Could you expound or cite the article about vag Estrogen increasing mucous membranes and not going to systemic circulation...or studies on vag e2 in breast ca?
Studies have shown that systemic estrogen absorption from vaginal estrogen products tends to decrease over time with continued use. Here are some key points from the research: Several studies have observed that estradiol absorption is higher with initial administration of vaginal estrogen products, when the vaginal lining is thin and atrophic. With continued use, absorption tends to decrease as the vaginal lining becomes thicker and healthier ("estrogenized"). This pattern is hypothesized to be due to the thin, atrophied vaginal lining at the start of treatment absorbing more estrogen initially. As treatment continues, the vaginal wall thickens, potentially reducing absorption. While this pattern has been observed in multiple studies, not all research shows a clear difference in absorption between early and later treatment periods. Studies on various vaginal estrogen products (including tablets, creams, and rings) have demonstrated this pattern of higher initial absorption followed by decreased absorption over time. The biological significance of this initial higher absorption is thought to be minimal, especially with low-dose products. Studies measuring estradiol levels for up to 84 days of use have generally shown no accumulation of estradiol with lower-dose products, suggesting levels remain steady within the postmenopausal range with continued therapy. While this pattern has been observed, researchers note that the hypothesis needs further testing, as not all studies consistently show this difference over time.
I'm not finding much about HRT as it relates to my breast cancer scenario. I was diagnosed and successfully treated at age 31 for a relatively non-aggressive stage 1 breast cancer. I am 47 now and no recurrence. (knock on wood) I was treated with surgery alone. No radiation, no chemo, no tamoxifen. I no longer have an oncology team and just see my GP. Now that I'm hitting menopause, I would like to have options to manage symptoms, not just told NO on any HRT because of my history. Any thoughts or research on this? Thanks!
This is a thorny subject! There are no data on the safety of HRT in people who are this far out from a diagnosis. While the risk is likely not zero, it is likely to be very low. The prohibition on estrogen is due to fear that a medical intervention (HRT) could risk recurrence, but again, this is a theoretical concern. Talking with a gynecologist who specializes in the care of people who have had cancer may be helpful.
Great video Dr. Griggs, I am on letrozole and suffering from vaginal dryness. Doctor recommended replens but not very effective. Do you have any other suggestions? My doctor is a man and doesn’t quite get that this is having an important impact on my sexual health.
Vaginal dryness is a common side effect of aromatase inhibitors like letrozole and can significantly impact sexual health, For some people, this is the worse side effect. If Replens hasn’t worked for you, consider asking your doctor about vaginal moisturizers like HyaloGyn or vaginal estrogen therapy, which may be safe in small doses. A women's health specialist or gynecologist may also offer helpful advice tailored to your situation.
Could you at some point talk about the role of testosterone in breast cancer? Both for cisgender men with male breast cances as well as for transmasculine (aka female-to-male transgender) people like me, who might be interested if cross-sex HRT is (still) an option for them. I'm 40yo with tripple negative inflammatory breast cancer, just got a pCR but my oncologist was pretty evasive when I asked if testosterone HRT would be possible for me in the future.
Thank you for the question. Due to a great deal of neglect of this question scientifically, there are more unknowns than knowns. This is now an active area of investigation for trans people. Clinical programs and registries are being created to help answer these questions. In the meantime, balancing theoretical concerns about exposure to testosterone with the very real benefits of testosterone means that your preferences will play an important role. If you haven't already, seeking out specialty care may be helpful.
I am confused about the use of intrarosa also. My gynecologist suggested it but my oncologist said it’s estrogen so not a good idea due to my DCIS being estrogen positive. I’m taking anostrozole so it’s blocking estrogen production. Is intrarosa absorbed systemically?
Vaginal preparations do get absorbed into the body, so there is a theoretical concern. The key is that we have to balance quality of life with that theoretical concern.
Thank you for discussing this topic. I’m in my early 60th, have been on Letrozole for 4 years. How safe to use Intrarosa Prasterone to treat vaginal dryness for postmenopausal women with history of breast cancer as my GYN mentioned it?
I was suggested intrarosa by my gynecologist also but my oncologist said it wasn’t a good idea. I am confused about the absorption systemically when I am taking an AI that blocks estrogen’s effect on the breast. Does it stay local or get into the blood stream?
