By Admin at 18 Mar 2016, 16:14 PM

Many women experience vasomotor symptoms, such as hot flashes and night sweats, as a result of menopause (either natural menopause or early menopause due to cancer treatment). Sexual dysfunction, such as vaginal dryness, and lower urinary tract infections may also occur.

Systemic and vaginal (topical) estrogens are widely used for relief of these symptoms, but there is concern about using this hormone in women with a history of estrogen-dependent breast cancer. Generally, these women are told to avoid estrogen because of the risk it could promote cancer recurrence.

However, according to an updated committee opinion from The American College of Obstetricians and Gynecologists (ACOG), topical estrogen appears to be safe for women with breast cancer (or breast cancer survivors). They reported:

“Data do not show an increased risk of cancer recurrence among women currently undergoing treatment for breast cancer or those with a personal history of breast cancer who use vaginal estrogen to relieve urogenital symptoms.”

There were some caveats mentioned, however. ACOG recommends that non-hormonal approaches, such as moisturizers, lubricants, and topical anesthetics, be tried first. If the non-hormonal methods do not provide relief, low-dose vaginal estrogen can be considered.

ACOG explained that, in general, vaginal estrogen delivers lower doses of hormone compared with formulations that provide systemic relief. There are several options available – vaginal cream, vaginal ring or vaginal tablet; you can discuss the benefits and risks of each with your health care provider. According to ACOG:

“Studies show that use of low-dose vaginal estrogens does not result in sustained serum estrogen levels exceeding the normal menopausal range; the lowest rates of systemic absorption are found in the ring and the tablet. When used at the appropriate dose, estradiol creams also deliver a low dose of hormone.”

One population that may want to avoid even vaginal estrogen is women using aromatase inhibitors, which are cancer-treatment drugs that stop the production of estrogen. ACOG explained:

“ … the threshold for systemic estrogen levels associated with breast cancer recurrence risk has yet to be determined [among women with breast cancer who use aromatase inhibitors].

Some authors note that even a small increase in systemic estradiol levels may have a detrimental effect on recurrence risk and that more data are needed before recommendations can be made regarding the use of vaginal estrogen among this population.”

If you’re a breast cancer patient or survivor and you decide to use vaginal estrogen, it should be prescribed at the lowest dose possible that provides symptom relief and be used for the shortest period possible. Use should be discontinued once your symptoms are improved.

Sources:
The American College of Obstetricians and Gynecologists March 2016
NPR February 22, 2016

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