Oestrogen cream for virginal atrophy

[Sue_C]

Hi

Please could you advise on whether it is ok to use oestrogen cream for virginal atrophy post breast cancer. I’m 58 and on tamoxifen. It feels like everyone has a different view on this!

Thank you
Sue xx

[naughty_boob]

I think you will need to talk to your team or see a menopause specialist.

I’m on Letrozole, 55 years old, and I have Imvaggis and Blissel (lowest oestrogen) on repeat prescriptions after speaking to a menopause specialist. I did a Maggie’s Menopause course and new research posted in Dec 2023 said it does not change mortality in breast cancer patients on Tamoxifen or Aromatase Inhibitors such as Letrozole. The clinical nurse specialist with the oncology team said it was ok but they would like me to see a menopause specialist and that being a cancer patient you are ‘priority’ referral. Having said that the NHS wait was 8/9 months so I paid privately to see them after 3 month wait.

This is the link to the research https://jamanetwork.com/journals/jamaoncology/fullarticle/2811413

The menopause specialist liaised with my breast cancer surgeon/oncology team to look at my Predict score. ( gives % of different treatment etc). The letrozole caused my vaginal issues and I had them before my diagnosis while on HRT and needed the vaginal oestrogen as well. It was discussed if I could come off the Letrozole but my team said they would prefer me to stay on them even with 5%.

I wrote this for the forum about my experience and it’s had over 2000 views

Letrozole menopausal symptoms Vaginal Oestrogen Fezolinetant/Veoza

Hi @mun4o Sorry to hear the oxybutynin didn’t work for you. Now 3 1/2 weeks and still getting flushes. but told to wait 4-6 weeks and was suggested could have double to dose. The Veoza /Fezolinetant worked with a few days, it didn’t take the hot flushes away totally but the ones I did have were manageable. Yes it is quite cost prohibitive, with £250 initial consultation, then £150 for follow up every 3 months by phone and then the cost of the drug, pharmacy charges and postage c…

There is a charity called www.menopause and cancer.co.uk who have lots of specialist such as oncologist that talk about HRT/vaginal oestrogen after cancer.

I’m sure the nurse will be able to reply in more detail but I wanted to share my experience and the study above.

[Coddfish]

You are right, there are differing views on this. When I found I had TNBC I told my consultant I was grateful for that, as I could continue using oestrogen pessaries. She said she was happy for all bc patients to do so as in her view very little oestrogen enters the bloodstream. But I have seen plenty of people say their consultant says no. Ultimately, as with all treatments, there will be trade off of benefit and risk. I think if you are talking to someone who hasn’t experienced vaginal atrophy, they don’t understand the devastating impact it has. Make sure they know what you are suffering. Non hormonal things like Hyalafemme, Replens or BalanceActiv help, but don’t fully resolve it.

[Tigress]

Hi @Sue_C I had vaginal dryness/atroply when I first started Letrozole and asked for some product with estradiol in it but my oncologist said, because I was er+8/8, she would happily let me have something like Vagifemme pessaries if I swapped from Letrozole to Tamoxifen. I did not want to swap so ended up dealing with it through Hyalofemme. The point being that she was happy to prescribe oestrogen products with Tamoxifen. That was over two years ago and I’d hope that the various studies which suggest that no material amount of oestrogen is absorbed through the vaginal walls have persuaded all oncologists that these products are safe even for those on AIs.

[Sue_C]

Thank you all for your replies xx

[HCP]

Hi Sue,
I am 56, I have been on Tamoxifen since June 2020 so only another 6 months on it.
I was recommended Replens vaginal moisturiser and Sylks lubricant for my vaginal atrophy. Sylks has been discontinued from Boots and Replens was only ok! I have had to battle with my GP to be prescribed with an oestrogen topical cream. My breast care nurse asked my oncologist who said she would be happy for GP to prescribe the lowest dose. Last week I was prescribed Estriol cream and YES lubricant for the first time.
Hope you get sorted. X

[naughty_boob]

@HCP make sure you have Yes moisturiser and lubricant. The moisturiser can be used daily with the oestrogen twice weekly. Lubricant whenever you need it.

I have low used Sutil lubricant from JoDivine website as it was better for me.

Tried Sylk and Replens both had their issues for me.

[Nurse_BCN]

Hi Sue_C

Thank you for your post.

Vaginal dryness/atrophy, together with other menopausal symptoms, is common in women who have had or are having treatment for breast cancer. This is because some breast cancer treatments, like tamoxifen, block or reduce the amount of the hormone oestrogen in the body. Oestrogen helps keep the vagina’s moisture and elasticity. A lack of it can cause the vagina and the surrounding tissues to become dry and less supple, causing pain, soreness and discomfort. This can impact on quality of life and make sex or intimacy difficult.

The most commonly used treatment for vaginal dryness/atrophy is HRT (hormone replacement therapy). HRT is not usually recommended for women after a diagnosis of breast cancer. However, as some of the helpful forum users have said, in certain individual situations it may be possible to have hormone treatments that are applied directly to the vagina (topical or vaginal oestrogen) prescribed. These include oestrogen pessaries, creams or a ring. However, usually your treatment team will prefer you to have tried non-hormonal treatments before considering topical hormone-based treatments.

As you’re taking tamoxifen, it may be possible for you to be prescribed vaginal oestrogen. Vaginal dryness and irritation can be very distressing and difficult to talk about. If it’s not treated vaginal dryness can get worse, so it’s important to report the symptoms you’re experiencing to your treatment team. They have all the details of your individual breast cancer diagnosis and are best placed to discuss the possible risks and benefits of using topical oestrogen with you. If necessary, they can refer you to a menopause clinic.

As you say, it can seem as if there are many different opinions on the use of topical oestrogen after treatment for breast cancer. It may help to reassure you that treatment teams follow the guidance provided by the National Institute for Health and Care Excellence (NICE) to guide treatment decisions. You can find the recently updated NICE guidance on genitourinary symptoms associated with menopause here.

We offer a range of free supportive services for anyone who has had a diagnosis of breast cancer which you may be interested in. They include face to face and online courses and events.

For more details about all of these services, please see the information on the link, or call our free helpline.

You are welcome to call our helpline if you would like to talk this through or have any further questions. The helpline team have time to listen, talk things through and signpost you to additional support and information if necessary. Your call will be confidential, and the number is free from UK landlines and all mobile networks. The number is 0808 800 6000, (Relay UK -prefix 18001).

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