Data on the safety of intrarosa contains prasterone intravaginal (DHEA) use in breast cancer survivors is limited. However, some studies have found that prasterone has beneficial effects on dyspareunia, vaginal dryness, and signs of vulvovaginal atrophy without significant adverse effects in postmenopausal women.
Greeting Dr ! I am 48 years old Since august 2023 .my oncologist has put me In tamoxifen , for 5 years..In 2 years time My oncoligist will later switch it to other anti estrogen ..So my question is if I am taking tamoxifen now is that Working for me ?? Then why would my Dr change it to other anti estrogen after 2 years Thankyou !
I'm on the same plan as you (tamoxifen for about 2 years, then aromatase inhibitors for 3 years). I was told that peri-menopausal people are put on tamoxifen until they enter menopause, after which the aromatase inhibitors are more appropriate for post-menopausal people. Not sure why, but you should speak with your doctor about this, because this isn't the only option.
Interesting talk. Pl can you elaborate on low dose for SHORT term. How much short term is needed for DCIS as in my papillary cancer? I was told to take Tamoxifen 5 mg but for 5 years. But did not opt for such long period of drugs.Pl let me know.
Great question, and it's good to see you back here. Giving an aromatase inhibitor after a complete course of tamoxifen improves survival. It doesn't mean that the tamoxifen isn't working. In fact, being this far out probably means that your treatment is working. You may find our video on aromatase inhibitors to be helpful: th-cam.com/video/LuI1mCJU2_U/w-d-xo.html
You don't go into the differences between progesterone and progestin or natural sources of progesterone and how those have been used/confused with this topic (and how they are used in the studies that are out there. You REALLY need to look deep into these studies for the type and form of the specific thing they are giving participants to test.) Or the differences in types of estrogen (estradiol E2 vs. estriol E3 for example.) Particularly with topical/vaginal use of a product, E3 could be a far better option for many women with a history or risk of breast cancer that can help avoid uro-genital issues. It's really unfortunate that it's only available in the US with a specialist compounded product and there is so little info available to women in the US. This is the first thing you'd be offered (usually a cream or ovule, also containing hyaluronic acid, available with an easy prescription) elsewhere in the world, especially Europe (my personal experience is in the UK, the NL, Germany etc.) Even the non-hormonal moisturizing options are far better outside the US. I've been appalled at the ingredients in so many of these US products as well as the outrageous prices. A compounding pharmacy has been a savior for my quality of life, along with an exceptional naturopathic doctor. But then I am aware of my privilege in this area to have access to such and live in a state where naturopaths can prescribe medications. I still have to sacrifice to afford it (not covered by insurance) but it's better than monthly UTIs/antibiotics and physically painful intimacy.
Thanks for your thoughts. We agree that there are limited options for improving vaginal and vulvar health in the United States. Clinicians in the US are also highly "risk averse" as is the medical approval process. Clinical trials to investigate alternatives have been nearly impossible to conduct because of the requirements of the FDA to ensure safety. Hyaluronic acid is extremely expensive in the US and is not covered by insurance, so we have been reluctant to discuss this option.
@@yerbba Thank you for the response. Perhaps mention the potential expense, but also let the individual decide based on the information and their personal situation? People should know all the options if they want to and best from a reliable source like yourself. I'm able to acquire vaginal suppositories from a compounding pharmacy that include E3, hyaluronic acid and vit E in a fatty acid base (ellage) which also helps with vaginal pH for approx. $1.50 - 2 per dose (depending on how many I order at once.) I'm currently using 1 every 4th day. They are worth it to me for the quality of life improvement. My oncologist is OK with this in my situation (although I must say, the difference between E3 and E2 is something a patient needs to educate themselves on to be able to discuss.) Such things might be worth it to others too. Expense should not be a factor in information exchange, although I agree it should be pointed out.
