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[Nain56]

I had estrogen positive breast cancer nearly 20 years ago followed by 10 years of Tamoxifen.

Now have severe vaginal atrophy and frequent UTIs. I am 70.

Was given vaginal estrogen to use 2x weekly. It was a game changer but seemed to trigger severe migraines with aura. Was then given Intrarosa to try. It is excellent inside but does not seem to help labia burning, frequency etc.

I have a couple of questions.

Is there a vaginal estrogen that you use daily like Intrarosa...my migraines are triggered by estrogen fluctuations so I thought it may be better to use it more frequently and regularly so fluctuations are negated . Or is it possible to use Intrarosa inside and an estrogen cream outside? Intrarosa has not triggered migraines and is doing a great job inside but doesn't seem to help outside.

Any thoughts. I am learning very quickly that at my age quality of life is more important than constant fear of BC.

[Firebearer]

How long have you been using Intrarosa for?  It takes 12 weeks or more to be fully effective.  I'm also pretty sure there are estrogen creams available.  Topical estrogen doesn't increase risk of BC despite what the dire warnings in the patient leaflet say.

[Nain56]

Thank you. I have been using Intrarosa for nearly 12 weeks so will perservere  and see if helps the terrible burning outside. It has done a great job inside .
Just trying to cope with terrible burning outside and frequent UTIs.

Thanks again.

[bombsh3ll]

I would just get a standard vaginal estradiol 0.1% cream and use it daily externally in addition to the prasterone.

Systemic absorption is negligible, however when genital tissues have gone untreated for a prolonged period they can become so dessicated and the skin barrier so dysfunctional that paradoxically there is an initial, transient increase in systemic absorption (still clinically minuscule) until the health of the tissues has improved.

Additionally, the nocebo effect is a very real, scientifically established phenomenon, I have experienced it myself in a different context, and I would not be surprised if following your cancer it had been absolutely hammered into you that estrogen = the devil. Therefore feeling potentially stressed and conflicted about using a vaginal treatment could quite plausibly have exacerbated your migraines.

[Ayesha]

I have experimented enough on myself to know that using one treatment is not always enough to treat VA. I am not on systemic HRT and its probably the reason why at over 70 I need more help.
Ask or buy estriol cream, Boots sell it under the name Ovesse, it only takes a smear twice a day to relieve symptoms.   

[Nain56]

Thank you Bombsh3ll and Ayesha

I really appreciate you thoughts and guidance.
I have started using a tiny bit of Ovestin on the outside as well as continuing with Intrarosa.