Vaginal Atrophy

When I went to my Uro Gyn about a pelvic floor prolapse question, he mentioned vaginal atrophy to me after a thorough exam. Yes, sex had been excrutiating and yes I was interested in treating it. He prescribed Premarin Vaginal cream and let me tell you. WOW. After the first week of use, I could enjoy sex again! It wasn't the most comfortable it's ever been, but I wasn't cringing and crying in pain. Now, about 2 or 3 months out (and using the cream 2x/week) it is actually enjoyable again!! I don't know if your ER+ dx rules out using Premarin, but I thought I would mention it for you and others that are suffering.

Talk to your Gyn. May require approval from your Onc as well, but some type of vaginal estrogen could be a big help. I have in the past used estrace cream and now use a compounded estradiol, estriol, and testosterone cream. This works the best for me and also seems to help improve the arousal and sensation.  There is also the Estring and a pill called Vagifem. Some oncologists are against any type of estrogen, but these are all low dose and used only in the vaginal area. Many studies have shown that after an initial spike in estrogen levels from these products, that levels then settle back down. They help to plump the tissue back up, take away that raw feeling, help you to make your own lubrication again. And this is an extremely important quality of life issue! Find a Gyn who deals frequently with menopausal issues if your current one doesn't get it.

Hello, are any of you on tamoxifen and considering discontinuing it due to this atrophy?  I am finally coming up for air after denial of how bad my body has deteriorated after chemo in 2010 and almost 3 years of tamoxifen.  Any thoughts on stopping tamoxifen to restore?  I'm still testing pre-menopause at age 50.

Karen, is switching to a new ONC and a new GYN an option?  I've changed GYNs twice since diagnosis.   My current GYN would not prescribe anything until he got written permission from the ONC and luckily, my ONC is in agreement that quality of life is important, and not just the idea of avoiding any type of estrogen in any area forever (which I never agreed with anyway).  I too felt that going through menopause was devastating, and was enough to deal with, and was unwilling to compound the problem by further depriving myself of estrogen .And I also quit tamoxifen early (after 3 years) and additionally, refused to take the aromotase inhibitors.  I did make exercise a regular part of my life and improved my diet.  I am over six years post breast cancer and am comfortable with my choices.  And I would gladly use the vaginal hormones for life should I feel the need.

For those that are experiencing such pain, and atrophy a patch biopsy is important to rule out a treatable cause. Assuming it is strictly related to the absence of hormones is an error on the docs part.

My scenario with the LS, I already had a dx when it became a problem. Initially it was dx'd with a patch bx done during my yearly head to toe dermatology vivist. Derm doc didn't ordinarily do vulva screenings. Once the dx was made, she recommended I f/u with a Gyn as she didn't ordinarily do vulva's.

My situation was not a problem until RAI-131. Then the lid blew off.

Generally, a Gyn can dx it readily b/c there is a certain color to it. But in my case their wasn't. It was different. How, Lol, I couldn't see. The reason I'm adding this is, I didn't want it to appear I was dissing all docs. If it doesn't fit the textbook pic and they don't have other clues, it's not unreasonable that they wouldn't think post menopausal atrophy.

In the research before and after it became a problem, I learned so much. Thyroid can be related, as can the hormones. No question RAI-131 being pee'd all over the area was a,  particularly, unique issue.

 My body is having a particularly hard time getting adjusted on thyroid replacement hormone. The Moffit Cancer center NCCN Really Big Wig Doc said that the wildly swinging thyroid levels going through the treatment protocol was the trigger.  For some reason those swings are still going on (no Hashi's, antibody negative).

My own Endocrin doc(now fired). had no clue eczema &  psoriasis, can be caused by thyroid. Subcategories of Eczema are Lichen sclerosus and Lichen planus. My Derm doc didn't point out the thyroid  connection. AND she didn't point out that LS was a form of eczema, yet she did the vulva bx mid 2013. My hands were a huge problem from early 2013 till mid 2014 for which she followed me all year. The hand dx was dishydrotic eczema. Once an eczema dx is made other forms of eczema are possible. It took me searching it on the internet  on thyroid and lichen sclerosus to make the connection between the two. One of those Oh SHIT moments.

 The reason I'm lucky is the research said in many articles that women can go for years without a proper dx because a biopsy was never done. I happened by serendipity to have started out with an incidental dx because I asked for a vulva exam in my yearly derm exam in mid 2013. My derm doc actually thought it was something else when she did the bx. When it became an issue in May 2014, I was able to react very quickly with steroids and protecterant ointments.

Karen, As you look at lichen sclerosus, key in on the description of the vagina entry. You are not describing usual post menopausal Introitus and labial atrophy. You're describing very severe. It just would be a good thing to make sure it's not one of the Lichens. The lichens are described as you describe it. In the severest form of the scarring, there can be closure  or almost closure of the vaginal opening. AND in the severest form of postmenopausal atrophy there can be closure or near closure.

The treatment of serious atrophy. and LE/LP is very different.

If you get a biopsy ask specifically for it to be read by a Dermopathologist, many articles stated this is important b/c it can be missed by a regular pathologist study. Also, the more recent reading( this week) stated it is very important to read articles/publications that are recent(< a few years). The management has evolved very fast.

Your scenario is now several years old. Generally, my research said early treatment is very important to prevent what you have described if it is LS/LP. But this is why it's important to get to a Vulvovaginal treatment center. They will be most uptodate. Plus, they are going to have a connection to a plastic surgeon that can help with the scar tissue formed because the proper treatment of steroids wasn't used. This allowed scarring with contractures to occur at the vaginal opening.

If your opening of the vagina is postmenopausal atrophy, you get the PS that is trained to fix it, by going through a vulvovaginal center. NOT some surgeon that maybe does something a couple times a year.

Hope this all makes sense. It's a tad jumbled. Sassy

Anyone here been prescribed DHEA suppositories? My team says it doesn't get absorbed into the bloodstream and is okay for ER+ survivors. No guarantees, though, of course! I can't find any studies that have been done on bc survivors. I am hesitant to do this, but really need something desperately. Even exams are painful at this point.

Has anyone heard of the Mona Lisa thing? I guess it's some type of laser treatment for this?