estrogen creams

dberg · 06-30-2007, 09:19 AM

I was dx three years ago at age 45. I have tried every lubricant under the sun and and am suffering with vaginal atrophy. I finally mentioned it to my onc at my last visit and he really surprised me with his recommendation of a vaginal cream. Being er+/pr+ I am very hesitant to use it.

What are your thoughts? What about estring and vagifem?

Cosmo · 06-30-2007, 11:08 AM

I use estring for quality of life reasons. My gyno and onc okayed it.

Karen

IRENE FROM TAMPA · 06-30-2007, 12:10 PM

I also am suffering with vaginal atrophy and have tried several different lubricants to no relief. My gyn recommended the Estring to me several years ago but when my onc at Moffitt checked on it she thought it might not be a good idea. She had a patient on it and it turned out it was relieveing her hot flashes, meaning it does have estrogen benefit, but unfortunately might not be good for a cancer patient. Needless to say, I did not try it since I got a little nervous about it.

GEEEE what else do we have to go through....

Any other ideas anyone?

mslinda · 06-30-2007, 01:11 PM

I just saw my oncologyst this past week. I talked to her about the problems I was having. I have tried everything also, Replens, etc. I asked her about the estring, as I had been reading about it. I am er-pr-. She said to go ahead and see my gyn and get it. That the estrogen in your vagina does not infiltrate to the rest of your body. I am not sure I am saying that correctly. My brain is not working right today. Still trying to get adjusted to the Neurontin. Haven't got the estring yet. Hopefully will be able to get an appointment in a couple of weeks. I am scheduled for a brain MRI on the 5th.

Take care everyone. I love and pray for each of you. Maybe not by name, but God knows.

Love and Hugs,
Linda
S. Mississippi

Catherine · 07-01-2007, 10:28 PM

Please keep this post going. Atrophy is what I have. My husband and I just keep waiting. Need to talk to my doctors. Still on Herceptin. It has been 8 months since we tried to have a little fun. Oh well, we hope to figure something out, someday. Is this TMI?

Catherine

harrie · 07-01-2007, 10:46 PM

Just prior to this last episode of IDC, I was using Premarin vaginal cream sparingly. It worked WONDERS!!! My former oncologist and gyn felt it was safe to do so with the small amt of cream used and the benefits for me and my husband. I was really uncomforatable with sexual relations prior to the cream. Then I had this last episode of IDC and since my tumor was ER+, my oncologist recommends I stay away from all forms of estrogen supplements. He has suggested I consult my gyn and look at nonhormonal options such as Replens, astroglide, or testosterone cream. I have not consulted my gyn yet about this.

I don't know if it was coincidental, but it was after using the premarin vaginal cream for 2 - 3 months did I discover the calcifications on my mammogram which turned out to be positive for bc.

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.

harrie · 07-02-2007, 11:01 AM

Very interesting information Debbie.
I think what the decision boils down to, like with so many other issues, is determining the relative risk vs benefits for the quality of life/relationships.

Jen · 07-02-2007, 09:21 PM

This is very good topic especially for the women with ER+ breast cancer. Unfortunately vaginal dryness and atrophy are undesirable effects of not having estrogen. There is NOTHING wrong with trying to seek out solutions to save your sex life!!!!

Catherine · 07-02-2007, 10:05 PM

Here ye, Here ye. I think I miss my sex life more than my husband does. I am going to research Debbie's information.

Thanks for the informative and honest posts (as always)

Catherine

Jen · 07-02-2007, 10:13 PM

Catherine I am glad to hear that you are going to do some research and seek solutions. I wish you the best of luck.

