Tamoxifen/thyroxine/topical estrogen

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Hi I was diagnosed with ER+ stage 1 breast cancer from my first ever mammogram in 2020 aged 51. I had a lumpectomy & lymph node surgery, followed by radiotherapy and prescribed Tamoxifen for 5 yrs, all during first covid lock down. I was diagnosed with an under active thyroid, 20 yrs ago and take thyroxine.

I get hot flashes, night sweats, clammy feeling, trouble sleeping, low sex drive, memory brain fog, itchy skin, achy joints/muscles, weight gain, change in body odour, ringing in ears, dry mouth/tongue and have stress & urge incontinence and vaginal atrophy.
I have been told that I can’t take HRT but is it safe to use topical estrogen. I have been using Replens vaginal moisturiser for 4 years but not getting much relief.
My Gp has contacted a gynaecologist for advice in prescribing topical estrogen and is reluctant to prescribe it saying it is a grey area. My oncologist just said it is up to my GP to decide.
I just feel like I’ve been told that there is no help and I’ve got to live with all the symptoms, put up and shut up basically.
Any help, advice or guidance will be greatly appreciated.

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I feel your Pain. I was diagnosed in 2015 age 49. The menopause symptoms are horrendous! The hot flushes were ruining my life. After 7 years of it my Oncologist said i could stop the tamoxifen, but unfortunately my cancer returned in my bones and liver and im on treatment for life now. I tried sage starflower oil and evening primrose. May work for you. I was prescribed venlafaxine which helped at first, so may be worth a try. I hope you find some relief xx

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Hi @HCP, I know the feeling…my oncologist referred me to a gynecologist but honestly, your GP can prescribe vaginal tablets called Vagifem.

I am also struggling with the effects of the menopause. They are horrendous, worst than chemo, and it’s not getting any better, especially as I need to be on Letrozole for another 5 years. Having Prostap injections every 3 months doesn’t help.

I was prescribed two different antidepressants for the hot flushes - currently on Venlafaxine as @Freespirit.

There is a new drug not available on the NHS at the moment that it’s nom-hormonal called Veozah.

But not sure if you can get it on a private prescription.

There is another treatment for vaginal dryness and atrophy

I think it’s very controversial prescribing oestrogen products to breast cancer ladies so that’s why many doctors are not willing to do so!

Wishing you all the best and hopefully, you will find a more understanding GP. Xxx

P.S. Have you been referred to the menopause clinic by your GP? Even though you can’t have HRT they can still advise.

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Hi HCP

Thank you for posting.

It sounds as though you’re having a difficult time at the moment with menopausal symptoms.

Vaginal dryness, together with other menopausal symptoms, are common in women who have had or are having treatment for breast cancer. This is because some breast cancer treatments, such as 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 and discomfort. This can make sex or intimacy difficult and, as you’ve described, may lead to vaginal atrophy and incontinence.

Vaginal moisturisers such as Replens can give some women relief from dryness and discomfort and should be used regularly, every few days for best effect. As you’ve being using this for some time now though and feel it hasn’t greatly improved your symptoms, it may be worth trying different products. Pelvic floor exercises can also help improve vaginal dryness by increasing blood flow to the area. The links above to our information give suggestions which may help.

Vaginal dryness and irritation can also be caused by infection so it’s a good idea to discuss this with your GP to rule this out.

The most commonly used treatment for vaginal dryness is HRT (hormone replacement therapy). HRT is not usually recommended for women after a diagnosis of breast cancer. However, some specialists will consider prescribing hormone treatments that are applied directly to the vagina (topical or vaginal oestrogen). These include oestrogen pessaries, creams or a ring and will consider it when vaginal lubricants have been tried but, as in your case so far, have not been effective.
As you’re taking tamoxifen, you may be able to be prescribed vaginal oestrogen, and you could ask your GP for a referral to a specialist menopause clinic to discuss this. You may find the information and links in our Facebook Live session on Menopause and Breast Cancer helpful.

Our booklet Menopause and Breast Cancer covers ways to help you cope with the other menopausal symptoms that you’ve described. This information includes complementary therapies and prescription drugs which may help with symptoms such as hot flushes and as @Freespirit says these may be worth a try.

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.

Do 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 more 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, If you have hearing or speech difficulties prefix our number with 18001 and the call will go through Relay UK. Our helpline has access to telephone interpreters if language translation is required.

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Best wishes

Julie

Breast Care Nurse

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