Vaginal Estrogen Therapy for Patients with Breast Cancer

Abstract

On account of the good prognosis for patients with breast cancer, improving or maintaining the quality of life in the aftercare period is becoming more and more important. In particular, the increasing usage of aromatase inhibitors in the past few years has led to an increased incidence of vaginal atrophy with symptoms such as vaginal dryness, petechial bleeding, dyspareunia and recurrent cystitis. And just these symptoms have a detrimental impact on the quality of life of breast cancer patients. Application of a topical estrogen therapy represents the most effective means to treat vaginal atrophy. The use of a systemic or, respectively, topical hormone therapy is, however, contraindicated for breast cancer patients. Further clinical trials are needed in order to assess the safety of vaginal estrogen therapy.

Intravaginal Delivery Approaches for Contraception: An Overview with Emphasis on Gels

“…Dienoestrol (non-steroidal estrogen) formulated in a cream base is indicated for the treatment of vaginal atrophy, a condition that occurs mostly after menopause (48). Two other vaginal creams: ovestin and Estrace have also been developed for treating atrophic vaginitis (49). Creams have certain drawbacks that include messiness, inconvenience, and inability to deliver an exact dose due to non uniform distribution and leakage (14).…”

Vulvar and Vaginal Atrophy

“…18 The symptoms of VVA/GSM 19 In contrast, 2 small, prospective, randomized studies of 6 and 24 BC patients under endocrine therapy showed a significant increase in the serum estradiol level upon use of estradiol vaginal tablets (25 mg) or estradiol vaginal ring, and clearly illustrated that a systemic absorption is possible. 17 Same controversy also exists regarding estriol-containing vaginal preparations. In a prospective, randomized study of 10 postmenopausal BC patients under AIs therapy it was found that the daily use of 0.5-mg estriol for 2 weeks did not result in elevated serum levels of estriol or estradiol.…”

“…In some earlier studies on postmenopausal patients, however, increases of the serum estriol concentrations to values between 100 and 150 pg/mL were observed within 2 hours after use of 0.5 mg of estriol. 17 …”

“…Estriol is probably safer compared with other estrogen preparation in BC patients. 17 Vaginal estriol preparations (Ortho-gynest pessary, Ortho-gynest cream, and Ovestin cream) are available in Europe, but not in the United States.…”

“…Such treatment can be initiated only after appropriate informed consent discussions with the individual patient and after consultation with the patient's oncologist. 9,17 Patients with hormone receptor-negative BC should be treated analogously to those with hormone receptor-positive BC. 17…”