MonaLisa Therapy for vaginal atrophy

Sydneybased

Hi, wondering if the Mona Lisa laser therapy which is said to help a considerable amount with vaginal atrophy is safe / proven. Anyone tried it? Anyone planning to? Any advice would be most welcome.

Sydneybased

Here's a link to an article

http://www.medicaldaily.com/fda-approves-mona-lisa...

Jubby

Hi Syndeybased, I am doing it at the moment. I had my second treatment on Tuesday here in Melbourne. I did not have noticeable results after the first treatment but the doc administering the laser says it will get better. I have to wait another 4 days before sex so will check in to let you know if session #2 has helped. I have TERRIBLE vaginal atrophy since BC. I was willing to try ANYTHING! I am 43 and BC has done a number on my vajayjay. I am hoping it will help. Even a 20% improvement would be good. Watch this space............

Sydneybased

Hi Jubby,

Thanks for responding. It's a cutting edge treatment, so the evidence base on whether or not it works - and whether benefits are sustained - is still quite weak. But if it does work, it will be game changing for a lot of people.

I'm going for a consultation tomorrow, so will report back also. I understand how you feel regarding the atrophy. I'm sure it happens to more people than is at first apparent. It's not really something that woman feel able to talk about openly.

Good luck! x

Sydneybased

Have started my treatment. Will feed back on whether it's worth the hassle / investment

rleepac

I'm 43 and was diagnosed 6 months ago. I'm doing chemo now so I'm in chemo-pause. Over the last month or two I've noticed that sex is painful. I use coconut oil for lube so I don't think it's a lube issue. It just feels like something pinching along the lower (back) half of the vag opening during sex. Is that from atrophy? Is it going to get better after chemo? I've heard of dilators - is that something I should be considering? I want to please my husband and I wouldn't mind enjoying sex again for my own pleasure. Help!

Sydneybased

Hi rleepac,

I've sent you a private message.

Lily55

i have it, cannot even be examined,good old aromasin.....

kareenie

Hi just wanted to mention there is another thread on this in the Sex Matters section.

https://community.breastcancer.org/forum/150/topic...

Sydneybased

Well, I'm 7 days out from my first laser treatment, and have noticed improvements.

Will the improvements last? Exactly how improved am I? Not sure yet.

Sydneybased

14 days out and happy to report that I feel very improved!! Laser therapy works - yes it does!!!

rleepac

Happy to hear it! Thanks for the positive report!!!

Sydneybased

Gearing up for my second treatment. Three weeks out from first treatment. I haven't had to use oestrogen cream over this period. My day to day discomfort has disappeared. I feel liberated. All I can say is that it's working for me.... I'd urge others in a similar position to try it. Of course, no guarantees, but I'd describe it as a GAME CHANGER for women left with distressing symptoms post cancer treatment.

Nice to share some good news for once

froggy12

So happy to hear this! I went for a consultation visit today. Was it painful? After what I have read on this site, I think I have to give it a try!

Sydneybased

No more than a cervical smear...so fine really.

Jubby

I am 3 sessions down and not seeing great results from the Mona Lisa laser treatment

The doctor administering the laser says things look better but I am still really struggling with sex. It's the 'ring of fire' issue. Bloody awful. I bleed after sex every time.

Going to have another treatment next week which will be #4. I think the plan is to keep going until I see results. I sure hope some are forthcoming!

J

froggy12

I am 4 weeks out from my first treatment. I can tell there has been some improvement in the day to day discomfort but not in the sex department. It is still very painful. I will have another treatment in 2 weeks, hoping for more improvement!

Sydneybased

Without getting into too much detail, perhaps try positions other than missionary These may be less painful because they take the pressure off some areas that are fragile / sensitive.

After two sessions, I am living without oestrogen cream (which is a huge relief because of doubts about its safety). This is a great step forward....

TallyLassie

This is exciting. Until yesterday when I visited my gyn, I had never heard of this therapy. He just got the machine a couple of months ago and says that the patients who have used it report great results. I have used laser on my face and it helped me there, so I'm inclined to give this a try. However, it costs $1500 for three treatments (though he gives a discount to breast cancer survivors). I'm going to call my insurance company and start bothering them about this. If I try it, I will report results.

Also, I wanted to add that both the gyn and my oncologist confirmed to me that since I have HER2 driven cancer, estrogen should not be a concern for me. That said, neither one of them would prescribe estrogen for me "just in case they are wrong." I'm also battling osteoporosis, made significantly worse by chemo (I had dexa scans in the 6 months before and after chemo). Not sure if it's from loss of estrogen or the chemo, but we decided to keep up with daily calcium and vitamin D plus weight bearing exercise (which I did all through chemo) and see if the numbers change. I also do yoga, which I feel helps me maintain balance to prevent falls, and help me fall "better" when I do.

froggy12

Thanks for the advice sydneybased! I am off the estrogen cream and have had the second procedure. Things are better, I have high hopes!

Laura

Sydneybased

I've had all three treatments now. My conclusion, at this stage, is that the laser therapy helps quite a lot, but it doesn't take you back to where you started (before chemo and before tamoxifen). The main benefit is that I'm surviving, just about, without the oestrogen cream. That's got to be worth the investment in the laser therapy. However, I do think that the benefits are overplayed - testimonials that claim that the treatment rights all wrongs. It doesn't. But I will continue to monitor progress and post it up here!!

Yazmin

Sydneybased: Thanks for this assessment.

froggy12

Thank you for the update. Things have gotten better, hoping for more improvement with the third treatment.

Sydneybased

I said I'd continue to post up my experience with the Mona Lisa laser therapy. Four months after I stopped using the oestrogen cream, I'm back on it. So, all in all, the treatment didn't have any lasting benefits for me. Sorry to say this - I had such high hopes.

