Prior to breast cancer, I was using oestradiol pessaries for urethral atrophy which one breast surgeon me to stop and another told me it was ok after I was diagnosed - I carried on with the 2 per week maintenance dose. After just 3 days on letrozole, my urethral and bladder pain have come back even worse than before and now I’m also suffering from vaginal dryness which is being made worse by my prolapse. I mentioned this problem to the oncologist when he prescribed letrozole and said that I’d heard that the oestradiol pessaries are considered safe for E+ breast cancer as it was such a small topical dose but he wasn’t keen on me continuing. I don’t want to continue on letrozole with such a horrible side effect and worry about getting UTI’s and the long term implications of atrophy on my bladder and urethra. I wondered if there was any alternative to letrozole which would either not have the same side effect or would let me continue with the oestradiol pessaries - I’d be very grateful for any advice
Hi there . Sorry you are having such a tough time . I have ER+ breast cancer and am on letrozole. I found the dryness etc absolutely awful and spoke with my oncologist, who was fine about me using oestrogen pessaries or cream . For me using the cream works much better than the pessaries . Maggies the charity are also very helpful with managing side effects from letrozole
Hi, thanks for reassuring me - I’ll speak to my GP re the cream. I just wish all oncologists were on the same page about oestradiol as it would make life a lot easier!!
I’m ER+ two separate tumours and HER2+ in one. I needed vaginal oestrogen when I was on HRT, which I abruptly stoped on finding a lump. I suffered for over a year having treatment and could barely sit down. I saw a menopause specialist, with the approval of my breast surgeon, who prescribed low dose Blissel/Imvaggis and it has helped so much. I’m was on Letrozole and changed to Exemestane and vaginal atrophy is common with all AIs. I had to talk about my own risks and benefits. The fact I’d had two separate tumours counted as two cancers for family history and dint want a third but I have to live and I’m happy to take the small risk.
Ask your doctors for a menopause referral if GP/oncologist/breast surgeon not happy to prescribe alone.
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Hi jeh1,
Thanks for posting.
People often underestimate the impact vaginal dryness and symptoms of urethral atrophy can have on your quality of life. It certainly sounds as though you are suffering with your symptoms.
Some breast cancer treatments such as the letrozole you’ve been prescribed, block or reduce the amount of the hormone oestrogen in the body. As oestrogen helps maintain 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 is in addition to the symptoms you were experiencing prior to your diagnosis of breast cancer.
There has been a lot of discussion recently about the use of HRT (hormone replacement therapy) for women after a diagnosis of breast cancer.
Some specialists will consider prescribing low does hormone treatments that are applied directly to the vagina (topical or vaginal oestrogen). These include oestrogen pessaries, creams or a ring. Vaginal oestrogen is generally not recommended for people taking aromatase inhibitors such as letrozole but can be used in women taking tamoxifen However, as @Pitters and @bluesatsuma have found, this can vary based on someone’s individual situation, as long as they understand the potential risks. It can be a very difficult decision to make.
The organisations Spiced Pear Health and Menopause and Cancer have information that you might find useful to support you.
Do talk to your breast care nurse or treatment team about the impact these symptoms are having on your quality of life. They will be able to discuss the risks and benefits of restarting the pessaries with you, as well as if an alternative hormone therapy, such as tamoxifen, would be an option for you. You may also want to ask about the possibility of being referred to a menopause clinic due to the severity of your symptoms.
If you haven’t already tried them, vaginal moisturisers can help give relief from dryness and discomfort. They should be used regularly, every few days for best effect and can usually be available on prescription. More information about them can be found on the link above.
Vaginal lubricants tend to be shorter acting and are either water or oil based and can be used alongside moisturisers.
It’s important to find a vaginal moisturiser and lubricant that works for you. Some vaginal moisturisers contain ingredients that can cause irritation, so we would always suggest you do a skin test on the inner and outer lips of your vagina before using any products.
If you continue to have vaginal dryness and irritation and cannot find a product that suits you, do talk to your GP, breast care nurse or treatment team as they may be able to refer you to a specialist menopause clinic.
Our booklets Your Body, Intimacy and Sex and menopausal symptoms and breast cancer contain information about menopausal side effects that you might find useful.
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