safety of vaginal estrogens?

[RobinP]

Sometimes I wonder how safe vaginal estrogens are? I worry that that residual drug application may contaminate other areas of the body, particularly the breast, if one is not extremely careful. Any comments on this potential estrogenic problem?

[Lani]

...
It is well known that atrophic vaginitis in postmenopausal women can be worsened or
induced by the use of aromatase inhibitors for the treatment of breast cancer. In fact, these drugs
exert their benefits on breast cancer by decreasing E2 biosynthesis, thus increasing the frequency
and severity of menopausal symptoms [28; 29]. In a recent study where seven breast cancer
patients treated with aromatase inhibitors received Vagifem (estradiol tablet) at a daily dose of 25
!g for 2 weeks and then, thereafter, twice weekly, serum estradiol (E2) rose from a median of 3
pmol/l to 72 pmol/l, at 2 weeks (range 3 to 232) [30]. Serum E2 levels generally decreased
thereafter to values of 40 pmol/l or less although values of 137 and 219 pmol/l were found at
weeks 7-10. A patient who received Premarin cream had serum E2 levels of 83 pmol/l at 2 weeks.
It should be mentioned that blood sampling for E2 measurement was done at time of patient’s
visit, a timing not likely to correspond to the highest levels of serum E2 after Vagifem
administration. It is thus more than likely that the values reported in [30] underestimate, up to an
unknown extent, the true elevation of serum E2 after Vagifem administration. The authors
concluded that the use of Vagifem with aromatase inhibitors is contraindicated. These findings
obtained in breast cancer women treated with aromatase inhibitors raise a serious issue about the
use of any vaginal estrogen preparation in postmenopausal women.
In previous studies with Vagifem, maximal and mean 24 h serum E2 concentrations were
measured at 180 ± 99 pmol/l and 84 pmol/l for the 25 !g dose while values of 81 ± 62 pmol/l and
40 pmol/l, respectively, were found for the 10 !g dose [30]. Other vaginal estrogen tablets and
creams have led to high or even higher serum estrogen levels [31-33].

[RobinP]

Thanks for the post. I see the level of serum estrogen increases, as I expected. I guess it is possible to to have estrogen cream accidentally placed on the breasts with contaminated hands after application, which I was trying to state in the first place. This dangerously could cause a situation of gynecomastia and hyperplasia, precursors of breast cancer.

[Donna]

Hi Robin and Lani,

I have both the Vagifem and Premarin cream in my medicine cabinet. Even though both my OB/GYN and my oncologist said they are safe and each recommended one over the other, I just didn't feel okay using them. It always sounded good while I was in the office, but when I got them home, something about taking them didn't seem right.

I pretty much follow my gut feeling on these things and I am gratified to find it backed up by science. I had stopped taking my bioidentical estrogen a couple of months before I was diagnosed just because all of the sudden it didn't feel right to use it anymore. Don't know why, but when I pay attention to my "gut" feelings, they usually pan out to be the right thing for me, sometimes despite recommendations to the contrary.

Now, if only I could get a "gut" feeling for the lottery :-)

Have a great day!

Donna

[AlaskaAngel]

Robin,

If a cream is used it should be applied only where intended. If the fingers are used there is some absorption even by the fingers, so immediately washing the hands with soap and water and minimal friction helps to minimize any stray absorption.

A.A.

[Becky]

My onc measured my estradiol level before starting Premarin cream and measures it at every visit. Absolutely no change whatsoever - even when I was using 1/2 g twice a week. Eventually I went to once a week and now it is every other Tuesday.

I was having so many bladder infections I couldn't tell anymore. When I wiped and there was blood, I'd look in the toilet and start my Cipro or Augmentin. Super frequent UTIs cause bladder cancer and this was more than a sex problem.

[dlaxague]

Two separate things are coming up here.

1. Caution in transmission of estrogen to others (studies about children of mothers using estrogen, sexual partners, etc).

2. Concerns about transmission of estrogen to the body that has just ingested the estrogen. Again, I'm not sure that having just applied estrogen to a mucous membrane (vaginally), we need to concern ourselves overmuch with touching any other area of our (own) body. It's kind of like trying to use a towel to get a dry spot on your windshield in the middle of a driving rainstorm. Although now I'm thinking - maybe a little stroking of the wrinkles about the eyes and mouth ... ? Do you think that would work (tic)? Am I the only one who noticed a pretty drastic increase in wrinkles and general sagginess, with AI use?