Jennifer

Patricia · 07-02-2007, 10:42 PM

I am also using Estring. My breast surgeon recommended it to me and both the onc and gyno approved it. It seemed to make a big difference initially, but it has felt less effective lately, so it is interesting hearing Debbie's experience with it. I have been on it about 9 mos now. For me it was so bad that even wiping would cause me to bleed so I needed to do something! As far as sex goes, I still rely on also using lubricants but it is doable and even enjoyable, whereas before it was literally impossible. I think the hard part for me was that it seemed to really affect my husband as well. He did not want to hurt me and between recovery from surgeries, being sick through chemo and healing from radiation burns he just felt every where he went he hurt me, so when the vaginal atrophy became apparent as well I thought our sex life was over - really over. I was concerned with the warnings but with all the docs telling me it was ok even after we discussed the risks, it really became a QOL decision for me. I hope you find something that works well for you too.

Hugs,
Patricia

harrie · 07-02-2007, 11:29 PM

I have a friend who will be going for a consultation at this facility called Sklar Center for Women's Wellness in Southern California. Web site is: sklarcenter.com
It is a team composed of a physician (Dr. Susan Sklar), therapist, psychologist, etc that deal with nothing but women's concerns such as menopause, sexual issues, cancer sexual issues plus other issues I don't quite remember.
My friend is only 34 yrs old and has been thrown into "chemo-menopause" and is looking for advice and recommendations. Her oncologist has recommended this center for her.

tricia keegan · 07-03-2007, 02:59 PM

Does everyone get this? I had my ooph last year and am on Arimidex and so far no dryness or vaginal atrophy signs at all. Should I relax or is just a question of time, ie when will I get it??

Becky · 07-03-2007, 07:34 PM

I am using the estring too. I am not that much ER+ and PR-. After the ooph and Arimidex, besides the vaginal atrophy and dryness, I had never ending bladder infections. My onc and surgeon were gun ho for the estring (which I am using now) but my gyne preferred the premarin cream. I opted for the estring due to lack of messiness.

For me this thread is extremely timely. I am nearing 5 months on the estring and the first estring (for those that don't know - they last 90 days), it was like a miracle. I wanted to call my onc St. Myron but it is not as effective as before. Until I read this thread, I thought I might have gotten a "bum" ring but now I don't think so. If it keeps up this way, maybe I will switch to the messier cream if it works better. However, my onc did say that the estring is the only "allowed" vaginal product to use if you are in clinical trials. Also, it is the only featured product in conferences for oncs on quality of life issues/topics. It is very safe (according to them).

I did have my estrogens measured before insertion (I asked to have this done) and I got them measured again after 2 months and got the exact same readings. This greatly reassured me. I am just a bit concerned as it doesn't seem as effective. I did have my "yearly" with the gyne and he said my vagina looked nice and healthy with lots of adult cells sloughing off and it was not that way before (as I was going there with the UTIs and some vaginal soreness/infections due to atrophy).

Oh well - at least no UTIs and that is a huge blessing.

dberg · 07-07-2007, 07:40 PM

OK, the latest. I spoke to my onc today and he said he prescribed estrogen cream ONLY for those who had tried EVERYTHING else because we just don't know how much is absorbed. He also said if I wanted to use the estrogen cream, I'd have to stay on tamoxifen and not switch to an AI, which actually makes sense given the estrogen absorption. But what about the crosstalk with her2??? Aaaarrgghh!

So I have vaginal atrophy, but I also ache in my bladder area. I asked for a consult to urology due to my constant "urinary tract infections" which don't always show up as such, but sure feel like one. Sometimes they are related to sex, sometimes they are not.

I'm a mess right now. I just hurt. Does this ever end? Will the premarin cream relieve me of all this?

Melinda · 07-07-2007, 08:54 PM

Has anyone read Dr Christiane Northrup's book titled THE WISDOM OF MENOPAUSE? Starting with perimenopause through menopause she focuses on HRT synthetic vs bioidentical,, food supplements, the mind body connection and much much more. She caught my attention on a PBS station, so I bought the book I have only just started reading it but what is interesting is that she supports her information from her experiences, both as a DR and a woman and through extensive research siting specific studies. Its just not for sisters with cancer, but for all women reaching "this new age". I hope you find it as interesting as I am.
Melinda

harrie · 07-08-2007, 01:52 PM

I have that book, The Wisdom of Menopause by Christiane Northrup, MD. I think it is has very good information and is very comprehensive.

