Vaginal atrophy - Estring

mawhinney

My new gyn wants me to use Estring for vaginal atrophy. The Patient Information sheet states do not use if you have had breast cancer! Scary but gyn says there is very little risk as Estring lets only a small amount of estrogen into the body & the statement is probably on the list for legal reasons.  He also said menopause & HT meds often cause the vaginal tissue to dry out & that Estring will take of the problem.  I really don't want to take anything with estrogen in it but the vaginal atrophy is painful.  Has anyone had experience with Estring?

cmb35

My onc was not concerned about the small amount of estrogen (but my gyn would not prescribe it without permission from my onc.) I can tell you it worked fabulously, but I did have a little yeast infection issue (not related to the estring I'm sure) the last time, and ended up taking it out. If you're having an pain/dryness at all, I'd say give it a shot, because it made a HUGE difference for me. Good luck!

mawhinney

Has anyone used estrogen creams for vaginal atrophy? Were they helpful and what are the brand names?  My new gyn prescribed Estring but when I checked with my surgical oncologist  about the med she said no way.  Possibly a low dose estrogen cream.  The two doctors are in discussions over the matter and I'm in the middle!!

Member_of_the_Club

I was on an estrogen cream for an unrelated condition when i was diagnosed with bc and I would not use one again.  I was told immediately to stop using it.  I have read and been told that the creams can actually release quit a bit of estrogen while the ring is safe.  I would ask a medical oncologist and not a surgical oncologist.

07rescue

I use a tiny amount of a compounded testosterone cream, which works perfectly for me. There was a clinical trial done and reported on at the San Antonio Breast Cancer symposium that reported that compounded testosterone, applied vaginally, worked well and was tolerated and appeared safe for the women with breast cancer who used it. There is much controversy over whether testosterone can be safely used by anyone with a hormone sensitive cancer, however. Studies have provided only contradictory results, so no one can say for sure.

For me the benefits outweigh the risks because without the testosterone I develop constant vaginal infections from vaginal atrophy that migrate into my bladder and threaten my kidneys. My kidney function has been very depleted and is barely adequate already, so I cannot afford any further damage. The testosterone is protective. For me it would mean living on dialysis and an early death to lose much more kidney function, it becomes progressive in short order. I've decided taking a possible, but unproven, risk of future cancer is worth it to protect my kidneys.

Taking a tiny dose of testosterone should theoretically be even safer if taken with one of the aromatase inhibitors. But again, it depends on your risk factors and is an individual choice. For me the preliminary results offer enough reassurance about the safety profile of a very low dose of testosterone. It also helps bolster my hemoglobin and gives me a little more energy and strength, and has a somewhat antidepressant effect. I overall feel better with it, in addition to no longer having infections.

kerry_lamb

07, the infections you describe..I have regular 'almost' UTIs and spend days absolutely uncomfortable and dreading an escalation. I pee 6 times a night. Would this be caused by the vaginal atrophy? I'm so sick of seeing doctors about things..my urologist can't tell me much and has been pretty thorough and yet still it happens. The cream you use..what is the prescription and what should I ask for? I am interested in trying it. Anything I should worry about?

07rescue

Hi Kerry, 

I'm sorry you are going through this also. I know that the vaginal atrophy for me causes increased permeability of the vaginal wall and increased susceptability to chronic infection, not matter how stringent the infection control measures I take. There is nothing more I could do to protect myself, it is the fragility of the wall from estrogen depletion that makes the difference.

 

I am lucky that my primary care physician is willing to work with a compounding pharmacy here in the US to treat the infections with testosterone cream My prescription is for topical testosterone cream at 100 mg/gram in a 60 gram tube. One tube lasts me for around 4 months at $54 cost, plus $10 shipping. I apply a tiny amount daily - approximately the size of a small early spring pea - is the best, but unscientific description I have for my dose, and it returns my vaginal wall to the state it was in long before aromatase inhibitor therapy, no infections, no pain. It has really worked for me, so it was very reassuring to see the report come out of the SABC that at least one clinical trial deems it safe and effective.