Seems to me that the answer, if you're that concerned about estrogen in your body, is not to put estrogen in your body in any way. I wish there were better answers to this whole issue of maintaining our bodies and our functions, without estrogen. But right now, they do not exist.

Debbie Laxague

[AlaskaAngel]

Hi Debbie. Are you saying that you have documentation supporting your contention that stray estrogen contact is of no additional physiologic concern in regard to breast cancer patients as long as they also use it vaginally?

A.A.

[dlaxague]

Hi Debbie. Are you saying that you have documentation supporting your contention that stray estrogen contact is of no additional physiologic concern in regard to breast cancer patients as long as they also use it vaginally?

No. I didn't realize that was the question. I thought that we were talking about the circumstance of possibly touching the applicator or suppository when applying vaginal estrogen, and then that finger absorbing estrogen and/or contacting some other body part that might absorb it.

I have no evidence either way. But if you're applying cream or suppository into a closed space lined with mucous membranes (vagina), I know that you are going to get higher systemic absorption from that than would be possible from any small residue left on your finger. Closed space and mucous membrane vs. open-to-air skin (hence prone to washing/rubbing/drying off) would seem no contest. Especially fingertips which seem more impervious (I don't know if that's true but it seems logical). We're talking about bits of residue from if you touched the applicator or the Estring and such, right? Not about taking the cream and intentionally smearing it around somewhere other than vaginally? The articles posted were, as nearly as I saw, not about vaginal estrogen creams anyway. The patches are INTENDED to be absorbed systemically and must have much higher doses than, say, estring, which is stated to provide the lowest dose of systemic absorption. My comment about wrinkles was labeled "tic" (tongue in cheek). I was joking. And I do wash my hands after inserting the Estring and using Estrace cream (tiny dollop).

Although again, I take it back to Susan Love's theory that supplemental estrogen (and she was talking of full-on HRT) made so little difference to risk because it's a drop-in-the-bucket to breast tissue that may be making its own estrogen via richly aromatase-enhanced cells.

And again again - measuring an increase in serum estrogen is not the same as proving that it's harmful. We are far from having good information to document risk OR safety.

Debbie

[RobinP]

AA, after thinking about it more, I think that it doesn't matter what the PDA says about the half life of estrogen because if the estrogen cream has not been absorbed, then it is still available as an active estrogen. I beginning to think that not only should estrogen be applied with an applicator or q-tip in only small amounts, but should be allowed to absorb into the vaginal tissues, then douched out after a period of so many hours after the vaginal mucosa has been rejuvenated with estrogen.

Estrogen is a double edged sword. On the one hand it is wonderful for bone health, skin, hair, libido, vaginal tone, urthra tone, etc. But on the negative side, it does have deleterious side effects, some effect caused even in small doses. I think that was what the article about gynecomastia in children and in men discussed. If even a small amount o estrogen cream on mammary tissue of a man or child can cause duct hyperplasia, the precursor of breast cancer, I'm sure it can in women too.

By the way, I find it interesting that the man, Dr. Pincus, who invented estrogen, many years ago, died of leukemia. It has been suggested that the chemicals, he spent years studying, caused his condition. I think he opened pandoria's box for himself and many.

No, I'm no posting all this to condemn those using vaginal estrogens or estrogens of any type, only to discuss and discover new insights to improve and sustain good health. I'm not telling anyone what they personally should do with estrogen cream. In the words of Margaret Sanger, the brainchild of birth control,"No Gods and No Masters" and that each woman be "the absolute mistress of her own body." Might l add, let each woman have the knowledge, seek the answers for her own mind to protect her own body from the substances that may harm, while allowing the substances that may heal.

[Hopeful]

Just an observation, here: if one of the purposes of using vaginal estrogen is to restore the body's own moisture through cellular health, douching is counterproductive.

Hopeful

[Becky]

Douching is a complete no-no to vaginal health in general because it disrupts normal vaginal flora and fauna and its natural lubrication.

It is the cause of many a bacterial or yeast infection.

Estrogen cream absorption on a thirsty vagina is immediate and great. The trick is lowering the amt of cream used to maintain health versus the amt you need to get healthy.

I went from 2X a week to once a week to now every other week. When tested 6 wks post first use, there was no difference in my estradiol reading vs pre using.

Don't douche for any reason ever!