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Author Topic: Vagifem ovestin and cancer risk  (Read 15942 times)

Shelly65

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Vagifem ovestin and cancer risk
« on: January 16, 2019, 09:12:18 AM »

Hi all, just been to GP  for my hrt plus a script for ovestin. I use vagifem 5 to 7 days a week plus a smear of ovestin 1 to 2 times a week. Sooo  annoyed because my preferred gp is happy to do this but this one today to!d me there is a VERY high risk of womb cancer. My answer was "well I'll take the risk thanks". Feel so angry right now. Do they actually have any evidence to support this. If so where is it coz I haven't seen anything. In future wil see my preferred doctor.
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suzysunday

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Re: Vagifem ovestin and cancer risk
« Reply #1 on: January 16, 2019, 11:02:50 AM »

Hi, I assume you meant the risk the gp said was for the vagifem/ovestin. Sorry your gp has worried /angered you.  I use ovestin and no other hrt for VA. I have been struggling with uti symptoms for a few months and saw my gp and she advised to use it every night for a while and alternate nights for life if need be and gave me a script for 4 tubes to keep me going. She said it's very safe to use. She mentioned that other gps at the practice might not agree, but she's the hrt expert there.  It was a relief to hear her.  I could not manage without it anyway.
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Shelly65

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Re: Vagifem ovestin and cancer risk
« Reply #2 on: January 16, 2019, 02:01:53 PM »

Ye from them both. My other doctor said very safe even to use every day. Only use a tiny bit of ovestin on the outside anyway not both internally. Maybe there are women who have had womb cancer whilst using vagifem or ovestin but maybe they would have got it anyway. If I hadn't been a bit shocked at what she said and how she said it i probably would have asked for fact and figures lol. I'll be ready next time😀
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Annie0710

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Re: Vagifem ovestin and cancer risk
« Reply #3 on: January 16, 2019, 02:17:45 PM »

Oh it's so scary these gps are even practising !

One vagifem tablet used daily for a whole year would be equivalent to one standard dose oral oestrogen tablet x
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Shelly65

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Re: Vagifem ovestin and cancer risk
« Reply #4 on: January 16, 2019, 03:03:57 PM »

Couldn't agree more. What I should have also said but forgot  because I was angry is I tried to explain to the doctor that although the vagifem is good for inside it doesn't do anything for outside. She just she just looked at me stupid. Thank goodness with forums like this we can make informed choices and hopefully feel more confident when we go to the doctors.

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CLKD

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Re: Vagifem ovestin and cancer risk
« Reply #5 on: January 16, 2019, 03:34:46 PM »

Well Tamoxifen has a huge risk of womb cancer and that is taken by mouth.  But rarely do medics point this out.

Life is a risk.  Quality is important.  I had breast disease and my GP never hesitated in giving me appropriate treatment for VA.  PHEW!

I would ask where she got her information from. 
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Shelly65

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Re: Vagifem ovestin and cancer risk
« Reply #6 on: January 16, 2019, 04:06:10 PM »

Oh i will be ready the next time it happens. Thank God she is not my usual doc.
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Conolly

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Re: Vagifem ovestin and cancer risk
« Reply #7 on: January 16, 2019, 04:38:59 PM »

Hello ladies,

I have one doubt regarding this subject, maybe one of you can clarify it.

This link that Jenna has posted on Tc's thread about how long an Estriol tube should last, says 'Topical oestrogens should be used in the smallest effective amount to minimise systemic effects. The endometrial safety of long-term or repeated use of topical vaginal oestrogens is uncertain; treatment should be reviewed at least annually, with special consideration given to any symptoms of endometrial hyperplasia or carcinoma.'
https://northeast.devonformularyguidance.nhs.uk/formulary/chapters/7-genito-urinary-system/7.6-vaginal-and-vulval-conditions/7-2-1-preparations-for-vaginal-and-vulval-changes

The leaflet states that a progestogen should not be added. https://www.medicines.org.uk/emc/product/5869/smpc

This is contradictory and confusing.

Another doubt is: If there's no need for scans -  Section 1.4.14. NICE guidelines: ‘Do not offer routine monitoring of endometrial thickness during treatment for urogenital atrophy.' - then why allow those warnings for products used solely for urogenital atrophy? If there is no cancer risk, the leaflets should be clear about it. If there is cancer risk, then women under vaginal atrophy treatment should be monitored for endometrial thickness.

Maybe some GP's are just following the rules, which obviously need some clarification.

Conolly X

« Last Edit: January 16, 2019, 05:32:27 PM by Conolly »
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Hurdity

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Re: Vagifem ovestin and cancer risk
« Reply #8 on: January 16, 2019, 06:13:19 PM »

Hi all, just been to GP  for my hrt plus a script for ovestin. I use vagifem 5 to 7 days a week plus a smear of ovestin 1 to 2 times a week. Sooo  annoyed because my preferred gp is happy to do this but this one today to!d me there is a VERY high risk of womb cancer. My answer was "well I'll take the risk thanks". Feel so angry right now. Do they actually have any evidence to support this. If so where is it coz I haven't seen anything. In future wil see my preferred doctor.

Your doc is completely wrong - as far as I know there is no evidence for this! The warnings given on vaginal oestrogen treatments are the same as for full HRT and have not been updated - there is even the same warning on my tube of 0.01% estriol cream!

It is true that there are no long term studies have been carried out on long term effects of vaginal oestrogen but nevertheless due to the very low systemic absorption (which has been studied) and extremely low doses in vaginal treatments, no progestogens are routinely needed nor is there a time limit on vaginal oestrogen treatments. The BMS 2016 recommendations on HRT recognise this.