It may be that the Mona Lisa therapy works better for women who are not on tamoxifen. I just don't know, and the medics using the therapy didn't have anything to share about who was more or likely to benefit from it.

It could be that I had lasting benefits from the oestrogen cream (confused with the impact of the laser) which wore off over time.

Either way, I'm $1,200 down and back to where I started.

Very, very disappointing.

My next question is, will I improve once I'm off tamoxifen? Does tamoxifen give you chronic atrophy, and when you stop taking it, this disappears or lessens? Anyone know?

Sydneybased

Anyone have an answer to the last question in the previous post?

LilacBlue

Been following this thread with interest since it opened. Went a week ago to see a private insurance gynecologist, rather than NHS nurse. I was informed the only way for me was estrogen and Mona Lisa would do nothing. Was offered Estring <--click link that she claimed does not get into the blood stream and these vaginal dilators. <--click link She sent a letter to my consulting onc and breast surgeon no response yet, but I don't think my breast surgeon will go for the Estring as I'm highly reactive to estrogen.

Sydneybased

Ovestin is supposed to be "safer" than vagifem. Might be worth mentioning it.

coconut123

omg....what Is this ..I had hysterectomy cause of her2.....just for piece of mind...I am like the desert...I have to use lube and lydocaine to get thru it..I'm only 43...I have that stabbing feeling on the back of the opening like skin tearing....I'm going to do this

DavisD

is anyone still following this thread?? I had problems identified as vulvodynia prior to BC but worse now. GYN gave me Estrace cream as long as I "assumed the risk" but not much help. My GYN said she has about 5 women with this condition but mine is the worst. Vaginal dryness and severe atrophy. This has severely affected my life and I have trouble even wearing jeans or sitting for very long. I've had Manual PT which helped minimally. I've never heard of this Mona Lisa laser tx but I'm going to research now. Breastcancer.organization is a wealth of information once again! Anyone else have difficulties prior to cancer tx?

Sydneybased

Hi guys,

This was posted by someone called "Lani" on the HER2 support.org website. (As an aside, I've been trying to join that site for a long time, but the administrators never answer my email requests).

OB/GYN 02.23.2016 0

ACOG: Vaginal Estrogen Safe for Breast Ca Survivors
No increased risk of cancer recurrence
SAVE
SAVED
by Molly Walker
Contributing Writer

Vaginal estrogen is safe for breast cancer survivors suffering from such urogenital symptoms as vaginal atrophy, vasomotor symptoms, and lower urinary tract infections, and there is no evidence of increased risk of cancer recurrence with the treatment, according to a statement from the American College of Obstetricians and Gynecologists (ACOG).
However, the decision to use vaginal estrogen should be made in consultation with a woman's oncologist, and only if "first-line choices" for managing urogenital symptoms -- which should be nonhormonal products such as lubricants -- are ineffective for breast cancer patients, reported ACOG's Committee on Gynecologic Practice, writing in Obstetrics and Gynecology.

Sexual medicine specialist Lauren Streicher, MD, of Northwestern University, who was not involved with the statement, said that although the treatment clearly eases vaginal dryness, many physicians are reluctant to prescribe it for breast cancer patients. But she said the response is quite different when gynecologists are asked about it.
"In 2011, I surveyed board-certified gynecologists about decisions they make regarding their own health care and asked, 'If you had breast cancer and had vaginal atrophy, would you personally use vaginal estrogen?' Ninety-three percent of female gynecologists said they would," Streicher wrote in an email to MedPage Today. "ACOG's position statement that it is safe to prescribe vaginal estrogen to women with breast cancer is long overdue, supported by solid data and is in fact a recommendation that many clinicians are already solidly behind."
The committee cited several studies that showed no increase in recurrence in cancer for breast cancer survivors using vaginal estrogen cream, and that vaginal estrogen may be appropriate for women using tamoxifen. The group cautioned, though, that "concerns remain about recurrence risk in women ... who use aromatase inhibitors." For this group, the statement said, urogenital symptoms not responding to nonhormonal therapies may benefit from "short-term use of estrogen with tamoxifen to improve symptoms, followed by a return to normal aromatase inhibitor therapy."
"These new recommendations are especially important and helpful because they provide the patient with the information needed to make an informed decision with the input of her health care provider," Diana Nancy Contreras, MD, chair, ACOG's Subcommittee on Gynecologic Oncology, said in a statement.
But there remains one major stumbling block to wider use of vaginal estrogen for breast cancer survivors: the current boxed warning on all estrogen products, including topical agents, indicating that increased risk of breast and endometrial cancer is a side effect.

"Even if a woman is given the go-ahead [to use vaginal estrogen], one look at the FDA black box warning is enough to dissuade all but the most motivated woman," said Streicher.
The North American Menopause Society (NAMS) recently presented evidence to the FDA in an effort to change the warning label. They argued that low-dose vaginal estrogen products, such as the type used to treat vulvar and vaginal atrophy, do not pose the same risk as higher doses of systemic hormone therapy.
The ACOG committee emphasized that decisions about treatment should include discussion of risks as well as benefits between a patient and her healthcare providers, so a patient can make an informed choice for herself. Vaginal estrogen should then be prescribed at the lowest dose and for a limited time, until symptoms improve.
Primary Source
Obstetrics & Gynecology
Source Reference: Committee on Gynecologic Practice "The use of vaginal estrogen in women with a history of estrogen-dependent breast cancer" Obstetrics & Gynecology 2016; Committee Opinion number 659.

LilacBlue

Sydney, thank you for your insightful post (Lani too). Seeing my breast surgeon today for yearly recall and feel better armed for our discussion after we discuss mammo conclusion.