The American College of
Obstetricians and Gynecologists’ (ACOG) Committee on Gynecologic Practice
advocated in favor of using vaginal estrogen in
breast cancer survivors in forthcoming march issue of Obstetrics & Gynecology: (March 2016 -
Volume 127 - Issue 3 - p e93–e96) .
In general population, systemic and vaginal estrogen
preparations are in wide use for relief of vasomotor symptoms, Lower UTI, vaginal atrophy and dysparunia.
However, some cancers are hormone sensitive creating a
safety issue specially in those patients who have breast cancer or are breast cancer
survivors.
Healthcare providers are becoming increasingly aware of the
need to address female-specific survivorship issues especially the urogenital
symptoms arising due to hypoestrogenic state because of cancer surgeries or
natural menopause in survivors.
Nonhormonal methods like moisturizers, lubricants, and
topical anesthetics, are always the first-line of treatment for urogenital
symptoms or atrophy-related urinary symptoms experienced by women during or
after treatment for breast cancer but in some women these treatment have
temporary or limited effect.
Studies have shown that low dose vaginal estrogen are devoid
of systemic side effects caused by oral preparations, because of minimum
absorption and levels attained in blood comparable to natural menopause.
Options include creams, ring and vaginal tablets. The data
regarding 17β-estradiol (commonly referred to as estradiol) cream is more
robust than data on creams with conjugated equine estrogen because of
heterogeneity of the formulation.
Controversy exists in use of vaginal estrogen in those women
with breast cancer using aromatase inhibitor. Such women may benefit from the
short-term use of estrogen to improve symptoms, followed by a return to normal
aromatase inhibitor therapy for the duration of the treatment course. On the other hand women on Tamoxifen can
safely use vaginal estrogen preparation.
The committee also advocates that treatment should be
tailored to each patient depending upon the need, therapy received and hormonal
status of the cancer cells.
The treatment should always be initiated in coordination
with the woman’s oncologist. It should also be preceded by informed decision making
explaining the risk benefit ratio.
When a final decision regarding prescription is made, it
should be prescribed in the lowest dose to relieve vaginal symptoms and for
minimum amount of time.
References:
http://journals.lww.com/greenjournal/Fulltext/2016/03000/Committee_Opinion_No__659___The_Use_of_Vaginal.43.aspx
