ACOG Says Estrogen OK With Breast Cancer

You Can Take Estrogen With Breast Cancer

Estrogen OK'd In Breast Caner.

For years, women and their doctors have worried that taking estrogen would cause breast cancer. I summarized why this wasn't the case in my soon to be published book, The Estrogen Window, and how estrogen, taken in your estrogen window, actually lowers the risk of breast cancer. However, the fear of taking estrogen has been so great that women who already have breast cancer understandably rarely use any form of estrogen including vaginal estrogen. 

That has created a particularly large problem for women with breast cancer. In addition to the physical changes that occur as a result of surgical removal of the cancer or in many cases, the breast, there are also the symptoms of menopause. The good news is that the physical aspects can be addressed with corrective surgery and while certainly not a perfect solution, it is an important option to addressing the surgical treatment side effects.

However, the symptoms of menopause have been much more difficult to address since estrogen is the most effective treatment available. There have been two new non-estrogen medications approved to address menopause symptoms. For hot flashes (Brisdelle) and for the vaginal dryness (Osphena), but vaginal dryness and painful sex are still major issues for many women post breast cancer treatment.

Now there is a game-changing report published by the American College of Obstetricians and Gynecologists (ACOG). A new Committee Opinion from the American College of Obstetricians and Gynecologists (Number 659, March 2016) states that ACOG believes there is enough evidence to say it is OK (working with your oncologist) for women with estrogen-dependent breast cancer to take vaginal estrogen. Even though estrogen does get into the bloodstream, it doesn't seem to affect ​the outcome. The blood levels do not exceed what the typical normal blood estrogen levels are in menopause.

And there is evidence to back it up. Whether you are currently being treated for breast cancer, have been treated for breast cancer in the past, and even if you are taking Tamoxifen, which is an anti-estrogen, the outcomes from using vaginal estrogen are no different than if you don't take it. I talk about this and related essential information about estrogen in my new book, The Estrogen Window.

This is huge for women because breast cancer is the most common cancer in women among all races. It's also the leading cause of cancer death among Hispanics. In the United States, breast cancer affects one out of eight women and currently there are over two million U. S. women who have been treated for breast cancer.  

There are several forms of vaginal estrogen:

How it is Provided What's In It How's it Taken
Vaginal Cream 17 beta estradiol Usually 1-2 grams daily for 1-2 weeks, then 1 gram 1-3 times/week
Vaginal Cream Congugated equine estrogen Cyclically 0.5 grams for 21 days then off 7 days, or twice weekly if less severe
Vaginal Ring 17 beta estradiol 2-mg ring releasing 7.5 micrograms/day for 90 days
Vaginal Tablet Estradiol hemihydrate One 10 microgram tablet/day for 2 weeks then One 10 microgram tablet/day 2-3 times /week
Formulations of Vaginal Estrogen

Many of the chemotherapy treatments used for breast cancer work in part by eliminating or blocking the all estrogen production. As a result, perimenopausal women who are still having menstrual cycles suddenly plummet into menopause and women already in menopause who currently have low levels of estrogen are given treatment medication that takes their low estrogen levels and drops it to none.

One of the worst consequences of have no estrogen is vaginal dryness, thinning of the vaginal and bladder tissues called atrophic vaginitis. The new medical term for this is Genitourinary Syndrome of Menopause (GSM) which  And causes painful sex and sometimes challenging relationships.

This is a major game changer for women with breast cancer. Although I've been offering vaginal estrogen selectively to breast cancer patients for years, many have refused treatment because their oncologists have said not to take it and they have been understandably cautious. Breast cancer alone is bad enough. And although non-hormonal treatments are sufficient to treat the symptoms of GSM for some, there is no question that many women will benefit from the use of vaginal estrogen; it's the most effective solution to relieve the symptoms of GSM. Now estrogen will be an acceptable option for many of the women with breast cancer.

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