The Safety of Local Hormonal Treatment for Vulvovaginal Atrophy in Women With Estrogen Receptor-positive Breast Cancer Who Are on Adjuvant Aromatase Inhibitor Therapy: Meta-analysis

Pavlović, Radiša; Janković, Slobodan M.; Milovanović, Jasmina R.; S, Stefanovic; Folić, Marko; Milovanovic, Olivera; Mamillapalli, Chaitanya; Milosavljević, Miloš N.

doi:10.1016/j.clbc.2019.07.007

Cited by 20 publications

(16 citation statements)

References 47 publications

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“…and osteoporosis as well, and for some, this might be avoidable. A recent meta-analysis, which included 11 high-quality studies, provided indirect evidence for the safety of intravaginal estrogens in women taking aromatase inhibitors 4,63 . Furthermore, the BLISSAFE study in women taking aromatase inhibitors randomized to either vaginal estriol or placebo for 12 weeks showed symptom benefit and no effect on gonadotropins, serum estradiol or estrone 64 .…”

Section: Part 1: Intravaginal Estrogenmentioning

confidence: 99%

Individual Benefits and Risks of Intravaginal Estrogen and Systemic Testosterone in the Management of Women in the Menopause, With a Discussion of Any Associated Risks for Cancer Development

Laing¹,

Newson²,

Simon

2022

Cancer J

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Several formulations of intravaginal oestrogen are available for the treatment of genitourinary syndrome of menopause (GSM). These are safe and effective treatments for the symptoms of GSM. Licensed doses of intravaginal oestrogen do not elevate systemic estradiol levels above the normal postmenopausal range with long term use and there is no evidence of an increased risk of coronary heart disease, stroke, thromboembolism, colorectal cancer, endometrial cancer, breast cancer or breast cancer recurrence with their use. This should reassure both women and their healthcare professionals and should lead to more women receiving these localised, vaginally administered hormonal treatments. Available evidence also suggests a positive safety profile for transdermal testosterone treatment when delivered at physiological concentrations.

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Section: Part 1: Intravaginal Estrogenmentioning

confidence: 99%

Individual Benefits and Risks of Intravaginal Estrogen and Systemic Testosterone in the Management of Women in the Menopause, With a Discussion of Any Associated Risks for Cancer Development

Laing¹,

Newson²,

Simon

2022

Cancer J

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“…Absorption is greater if the estrogen product is deposited higher in the vagina [54]. However, a meta-analysis of 11 studies concluded that vaginal estrogen administration in postmenopausal women with a history of breast cancer is not associated with systemic absorption of sex hormones after 8 weeks of treatment [56]. The preparations considered in the meta-analysis contained estradiol, estriol or testosterone.…”

Section: Breast Cancermentioning

confidence: 99%

Topical estrogens and non-hormonal preparations for postmenopausal vulvovaginal atrophy: An EMAS clinical guide

et al. 2021

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Introduction: Vulvovaginal atrophy (VVA) is a chronic condition caused by estrogen deficiency. It affects around 50% of postmenopausal women, reducing their general and sexual quality of life as well as the quality of their personal relationships. Aim: The aim of this clinical guide is to set out an individualized approach to the management of VVA with topical estrogens and non-hormonal preparations. Materials and methods: Literature review and consensus of expert opinion. Summary recommendations: An individualized approach is required for the management of VVA. Topical low-dose estrogens are effective and also alleviate urinary incontinence and prevent recurrent urinary tract infections. Women should not be denied long-term use of topical estrogens as long as they feel that this treatment is of benefit to them, because the safety data are reassuring. Non-hormonal preparations (lubricants and moisturizers) should be the first-line treatment for VVA in women taking adjuvant endocrine therapies for cancers considered to be hormone-dependent. They can be used over the long term.

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“…If genitourinary symptoms can be prevented and treated with early assessment and appropriate treatment (Sousa et al, 2017;Vincent, 2015), sexual functioning may improve (Gandhi et al, 2016). Vaginal estrogen treatment is contraindicated, though findings from a meta-analysis suggested low-dose vaginal estrogen was a safe and effective treatment (Pavlović et al, 2019). Women with earlystage breast cancer had improved genitourinary symptoms and sexual functioning after receiving 7.5 μg of estradiol every 24 hours for 90 days (Melisko et al, 2017).…”

Section: Implications For Practicementioning

confidence: 99%

Genitourinary Symptoms in Breast Cancer Survivors: Prevalence, Correlates, and Relationship With Sexual Functioning

Sheng

Carpenter

Cohee

et al. 2021

ONF

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The Safety of Local Hormonal Treatment for Vulvovaginal Atrophy in Women With Estrogen Receptor-positive Breast Cancer Who Are on Adjuvant Aromatase Inhibitor Therapy: Meta-analysis

Cited by 20 publications

References 47 publications

Individual Benefits and Risks of Intravaginal Estrogen and Systemic Testosterone in the Management of Women in the Menopause, With a Discussion of Any Associated Risks for Cancer Development

Individual Benefits and Risks of Intravaginal Estrogen and Systemic Testosterone in the Management of Women in the Menopause, With a Discussion of Any Associated Risks for Cancer Development

Topical estrogens and non-hormonal preparations for postmenopausal vulvovaginal atrophy: An EMAS clinical guide

Genitourinary Symptoms in Breast Cancer Survivors: Prevalence, Correlates, and Relationship With Sexual Functioning

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