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[Nain56]

I had estrogen positive breast cancer in the past so cannot take HRT. I am now 68 years old and had breast cancer when I was 50.
I have been suffering from GSM symptoms especially burning, frequent UTIs, soreness and very painful sex.

My gynae put me on vaginal estrogen, Ovestin and it was amazing and really helped me but then after about three months I started to get very severe migraines. I had not had a migraine for 50 years so it was a big shock. When I was young my migraines were linked to my monthly periods.
I stopped using Ovestin and the migraines stopped but my GSM symptoms have returned.

I am using replens and hyalofemme which are helping but not as much as the Overstin did.

I have two questions:

Would a lower dose vaginal estrogen still cause migraine?
I thought vaginal estrogen does not enter the blood stream but it seems to be linked with
my  migraines.
I am now concerned whether vaginal estrogen is safe for breast cancer survivors.
Is there any medical evidence that vaginal estrogen is  safe for anyone who has had estrogen positive breast cancer in the past?

Sorry for very long post. 
Any advice welcomed.

[bombsh3ll]

It is absolutely safe, even women who are having current treatment for breast cancer can use vaginal estrogen.

Check out breast cancer.org and also Lauren Vickers' article in JAMA 2024 for some of the scientific evidence.

There is negligible absorption of this treatment and blood tests have shown that it doesn't increase estrogen levels in any meaningful way.

Your options are

1) continue existing vaginal estrogen and treat the migraines with appropriate medication

2) use a lower dose - blissel is a topical treatment with 0.01% estriol, this works for some people

3) look into other options such as oral ospemiphene which is a SERM, or prasterone (vaginal dhea). I am not sure about availability of these on the NHS.

[CLKD]

Hi!  some find that they have headaches when they begin 'vagifem' which settle after the vaginal tissues plumps up and they get by with less treatment.  For most VA treatments the idea is nightly for 2-3 weeks then as necessary; usually every 3rd and 6/7th night.

How often were you inserting the 'ovestin'?

Even though some GPs still prescribe it, I wouldn't use replens, it has 'nasties' in it and isn't for oestrogen replacement.

It is safe in general for all of us, however migraines are awful.  If they are linked to the Ovestin/estriol, mayB try the 'vagifem'.  U can of course report these migraines on the Yellow Card system.

Migraines, along with nose bleeds, I dread!

Let us know how you get on.

[Nain56]

Thank you for your advice, links and info.
I really appreciate it.

[CLKD]

We're here, simply ask ;-)

[Nain56]

What nasties are  in Replens. I have found it helpful and haven't had any side effects

I was using Ovestin 2 x a week using the  applicator..

[bombsh3ll]

There's nothing wrong with using products like replens if it helps you and doesn't cause any irritation.

My only problem with that type of product is when it is being paid for out of pocket with huge profit margins, as commercial products marketed at women, and in particular menopausal women often are, or where it is being used in place of estrogen inappropriately due to fear, misinformation or lack of access to good medical care.

[CLKD]

Many find 'replens' causes discomfort.  I agree with bombsh311 . 

Your regime of twice a week shouldn't induce migraines - it may at a push be the fillers or packaging rather than the active ingredient .  Let us know how you get on.

[VioletAquarius]

Instead of hrt, you could try acupuncture.

[bombsh3ll]

Instead of hrt, you could try acupuncture.

😂

If you use a really, really big needle it might briefly take your mind off the pain of vaginal atrophy. Goodness only knows where you'd have to stick it.

[CLKD]

I found acupuncture really painful whereas DH didn't feel a thing  . 

[Ayesha]

Replens is fine to use if you are getting on alright with it. It does contain chemicals and a lot of us here prefer the more natural moisturisers like Yes or Sylk.

I remember my migraines returning in my 50's but they soon passed as time went on, probably some left over hormones still active which might explain yours. Topical oestrogen is safe to use and its the only treatment that will keep GSM symptoms in check.

I honestly can't see how acupuncture could help with this chronic condition and where on earth do they stick the needles?

[CLKD]

Well acupuncture points aren't related to the painful areas.  Apparently.  i.e. putting needles into the feet then tapping them gently to activate response in other parts of the body 

[Nain56]

Thanks everyone for your time and advice. I am going to try a lower dose estrogen 00.1 instead of 0.1 I was using andxsee how it goes.
I really appreciated your comments.😊

[CLKD]

Let us know how you get on.