for those considering using or using estrogen containing vaginal creams or pills

[hutchibk]

If I read this right, I think I am really glad that we have stuck to Estrace...

[dlaxague]

Brenda said: "If I read this right, I think I am really glad that we have stuck to Estrace..."

Hmm. I dunno. The only reason Estrace wasn't implicated was that they didn't study it. I'd assume that its absorption would be just as bad (or good, depending upon your perspective). I started with Estring which at that time had shown the smallest systemic absorption. But over the years that just wasn't cutting it and now I use a dab of Estrace.

However. This is just one study. There are other (older) studies that do not show much systemic change and what they show is typically still within normal menopausal ranges. I don't have those normal ranges at the tip of my fingers so cannot say if this studies "5-fold increase" took the levels above normal menopausal ranges.

Plus, I'm assuming that the dose used (1g of Premarin cream) is much larger than my dab - an applicator-ful I'd guess.

So I'm hedging, on my personal decision. I wish they'd do some large studies on menopausal breast cancer survivors. Since the majority are on hormone therapy, I'd like to see these results of serum levels for those on Tamoxifen, and especially on AI's. But the only thing that will really tell the tale is to do long term recurrence and survival studies. And that won't be in time to help us figure out the best thing for us, today.

Debbie Laxague

[RobinP]

Dr. Love Recommends Only Using The Smallest Amount Of Vaginal Estrogen Cream To Combat Vaginal Atrophy And Assoc. Symptoms, Which May Have A Lot Less Serum Estrogen Level Impact.

[Becky]

As a Premarin cream user (down to 0.5g every other Wednesday), I want to comment that we don't know the vaginal atrophic state of the women in the study. If they started out fully atrophic, then their vaginal vault had no mature cells in the lining to prevent any absorption of estrogens into the bloodstream. Also, they were using the cream everyday at 1g (1g - 1.5g is the usual dose to be given daily via package directions. After relief, one should scale back to the smallest effective dose). So, they are measuring the estrogen uptake during the absolute worst time ever_ during true therapy to replenish local estrogen levels in order to get maturation of immature vaginal epithelial cells. Not a good study at all. Good only in that we know that even Estring causes a temporary rise in systemic estrogen for the same reason and then it scales back.

I have had my prior to use level taken and then my onc didn't want to remeasure until after 6 wks on Estring (started with this product) and my level was the same. At 9 months, I switched to the small dose of Premarin once a week to "maintain" and I eventually moved to the once every other week and I am fine. I don't worry about this issue at all due to a healthy vagina protecting me as well as such a reduced use.

[Hopeful]

Becky,

I agree with you - this does not seem to be a very well designed study. Also, the amounts of these preparations the participants used, plus the frequency of use, are not at all what bc patients are advised to do, so the applicability to our demographic is not a one-to-one correspondence.

My surgeon and gyn are very supportive of my use of Estrace under their supervision and as they direct, which is very similar to your usage. My rads onc would prefer I use e-string, but is not against local estrogen therapy in general.

Some parts of the body require some estrogen to function, and they are parts I, for one, want in good working order!

Hopeful

[AlaskaAngel]

Having used the Estring for several years as a Stage I, and then dropping off it for various reasons, I agree with Hopeful and Becky that even though it is in some ways less convenient to use Estrace than the Estring, using Estrace does let one adjust the dose to fit the need better. I'm back on the Estring at present, but planning to get a prescription for Estrace. Also, I did find that the Estring ring itself ended up being somewhat uncomfortable for intercourse at times (it seemed to pull on the tissues sometimes with movements).

AlaskaAngel