Yes the leaflets are and have always been contradictory in this regard and worry women needlessly. These warnings were in place when I first started vaginal treatment sometime around 2005 or so before I even started HRT - and they worried me too! Shocking though that the GPs have not educated themselves.

As always though if you have any persistent abnormal pain or unscheduled bleeding - do see your GP.

The link you posted and quoted from Conolly refers to out of date info - I don't know when it was written but needs updating ( as does quite a lot of info out there!). Heaven help us if GPs are referring to this and passing scary stuff onto patients! Gynest cream is no longer available - was discontinued some time ago and is now a generic. That info you quoted about the addition of a progestogen was in the guidance/warnings I referred to above - which is for full HRT but still appears in some of the vaginal treatments. However my latest leaflet for estriol 0.01% cream obtained today has actually modified the advice re endometrial cancer - so anyone who gets this should not be alarmed. (the info on dosage is still valid as the tube size and estriol concentration of the generic is the same).

Hurdity x

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Conolly

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Re: Vagifem ovestin and cancer risk
« Reply #9 on: January 16, 2019, 08:03:43 PM »

Hello Hurdity,

From the latest Ovestin 1mg leaflet: http://www.mhra.gov.uk/home/groups/spcpil/documents/spcpil/con1536293554114.pdf

Endometrial cancer (cancer of the lining of the womb)
Taking oestrogen-only HRT tablets for a long time can increase the risk of developing cancer of the lining of the womb. It is possible there may be a similar risk with oestrogen cream used directly in the vagina for repeated treatments or over a long time.
You do not need to take a separate progestogen with Ovestin.
If you get breakthrough bleeding or spotting, it is usually nothing to worry about, but you should: Talk to your doctor. It could be a sign that
your endometrium has become thicker.

Ovarian cancer
Ovarian cancer (cancer of the ovaries) is very rare, but it is serious. It can be difficult to diagnose, because there are often no obvious signs of the problem. Some studies have shown that taking oestrogen-only HRT for more than 5 years may increase the risk of ovarian cancer. It is not yet known whether other kinds of HRT increase the risk in the same way.

It still sounds confusing to me to say: 'Taking oestrogen-only HRT tablets for a long time can increase the risk of developing cancer of the lining of the womb. It is possible there may be a similar risk with oestrogen cream used directly in the vagina for repeated treatments or over a long time.' and then adding 'You do not need to take a separate progestogen with Ovestin'

Also... If there's no risk for endometrial cancer under this treatment why the Estriol generic leaflet (from 2018) says: 'Make sure that you go for regular breast screening and cervical smear tests' if cervical screening and scans are not offered for ladies over 65 under the NHS? My question is: if there is a risk, even if it's a small one, that vaginal oestrogen can increase the chance of certain types of cancer, why the NHS isn't extending scans and screenings to ladies under oestrogen vaginal treatment?

Conolly X
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Conolly

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Re: Vagifem ovestin and cancer risk
« Reply #10 on: January 23, 2019, 03:43:24 PM »

Hello ladies,

From Vagifem leaflet:

'HRT and cancer

Excessive thickening of the lining of the womb (endometrial hyperplasia) and cancer of the lining of the womb (endometrial cancer)

Taking oestrogen-only HRT tablets for a long time can increase the risk of developing cancer of the womb lining (the endometrium).

It is uncertain whether there is a similar risk with Vagifem® when it is used for repeated or long term (more than one year) treatments. However, Vagifem® has shown to have very low absorption into the blood, and therefore the addition of a progestagen is not necessary.

If you get breakthrough bleeding or spotting, it's usually nothing to worry about, but you should make an appointment to see your doctor. It could be a sign that your endometrium has become thicker.

The following risks apply to HRT medicines which circulate in the blood. However, Vagifem® is for local treatment in the vagina, and the absorption into the blood is very low. It is less likely that the conditions mentioned below will get worse or come back during treatment with Vagifem®, but you should see your doctor if you are concerned.'

Is it necessary to have absorption into the blood to cause local (vaginal and endometrial) cancer?

Conolly X
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suzysunday

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Re: Vagifem ovestin and cancer risk
« Reply #11 on: January 23, 2019, 03:51:27 PM »

Worried and confused. Using ovestin every night for VA for a few weeks. Still getting frequent weeing and fed up.  Don't want to use any other hrt as had bleeding on tiboline. I'm permanently worried these days.
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Conolly

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Re: Vagifem ovestin and cancer risk
« Reply #12 on: January 23, 2019, 04:03:03 PM »

Hello susysunday,

So am I.  I'm not on HRT anymore but it's likely I will need some in the near future, VA is already lurking around.

I am trying to read as much as I can on this subject to make an informed decision.

I hope your symptoms will ease soon. The worries are a different matter, I think they don't go away as long as we live.

Conolly X
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CLKD

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Re: Vagifem ovestin and cancer risk
« Reply #13 on: January 23, 2019, 04:30:02 PM »

Quality of Life Girls, Quality of Life.

This is 'can', 'may' and 'perhaps' with nothing to back it up.  Companies feel the need to state everything in case they get sued at a later date.

Should my cancer return I wouldn't be blaming anyone but would prefer to become part of Research Study because without bums on seats, no-one is really going to know! Maybe I ought to suggest this to my GP at my annual visit? 
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suzysunday

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Re: Vagifem ovestin and cancer risk
« Reply #14 on: January 23, 2019, 04:33:06 PM »

I think I've read too much and my brain jumps from one worse cae scenario to the next.
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