Ask the Nurse

I am 52 years old and post-menopausal. In January, I had a surgical biopsy of my breast following the discovery of "pre-cancerous" or "high risk" cells. No cancer was found, but my doctor stopped my hormone therapy anyway. Almost immediately, I developed osteoporosis and severe vaginal dryness. I am taking Actonel now for osteoporosis, but am having difficulty with the cost. Less expensive options have more serious side effects. I have yet to find a non-estrogen remedy for vaginal dryness that works for me. Is there a compelling reason not to go back on hormone therapy?

When it comes to breast cancer and pre-malignancy as well as hormonal therapy, there is so much misinformation on the Internet and the community. There is no wonder why so many women come to physicians dazed and confused. Here are some basics:

  1. Breast cancer is the most common non-cutaneous malignancy in US women, and a woman’s lifetime risk is 1 in 8.
  2. Over-diagnosis with screening mammograms is a real problem.
  3. Rates of over-diagnosis vary and range from 1 to 50%, with most publications hovering around a 10% rate of over-diagnosis. This means that breast cancer is being diagnosed, and it would otherwise NOT go on to cause symptoms or death.
  4. There is no way to determine who has this type of cancer, so all women who are diagnosed are evaluated and treated.

You, however, were not diagnosed with breast cancer. Thus, barring other medical conditions, you do not have a contraindication to hormone therapy. In fact, you may have several indications for hormone therapy. Hormone therapy can help protect the bones, as estrogen is needed to mineralize them. Most patients don’t realize this, but osteoporotic fractures are more common in women than heart attacks, strokes and breast cancer combined. Also, estrogen is needed to keep the vaginal tissue healthy and plush. Hormone therapy comes in many different forms including:

  • Oral
  • Transdermal
  • Local vaginal formulations

There is a “designer” estrogen/SERM (selective estrogen receptor modulator) combination pill called Duavee (CEE/bazedoxifene) that can treat:

Another SERM, called ospemifene, is a non-hormonal FDA-approved drug to treat vaginal dryness.

There are many options for you. Without knowing your full medical history, it is challenging to make specific recommendations for you. Please see your physician to discuss your needs.

All my best,
Speaking of Women’s Health Nurse

Be Strong, Be Healthy, Be in Charge!

October 26, 2015 at 10:41am