 

I feel much better about a tiny dose of testosterone than I do about topical estrogen, because I have an extremely estrogen sensitive breast cancer (100% positive staining). I really needed to do something about the infections, it wasn't a matter of being willing to tolerate all that pain, constant pressure, and waking up all night to urinate. Having that constant threat of kidney infection is not tolerable to me. The testosterone was an acceptable alternative. Feel free to PM me if you have any questions. 

AccidentalTourist

Ovestin cream may be another possibility. It does contain estrogen but a form called estriol which according to Dr Lee (of 'What doctors don't tell you ...' fame books) is not implicated in Breast Cancer.  Not everyone agrees with this and this cream has a warning to not to be taken by BC survivors.

kerry_lamb

07, thanks! I'm going to talk to a GP here, a lady who has a special interest in hormone-related matters because I have a feeling she will prescribe for me. Your info/experience is encouraging and has given me some optimism. I thought I was facing another 30+ years of 'almost UTI' peeing pain and  problems. That's way too long!

07rescue

Hi Kerry,

Good luck with your doctor! As soon as I had a moment I went and found the report from SABC about the topical testosterone clinical trial for you. It was reassuring for me that I was doing the right thing, given my kidney vulnerability. Perhaps your doctor might also be interested if she hasn't seen it already. Here is the webpage:

http://www.medpagetoday.com/MeetingCoverage/SABCS/7729 

I find it very shortsighted that researchers have not concentrated more on finding alternatives to global estrogen depletion strategies to combat breast cancer. Being estrogen deficient long term is simply an unhealthy and intolerable way to live, and puts so many body functions at risk that it causes multiple major long term problems. I hope more research will be devoted to the development of targeted therapies that address the cancer, and do not put the entire body at risk.

gymgirl

I am taking part in a clinical trial at UCSF for women on AI's with vaginal atrophy. Half the women are randomized to Estring and the other half to a vaginal testosterone cream. Monitoring includes a clinical exam, scoring of 6 vaginal conditions and blood tests to monitor estrogen levels. The doctors feel that both choices are safe even for ER+ patients because the doses are so low. I will say that after only 1 month with Estring, I have noticed a real improvement. I do have some discharge, like I did off & on for those 40 years before menopause. My onc referred me to the study. Talk to your onc to see if it is an option for you.

mawhinney

Thanks to everyone for their helpful replies.  For most of the past week my "team" of doctors have been discuss my using Estring.  The consensus is that I should use it as it is a very small dosage, smaller that estrogen creams.  I haven't filled the Rx as yet as I have  seen the warnings and have many concerns but at this point I need to do something. I feel like I'm dammed if I do and dammed if I don't!

 My new gyn said my urinary infections were most likely caused by vaginal atrophy & my symptoms would greatly improve if I used Estring.  He said maturing and the use of AI drugs is the main cause of dryness.  He said tamoxifen can cause the lining to become paper then. Almost like tissue paper.

I will check out the testerone cream and the study.  Has anyone tried Vitamin E suppositories?

Mary-Lou

This may help to explain what it is.  I had just posted it when I found this thread. Thanks for the post. At the bottom of my post is some other cream with out hormones.

Sexuality and Reproductive Issues (PDQ®) - Factors Affecting Sexual Function in People With Cancer

Sexual dysfunction may be multifactorial; both physical and psychological factors contribute to its development. Physical factors include functional damage secondary to cancer therapies, fatigue, and pain. In addition, cancer therapy such as surgery, chemotherapy, radiation therapy, and bone marrow transplantation may have a direct physiologic impact on sexual function.[1] Medications used to treat pain, depression, and other symptoms may contribute to sexual dysfunction. Psychological factors include misbeliefs about the origin of the cancer, guilt related to these misbeliefs, coexisting depression, changes in body image after surgery, and stresses to personal relationships that occur secondary to cancer.[2,3] Increasing age is often believed to be associated with decreased sexual desire and performance; however, in one study, elderly men reported that sex remains important to their quality of life, that performance can be maintained into the 70s and 80s, and that altered sexual function is distressing.[4]

Treatment-Related Factors Secondary to Surgery

A number of cancer treatments have a direct physiologic impact on sexual function. As treatment success has improved for some sites, attempts have been made to modify treatment to reduce sexual morbidity. Several predictors of postoperative sexual functioning include patient's age, premorbid sexual and bladder functioning, tumor location, tumor size, and extent of surgical resection.

