- Question from Website Question: My OB/GYN (with my oncologist's knowledge) prescribed Vagifem for severe problems with vaginal dryness and atrophy. My oncologist is not happy about this and has asked me to consider switching from Arimidex to tamoxifen, as he feels estradiol is getting into my bloodstream from the Vagifem. I don't want to stop using the Vagifem, but don't want to switch to tamoxifen, either.
Mindy Goldman, M.D.
Typically we treat vaginal dryness with local forms of hormonal therapy. These include estrogens or the male hormone, testosterone. Typically these are in the form of creams, ointments, gels, or suppositories. Some of the problems with these treatments are that women may have estrogen absorbed into their bloodstream, and that may be dangerous if they have an estrogen-receptor-positive tumor. The truth is that there have not been good studies that have shown the danger or safety of using local forms of estrogen.
Nowadays, what many oncologists are choosing to use is something called the Estring. What I like about this option is that it's not messy, it doesn't require a cream or an applicator, it stays in place for three months, and women can have intercourse with it in place. And the main reason I like it is because of any form of local hormonal therapy, it has the least amount of estrogen that gets absorbed into your bloodstream. In our breast center, our oncologists feel very comfortable using the Estring to treat dryness.
If your oncologist doesn't feel comfortable with any form of estrogen, it is possible to consider testosterone. But again, we have limited research done in breast cancer patients showing the safety and efficacy of testosterone. One of the things that can be tried is over-the-counter lubricants, and I think some are better than others. I have found water-based lubricants such as Astroglide and Probe or Silk very helpful. I generally recommend these first, because they are not hormonal-based at all.
Women may also use the moisturizer Replens, although this tends to be less successful as a sexual lubricant. If you don't have enough relief with the lubricants alone, I would recommend the Estring as a first-line therapy.
On Wednesday, July 21, 2004, our Ask-the-Expert Online Conference was called Managing Menopausal Symptoms. Mindy Goldman, M.D. and Marisa Weiss, M.D. answered your questions about how to manage menopausal symptoms, including hot flashes, vaginal dryness, loss of libido, and more.
The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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