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[Nain56]

I am 69 years old, post menopause and post breast cancer.
I had estrogen positive breast cancer in 2006, anc clearance and a mastectomy followed by 10 years of Tamoxifen. Now suffering severe vaginal atrophy, frequent utis and feel like a sore dried up prune

I was referred to a lovely gynaecologist who deals with gsm symptoms. It took months for her to convince me that vaginal estrogen was ok for me to use. Started using Ovestin and it was a game changer but I kept getting migraines with aura , last had them when I was younger from aged 9 to 40., so it was a big shock to get them again. As the migraines are likely due to fluctuations in estrogen it is being discussed whether estring may be an option delivering a regular dose of estrogen vaginally. Haven't tried this yet as before that they gave me Intrarosa to try. This was good too but did not ease vulva burning like Ovestin.
Now comes my confusion. My GP thinks it is not a good idea for me to have any form of vaginal estrogen because it could aid recurrence.
Have recently had a series of bad UTIs which are being dealt with and will be seeing my gynae soon to see where to go next re vaginal estrogen. Before I saw my GP I was not anxious about continuing with some form of vaginal estrogen but now I am.
It confuses and worries me that there are such wide differences of opinion amongst doctors on whether or not vaginal estrogen is safe for those who have had breast cancer.
Having taken ages to have confidence in using it I have now doubts. My instincts tell me it is ok and quality of life should supercede my doubts but my head keeps me awake worrying about it.

Apologies for long post. I don't expect answers ...Just writing my thoughts down to clear my head and wondering if there are others like me confused on this issue.
What are the 2025  statistics and medical opinions on this?

[bombsh3ll]

There is NEGLIGIBLE systemic absorption of vaginal estrogen. Even women with active breast cancer that is ER positive can use it.

The level of ignorance around all types of hormone therapy is shocking, and globally is leading to so much suffering.

Me personally if I was a breast cancer survivor 20 years clear and mastectomised, I would be on systemic.

However your question was in relation to vaginal estrogen, and an option you might be interested in is the estring, which delivers a stable level and can be left in for 3 months.

Unfortunately however this device is rather large and may be especially difficult to get into a vagina that hasn't seen estrogen in years, but some women are happy with it and it is worth a look if regular topical estrogen isn't preferred.

[Ayesha]

Many women use topical oestrogen post cancer treatment, its perfectly safe.
In this link there is a section on breast cancer and GSM, scroll down the pages and you should find it helpful.

https://bssm.org.uk/wp-content/uploads/2023/02/GSM-BSSM.pdf

[Nain56]

There is NEGLIGIBLE systemic absorption of vaginal estrogen. Even women with active breast cancer that is ER positive can use it.

The level of ignorance around all types of hormone therapy is shocking, and globally is leading to so much suffering.

Me personally if I was a breast cancer survivor 20 years clear and mastectomised, I would be on systemic.

However your question was in relation to vaginal estrogen, and an option you might be interested in is the estring, which delivers a stable level and can be left in for 3 months.

Unfortunately however this device is rather large and may be especially difficult to get into a vagina that hasn't seen estrogen in years, but some women are happy with it and it is worth a look if regular topical estrogen isn't preferred.

Thank you so much for your comments and reassurance. I really appreciate it.😊

[Nain56]

Many women use topical oestrogen post cancer treatment, its perfectly safe.
In this link there is a section on breast cancer and GSM, scroll down the pages and you should find it helpful.

https://bssm.org.uk/wp-content/uploads/2023/02/GSM-BSSM.pdf

Thank you for the link to this article and your reassurance. The article is very informative  and helpful.

[Nas]

Hi
Just to add, I’ve had primary breast cancer and now also live with secondary breast cancer. I use vaginal oestrogen in the form of pessaries and cream.

As bomb said, the amount of osestrogen absorbed, is TINY. You will be fine. If you can’t get it prescribed, just buy it in Boots (Ovestin cream and Gina pessaries).

Good luck.

[CLKD]

Quality of Life.  If HRT is as many medics still believe, dangerous, then bilateral mastectomy should be advised for us all!

Initially some ladies report headaches with Vagifem which resolve, mayB try that if estriol/ovestin is proving difficult.  The amount delivered is overall very small but may well impact, fortunately there are several products either OTC or via the NHS.  Out of interest, why 10 years of Tamoxifen and when did U stop using it?  [it almost killed me  ]

Intrarosa is worth trying with a smear of 'ovestin' on the outer labia when required.  Some find that keeping a mood/food/symptom diary of use.  I use KY Jelly when necessary as well as ovestin. 

[Nain56]

Thanks for the information and advice..
Re Tamoxifen  started 5 years in 2006 and finished in 2011. Had a year off then did another 5 years as the thinking at the time was that 10 years was beneficial. Didn't have any side effects at all. Finished with it in 2016/7. 😊

[CLKD]

U were very lucky.  I was advised by my oncologist in 1995 that 5 years would be enough.  I was unable to tolerate it after 4 weeks and as I hadn't felt physically ill during diagnosis and treatment, I stopped it.

Let us know what you decide?

[Nain56]

Will do. Thanks for your kindness and help.