Ask the Nurse

In 2004, I had a mastectomy of the right breast and lumpectomy of the left breast, removal of 9 lymph nodes under my right arm (4 were positive and cancer had gotten into the chest wall a little). I also had chemo & radiation, Herceptin once a week for a year, Tamoxifen for 5 years and I am working on finishing 5 years of Femara. My cancer was the type that is so-called “estrogen positive”. Now I have vaginal atrophy and since I can’t take systemic estrogen my GYN physician told me there is nothing I can do except use KY-jelly or a similar item for my discomfort, but nothing was going to help it get better. I’m 55 years old and this is very depressing news. The vaginal atrophy is very uncomfortable. Is their anything that I can do? I have a family history of breast cancer on both parents sides, and my mother had breast and ovarian cancer when she passed away.

There are treatment options that are safe and can be used for vaginal atrophy, including for breast cancer survivors whom are suffering from this atrophy also called genitourinary syndrome of menopause (GSM):

  1. Most of the anti-estrogen treatments you were given to treat the breast cancer have caused vaginal atrophy as a side effect, which makes sexual activity and vaginal intercourse painful, as well as pain during vaginal exams.
  2. Compounded vaginal DHEA is safe and effective for breast cancer patients, and converts into estrogen and testosterone at the intracellular level, helping to revive some of the damaged vaginal tissue without affecting uterus, breast or rest of the body. It is a vaginal suppository that is placed in the vagina nightly and does not go systemically, but has to be prescribed by a physician who has followed the research and compounded at a reliable compounding pharmacy.
  3. Another option, which is FDA approved is an oral treatment option called Ospemifene (marketed as Osphena), which carries FDA approval for GSM and is a 60mg pill taken orally every day with food and is very effective for treating vaginal dryness and pain during intercourse. Women with a history of blood clots should not take Osphena which is related in structure as a SERM to Tamoxifen, which you already took.
  4. Very low doses of vaginal estrogen like estring vaginal ring and/or vagifem can be used if approved by your oncologists.

You should talk to a local menopause expert about these medications as there ARE things you can do to improve your symptoms. You can also use olive oil as a vaginal moisturizer and lubricant.

All My Best,
Speaking of Women’s Health nurse

January 13, 2016 at 5:34pm