Does topical estrogen work if you're taking Tamoxifen?

Hi Rachael,

My onc says that it is ok to use vaginal estrogen.  But having said that, he won't write a Rx for me.  He says that it's not his area of expertise.  There seems to be a difference of opinion with oncs, as to whether or not it is safe to use estrogen topically.

I am so afraid of recurrence, so I haven't really pushed the subject.  I have read that Crisco works.  I was using Replens for awhile, too.

I haven't been using much lately, because last summer, I had some issues from the Tamoxifen. It caused uterine polyps to form, and it made my endometrial lining THICK!  So I had to have a D & C, which was NO FUN!!  I started to have bleeding, and that was no fun, either.

I really don't know the answer to your question.  Sorry if I can't be of much help.

Hugs

Harley

Yep, same here. Was given a script and used it of estrace cream from my gyno. Onco found out and told me NO!  HE said he would relunctantly agree only to using the e-string as it's supposedly less estrogen.

I do know when I was using the estrace, my hot flashes were very minimal and when I went off it, they were back worse.  Now I wish I hadn't used it the few months I did.  Think long and hard about it, b/c it is contraindicated with arimidex and I'm assuming the same for tamox?

I would be hesitant to experiment on myself with a treatment that had been tested on so few women.  The report mentioned by 07rescue was presented at the 2007 SABCS meeting.  Here's a link to a news release that discusses the findings: http://www.medpagetoday.com/MeetingCoverage/SABCS/7729

I'm reprinting the abstract from the meeting, because the news release does not mention the small number of women enrolled in the study and the very preliminary nature of the results.  I've left out the table, since all the relevant information is in the text anyway:

[6086] Efficacy and safety of vaginal testosterone for atrophic vaginitis in breast cancer patients on aromatase inhibitors: a pilot study.

Witherby SM, Johnson JV, O'Brien P, Demers LM, Mount SL, Muss HB. Fletcher Allen Health Care (FAHC)/University of Vermont College of Medicine (UVM), Burlington, VT; FAHC/UVM, Burlington, VT; The Pennsylvania State University, Hershey, PA

Background: Treatment options for atrophic vaginitis in post-menopausal breast cancer patients on aromatase inhibitors (AIs) are limited, as recent data suggest that even topical estrogen therapy may raise estradiol levels. Without access to systemic and topical estrogen cream, many women may have unrelieved vaginal symptoms. We hypothesize that topical testosterone could be a safe and effective alternative treatment.

Materials and Methods: Six of a planned ten women have been enrolled and treated with 300 mcg of vaginal testosterone applied daily to the vaginal epithelium for 28 days. All women were post-menopausal, had symptoms of atrophic vaginitis and were taking AIs as adjuvant therapy for early breast cancer. Baseline and post-treatment variables were: high sensitivity serum estradiol and testosterone, self-reported atrophic vaginitis symptoms (rated from none (0) to severe (3)) and vaginal examination with pH and cytology.

Results: Laboratory data are currently available in the first four women. In all four women, estradiol levels remained low after treatment at concentrations expected for patients on AIs (see table 1). Only small changes were seen in testosterone levels. Total symptom scores improved in five women and were unchanged in the sixth. Average symptom scores improved with the greatest benefit seen in perception of vaginal dryness (2.5 pre-treatment to 0.5 post-treatment), followed by dyspareunia (2.2 to 0.83) and vaginal itching/irritation (1 to 0.83). Dyspareunia scores were not tallied in one woman who was not sexually active. On gynecologic examination, three women had moderate to severe signs of atrophy which resolved after treatment. Average vaginal pH decreased from 4.83 to 4.5 (range 4 to 5.5). Cytopathology showed improvement in the maturation value in all six women. Side effects were minimal and included mild vaginal rash in one woman and transient headache and pruritis in another. No thrombosis, hirsutism, or increased acne were noted.

Conclusions: To date, vaginal testosterone improved the symptoms and examination findings of atrophic vaginitis without affecting serum estradiol levels. Results from the remaining women will be available at the time of the meeting. If these favorable initial results are confirmed, vaginal testosterone will be evaluated in a larger, double masked randomized trial.

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I've printed some of the numbers in bold-faced font, so you can see how small this thing was.  Apparently, there was a more complete version presented at the meeting.  But, even so, this was a very tiny study--it was designed to test the effects in 10 women.  A larger trial was being planned if the final results were good.

otter 

I realize that this is an old thread but I need to comment: ESTRING is not "e-string" ...it is not a string. It's a silicone ring that gradually releases estrogen vaginally....it's short for "ESTROGEN RING" so if you're going to hyphenate it, it's Est-Ring.