- Question from RZehr: I'm 50 and feel like the Sahara Desert. Is this something I just have to deal with or can I get help? I never suffered this until I got off tamoxifen, started taking Arimidex and had my hysterectomy. My doctor says I just need to have a lot of sex with my husband to keep things lubricated. Besides having lots of sex, is there anything else I can do to help ease this severe situation?
- Answers - Mindy Goldman, M.D. This is a very common problem for women who are on aromatase inhibitors such as Arimidex (chemical name: anastrozole). For moisture, Replens may be helpful. There are also lubricants that we recommend for sexual activity. Some examples are Astroglide, Probe, or Silk. The role of local hormonal therapies in treating vaginal dryness for women with hormone-receptor-positive disease is a little controversial. Some of the standard estrogen creams used in menopausal women such as Premarin (chemical name: conjugated estrogens) or Estrace (chemical name: estradiol) could cause absorption into the blood stream if used in the standard doses that we treat menopausal women. The safety of that isn't known. There are a few types of therapies where there is little absorption of hormones into the blood steam. One option is the vaginal Estring (chemical name: estradiol). Many people use this as a first line to treat dryness. This however is based on pharmacy data showing little absorption into the blood stream and there aren't good studies that evaluate this in breast cancer patients. Another option is compounded testosterone. Testosterone is only United States Food and Drug Administration (FDA)-approved for men, but it is possible to make tiny doses in vaginal preparations that can be useful for women without the male-hormone-like side effects such as acne, hair growth, and oily skin. Finally, there is an estradiol insert called Vagifem that is also thought to have limited absorption, although there has been a recent study published specifically for women on aromatase inhibitors that shows a rise in estradiol when women used these products. So some oncologists feel that Vagifem should be contraindicated in breast cancer patients who are on aromatase inhibitors. We are actually doing a study at University of California, San Francisco, looking at the role of vaginal Estring or testosterone for women who have dryness who are on aromatase inhibitors.
- Charles Loprinzi The one last thing to consider is to talk to your oncologist regarding the magnitude of benefit expected from the Arimidex you are taking. For some women the side effects might be more than the amount of benefit they might receive from the medication.
On Wednesday, August 20, 2008, our Ask-the-Expert Online Conference was called Managing Menopausal Symptoms. Charles Loprinzi, M.D. and Mindy Goldman, M.D. answered your questions about how you can manage menopausal symptoms such as hot flashes, vaginal dryness, insomnia, 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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