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My gyn prefers to use Estrace. When I first went on it a year ago, she had me do blood draws every three weeks to monitor the ER levels. The only "spike" was with the first application, and even that was not enough to raise the circulating ER above post-meno levels. I am 80% ER+ and 50% PR+, so have been on an AI since October 1, 2006. My onc initially suggested switching to Tamoxifen, for exactly the reasons Debbie sets out in her post above, but, due to the studies I have read about Tamoxifen being a potent Her2+ promoter, I said no way.
When I saw my gyn last month for my annual (which included blood work - my ER was just above the minimum threshold for detection), we noticed there was greater elasticity, but still not enough for me to comfortably have intercourse. (By way of comparison, she could barely insert the speculum last year, and was concerned about whether she could collect enough cells to do a pap smear. This year, it was uncomfortable, but no problem.) I asked her about it, and she said even in patients w/o bc who suffer from vaginal atrophy, there is a "transition stage" (which I am in now - she said this is the worst of it) when things don't stretch very much, but, once through that stage, the body would normalize again. She said she sees this in her patients in their '70's and '80's. (I am 54). I asked her how long this "transition" phase lasted, and she said it could be "quite a while, up to 10 years" Yikes! I am not really satisfied to wait all that time; who knows if my partner will still be able to perform then?
As to the amount of the cream used, it is a dab about the size of the tip of your pinky fingernail. I started with using it every three days for 6 months, then went to once a week for 4 months, and now use it around every 10 days.
IMO, Vaginal Atrophy has been a major health problem for women post and peri-menopause, whether natural or artificially induced, that has not been recognized or publicly discussed. As with a lot of other things, now that the "Boomer" generation has encountered the problem, we want answers, and won't settle for suffering in silence. With a huge market share waiting to be tapped, I would think the drug companies would be working on a non-hormonal response to the problem that is superior to the lubricants currently on the market.
Hopeful
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