRT is a mere drop in that local bucket. I'm not a big fan of MAMM magazine but they do have an interesting interview with Susan Love in their latest issue. http://tinyurl.com/25om9c FORTY times higher hormone levels in the breast? I wonder if that's true for both pre and post menopausal women? (note the misquote about mammograms decreasing breast cancer by 30% - surely what she really said was that they may decrease breast cancer DEATH - last time I looked, mammograms were not preventative).

Enough!
Debbie L.

07-02-2007, 06:44 AM	#7
dlaxague Senior Member Join Date: May 2006 Posts: 221	Hi, good topic and timely for me. I'm ERPR negative, was perimenopausal at diagnosis and post menopausal after treatment, I assume (no uterus so no periods). About two years after treatment, in desperation after trying all the other options, I began using an Estring. The research that I did on it at that time showed that when one first began using it, there was a small measurable rise in systemic estrogen, but that it caused the least rise compared to the other options (cream, vagifem which is a suppository). Also, after the initial surge, as the tissue became more normal and apparently did not suck up the estrogen so thirstily, levels returned to unmeasurable systemically. Initially, for me, the Estring made a marginal difference - just enough to make things do-able, with lots of moisturizer/lubricant support. But over time (almost four years), the pain worsened and we pretty much gave up. This year, six years out, as it becomes clear that perhaps I do have a longer term future to consider (age 55), I decided that we didn't really want to spend the rest of our lives without sex. I went to my gynecologist who prescribed estrace vaginal cream. It took a few weeks but what an incredible difference. I don't think they've done more than measure blood levels r/t use of vaginal estrogen preparations. I have not found anything that looks at survival or disease free survival in women post diagnosis, r/t use of vaginal estrogens, nor to ERPR positivity and same. This information is just not known. What it comes down to is each individual woman must weigh the potential risks against the benefit, make her own decision, and trust that it's right, for her. Maybe someday there will be more clear answers to help us make these decisions, but right now - no one knows. There's also the question of using vaginal estrogen while on Tamoxifen or an AI. Would that render it systemically safe yet still allow enough local action to make a difference? Susan Love has always intrigued me with her talk of estrogen being made in the breast itself, thus rendering almost moot any small increase in systemic estrogen. The HRT studies hint at that, when they show much less (or perhaps no) increase in risk when only estrogen is used (as opposed to cyclical estrogen/progesterone - it could have more to do with the fluctuation than the small overall increase systemically). Susan Love said that this theory could explain why hormonal treatment made such a big difference (it limits hormonal action in the breast tissue) while adding estrogen with HRT makes such a small difference in the other direction. HRT raises systemic estrogen but if levels in the breast are already very high, HRT is a mere drop in that local bucket. I'm not a big fan of MAMM magazine but they do have an interesting interview with Susan Love in their latest issue. http://tinyurl.com/25om9c FORTY times higher hormone levels in the breast? I wonder if that's true for both pre and post menopausal women? (note the misquote about mammograms decreasing breast cancer by 30% - surely what she really said was that they may decrease breast cancer DEATH - last time I looked, mammograms were not preventative). Enough! Debbie L.