For me the Premarin cream helped significantly reduce the uncomforatble symptoms.

Hopeful · 07-26-2007, 05:29 AM

I was dx with VA about 2 months before I was dx with BC. Needless to say, the VA treatment was put on hold. When I had my annual gyn exam this year, the vaginal opening had narrowed to the point that the doctor did not think she could collect enough cells for a pap smear (she did, thank goodness!) She told me to try moisturizers and "stimulation" to promote blood flow and get the tissues healthy. Needless to say, when one is on an AI, it is going to take more than that. I was frank with my onc at my last appointment, told him this was a huge qol issue for me and that I wanted to do some kind of ER therapy, although I am ER+ PR+. He agreed. I saw my gyn yesterday, and we discussed options. She is willing to let me try Estrace cream, BUT, I need to get stuck every week for the first month to monitor blood levels of ER (definitely the worst part of the deal). She told me to start slowly with just a daub on the area that is most affected 2-3 times per week, and we will work up from there. Her comments echoed what others have posted here, in that the most ER deprived tissue will absorb all the ER until it becomes healthier, thus, the reason to begin slowly and work up. She said once I became "re-epitheliaized," we could consider adding other drugs (I asked about viagra to increase blood flow) to get me stabalized and keep the tissues healty.

I think it is up to all of us to "re-claim" both our bodies and our lives after treatment for this disease. We are human beings, after all.

Hopeful

hutchibk · 07-26-2007, 09:19 AM

I attended an MDAnderson Living Fully With & Beyond Cancer Conference last Sept. This was a subject that was covered in one of the Breast Cancer break-out sessions. We talked pretty in depth about a few things to do to recover from atrophy and loss of sensation. Here's what I learned, but have yet to fully implement... but I plan to.

First, one thing my Gyn told me early on was to "continue to have sex after chemo induced menopause, even when you don't feel like it" - my partner was thrilled to hear her say this and he asked if she could write a prescription stating that. LOL. She said that continuing sex would be the best way to keep the vagina in shape and avoid atrophy. Well, that didn't happen in my world, as I am sure it doesn't happen in the lives of many of us.

I also learned... get this...I did not know this...that Taxol can also cause numbness and neuropathy not only in the hands and feet, but guess where else? Boy was I happy to learn that and know that it should self correct for the most part once I was done with Taxol.

So, I learned a "get back in shape plan" at the conference last year. Basically they suggested that we have to take this on as we would a training program.

First, talk to your doctor about using an estrogen cream or medication (Estrace, Estring, Premarin {which personally I don't like because of what it's made from and problems from it... google it}) Check this site for good info about using the creams: http://www.mayoclinic.com/health/dru...ation/DR202227
My onc does not feel that Estrace is strong enough percentage wise to have a systemic effect. Ask your doc about this before you proceed.

Second, acquire a good lubricant and a "personal massager." They suggested that using the cream and gently using the massager a couple to a few times a week in conjunction with the estrogen would slowly toughen and build back the vaginal walls, decrease pain and increase sensation. It might take several weeks or a few months to feel noticible results, but basically it is a training program for the female parts. Put yourself in training, they said. We all had a great laugh at that, but it made sense.

Third, slowly add in a "real partner" as you see fit and reap the benefits of your training...

I personally have used Estrace cream for a couple of years to stem the recurrance of UTIs and it has worked very well for me in mitigating the UTIs and restoring sensation. The UTIs were caused by dry, sensitive urinary track tissue being irritated to the point of infection by different caustic chemo drugs on their way out of the body. I also saw a urologist who echoed this and agreed with our plan.