Breast cancer

Sexual function after localized treatment for breast cancer has been the subject of a good deal of research. Several reviews concur that breast conservation or reconstruction have only a minor impact in preserving sexual function compared with a mastectomy alone.[5,6] Women who have breast conservation, in particular, are more likely to continue to enjoy breast caressing, but groups typically do not differ on less subtle variables such as the frequency of sex, ease of reaching orgasm, or overall sexual satisfaction. A cross-sectional survey of younger women (aged 50 years or younger) with breast cancer found in multivariate analyses that having a mastectomy was associated with greater problems in interest in sex; chemotherapy was associated with greater sexual dysfunction.[7] Other studies confirm that sexual quality of life is disrupted more among those receiving chemotherapy, those who have undergone total mastectomies, those whose cancers were detected at later stages, and those with more depressive symptoms near the time of diagnosis.[8] Adjuvant tamoxifen therapy increases the rate of hot flashes, night sweats, and vaginal discharge, and increases the risk of premature menopause in women older than 45 years by approximately 10%. Furthermore, though rates of sexual activity with a partner did not decline, women taking tamoxifen reported slightly increased rates of difficulty with sexual arousal and achieving orgasm.[9,10]

Few studies evaluate sexuality in women with breast cancer that recurs. One longitudinal study compared women who were recently diagnosed with recurrent cancer with matched patients who were disease free. The recurrence group had less frequent intercourse, although there were no differences in sexual or relationship satisfication. As noted in other studies of women with breast cancer, sexual changes were more common among younger patients.[11]

I found this also......

Vaginal Atrophy, also known as Atrophic Vaginitis can cause a number of side effects that can make sexual activity uncomfortable and even painful. A lack of lubrication or vaginal dryness is one of the most common complaints for women experiencing this condition. Lyriana is a world-wide patented topical gel that can help:

• Regenerate delicate tissue of the vaginal walls
• Make sexual activity more comfortable and enjoyable
• Prevent vaginal tissue atrophy without hormones
• Promote natural lubrication long term

Clinical studies have proven Lyriana's effectivenessin treating symptoms of vaginal atrophy. So if you're tired of trying temporary lubricants and want to avoid potentially dangerous hormonal treatments, learn more about Lyriana and discover why it has turned around so many women's sex lives.

Link: 

 http://www.lyriana.com/ppc2/vaginal-atrophy/cont/index.html?ucroi_kw=vaginal atrophy&ucroi_adid=27950&ucroi_google_type=GoogleAdWordsSearch&gclid=CLzcxJbVhJgCFRJ4xgodzw6slg

http://www.lyriana.com/ppc2/vaginal-atrophy/cont/index.html?ucroi_kw=vaginal%20atrophy&ucroi_adid=27950&ucroi_google_type=GoogleAdWordsSearch&gclid=CLzcxJbVhJgCFRJ4xgodzw6slg

mom_of_2

HELP...

I believe that I have some vaginal atrophy due to painful intercourse but honestly haven't had much sex since diagnosis. My periods never stopped during my 20 weeks of chemo and here I am 3 wks post bi lat and I have my period. Not a usual period so far...spotty and dark...but a period non the less. My question is...I started Tamoxifen 2 weeks ago and using a tampon hurts...is that ok? I don't want to freak BUT everything makes me freak  

Thanks for any advise 

wishiwere

Okay, for what its worth here is my 2 cents.  Chemo put me into full fledged menopause.  No period since the ond dec 5, 2007 when I had my first A/C infuson.  After chemo, I was so dry and thinned that even the tiny 1/4 inch wand to insert replens made me bleed, no less from relations with tender and caring dh. Tried replens, astroglide and nothing worked, actually gave me more soreness from their use.  about a month after startingarimidex I spotted for 2days.  TV U/S, showed I okay, just menopausal atrophy.  Started estrace (estrogen cream) per GYN instruction ad against pharmacists and ariidex warnings.  All was great after about 6 weeks.  No problems with dryness or pain.  Then onco said NO more. He said the Only thing he would agree to was estring.  When I went off it, i had hot flashes as bad as before and joint pain again.  I had not realized how warm ( rather than hot) my flashes had gotten to on the estrace. Although the blood test showed my estrodrial at the meno level, I know how much my flashes had decreased in quantity and quality and that I had much less in achesand pains in the thighs/joints.

Oh,, also Susan Love and this BC.org both okay estring and one of the creams, but NOT estrace.

mawhinney

It is my understanding that Estring has the lowest doseage of estrogen.  Lower than the creams.Today I  started using Estring.  I'd rather not be taking it due to the cancer risks but there seems to be no other alternative.  I'll let you know if it helps or not.

mawhinney

gymgirl ~ I am interested in learning more about the testerone cream/Estring study you are involved in at UCSF.  What is the name of the study? Do you know where I might find any information?  Thanks a bunch!

mawhinney

gymgirl & others  ~  In the UCSF study did they say anything about the difference between Estring & Vagifem? I am trying to figure out why one is better than the other.  On a weekly basis Estring puts a little more estrogen into  the body than Vagifem (52.5 mcg vs 50mcg.  However, Estring releases a 7.5 mcg unit into the body daily while Vagifem is used only twice a week and each time it releases 25mcg estrogen units..  Is Estring better because it delivers a small daily dose rather than Vagifem's stronger 2x wk dose?

mawhinney

Is it safe to use lubricants while using Estring?

What about Pap tests and exams - can they be done with Estring in place?

gymgirl

The Estring inserts like a diaphram. It stays in for 3 months but you could take it out if you wanted.My onc said no to vagifem but approved for me to be in the study using either Estring or test. cream. She said I could use a lubricant if needed with the Estring.

The study title is CC#067519:A Phase II study of vaginal testosterone cream vs. the Estring for vaginal dryness or decreased libido in early breast cancer patients treated with Aromatase Inhibitors. Principal investigators are Dr. Michelle Melisko and Dr. Mindy Goldman at UCSF. I haven't seen anything printed about the study yet; I assume that will come after it is completed. I am in the study for 3 months.

bomber410

I'm just curious.  Why not use a basic oil like Vitamin E oil?

Debbie

Mary-Lou

Debbie, it just doesn't last long enough....

This is how I feel these days...

OLD DRY

mawhinney

Gyn said our tissue doesn't really absorb much of the vitamin E.  Products like oils, Replens, KY liquid gels are merely lubricants. They do improve the tissue while Estring does..

bomber410

I apply vit E oil most days after I shower.  I do notice overall improvement.  I do also notice when I go for a time without using it. I guess I will bring the topic up with my primary and my onc when I see them next.

Good topic.

Debbie

Wailukugirl

Hi--I just picked up my new Estring prescription, and the price went up again! When I began using it in Oct. '07, my co-pay was $127. It has steadily risen to where I paid $174 yesterday. Does anyone know why this is happening? Are you experiencing similiar price rises? (Obviously I have crumby prescription coverage which barely pays anything for non-generic drugs.)

Thanks,

Jill

cp418

http://www.pfizer.com/files/products/uspi_estring.pdf

mmm5

Hi ladies Its official I went to Gyn on weds and they dxed severe vaginal atrophy. I am 42. the Chemo put me into early menopause and the AI only worsens things. I had a UTI then was on Cipro, then 4 days after finishing antibiotic I felt it again but urine culture was negative for infection. I just constantly feel uncomfortable in my bladder, is this all part of the atrophy cycle?

AccidentalTourist

Unfortunately, UTIs are common se of Tamoxifen.  I have had two full blown ones since I started taking it but managed to stop the third one by taking a capsule of oil of oregano as soon as I felt first signs of the third one.  Oil of oregano is a potent anti bacterial (as well as anti viral and anti fungal) oil but it can cause allergic reaction so be cautious when using for the first time.

I am considering using Ovestin cream for prevention of v. atrophy and am looking for anyone who has had experience with this.  Any advice would be appreciated.

mcgaffey

I got the go ahead to use the cream. I had a bladder repair operation and in the process removal of my uterus last summer. I used the cream for a month before surgery and have been using it sparingly since. The surgery and the cream have made my life so much better. I am careful with my diet, use of alcohol, and I take supplements and walk.

Firni

mcgaffy  which cream are you using?

Pharmmom

I posted this under mojo .  I found a product called "me again" vaginal lubricant.  It is specifically for post menopausal women.  It is working pretty well (surprisingly).  I got mine at CVS.