I'd like to add a further thought, please, to back up the "knowledge is power" and "expense should be discussed but..." aspects. When I was first diagnosed & discussing procedures with my surgeon, I was told the lumpectomy included wire localization & I would have to deal with the wires being placed & potentially be taped to me for hours while waiting to go into the OR. It was presented to me as a fact & how it was done. Due to past medical trauma, this was highly upsetting to me. Then I spoke with other women who told me that part of the process had been the very worst for them & highly painful (while some were accepting & OK w/ it, most I spoke to had been unhappy about this but felt they had no choice & swallowed the pain and trauma it caused in silence.) I also found out from a friend in healthcare that there is another option: placement of a Savi scout seed, that actually provides a better outcome. For some reason, my surgeon decided not to offer or discuss this far less invasive, but more expensive, option with me. This made me wonder what else had not been discussed or offered to me that could have resulted in a better outcome. What else was being withheld from me. I didn't have time or capability to switch surgeons and this one has exceptional surgical skill, but it was NOT her place or job to make such choices for me. I did end up having the Savi scout, but I had to learn about it on my own and request it directly. So please, I would encourage you to NOT make assumptions on what people don't want to know about. If preferences matter in treatment decisions, my preference is to know ALL my options. Choices include not only treatment paths/options but also choices about where I spend my money/finances. (And many of us are already spending a lot of money on trying products because our health care teams are not supporting us in these matters--especially those that are related to potentially embarrassing topics like uro-genital issues and sexual intimacy. Wouldn't helping us target the best options, that have science behind them, be worthwhile?)If a doctor is an educational resource to help a patient make decisions & high quality decisions require high quality information, that information exchange shouldn't have monetary limits arbitrarily placed on it. Knowledge empowers choices and so often in this process, we don't know what we don't know or where to find reliable information. That's part of the value of your work here.
We're sorry to hear the video wasn't helpful. We’re here to provide information support, and if there’s something specific you’d like us to cover, please let us know.
Could you expound or cite the article about vag Estrogen increasing mucous membranes and not going to systemic circulation...or studies on vag e2 in breast ca?
Studies have shown that systemic estrogen absorption from vaginal estrogen products tends to decrease over time with continued use. Here are some key points from the research:
Several studies have observed that estradiol absorption is higher with initial administration of vaginal estrogen products, when the vaginal lining is thin and atrophic. With continued use, absorption tends to decrease as the vaginal lining becomes thicker and healthier ("estrogenized"). This pattern is hypothesized to be due to the thin, atrophied vaginal lining at the start of treatment absorbing more estrogen initially. As treatment continues, the vaginal wall thickens, potentially reducing absorption. While this pattern has been observed in multiple studies, not all research shows a clear difference in absorption between early and later treatment periods. Studies on various vaginal estrogen products (including tablets, creams, and rings) have demonstrated this pattern of higher initial absorption followed by decreased absorption over time. The biological significance of this initial higher absorption is thought to be minimal, especially with low-dose products. Studies measuring estradiol levels for up to 84 days of use have generally shown no accumulation of estradiol with lower-dose products, suggesting levels remain steady within the postmenopausal range with continued therapy.
While this pattern has been observed, researchers note that the hypothesis needs further testing, as not all studies consistently show this difference over time.
I'm not finding much about HRT as it relates to my breast cancer scenario. I was diagnosed and successfully treated at age 31 for a relatively non-aggressive stage 1 breast cancer. I am 47 now and no recurrence. (knock on wood) I was treated with surgery alone. No radiation, no chemo, no tamoxifen. I no longer have an oncology team and just see my GP. Now that I'm hitting menopause, I would like to have options to manage symptoms, not just told NO on any HRT because of my history. Any thoughts or research on this? Thanks!
This is a thorny subject! There are no data on the safety of HRT in people who are this far out from a diagnosis. While the risk is likely not zero, it is likely to be very low. The prohibition on estrogen is due to fear that a medical intervention (HRT) could risk recurrence, but again, this is a theoretical concern. Talking with a gynecologist who specializes in the care of people who have had cancer may be helpful.
Thank you, Dr. Griggs, for your helpful advice.
Thank you for tuning in!
Excellent information. Thank you!
Thanks for the positive feedback and being part of our Yerbba community!
Great video Dr. Griggs, I am on letrozole and suffering from vaginal dryness. Doctor recommended replens but not very effective. Do you have any other suggestions? My doctor is a man and doesn’t quite get that this is having an important impact on my sexual health.
Vaginal dryness is a common side effect of aromatase inhibitors like letrozole and can significantly impact sexual health, For some people, this is the worse side effect. If Replens hasn’t worked for you, consider asking your doctor about vaginal moisturizers like HyaloGyn or vaginal estrogen therapy, which may be safe in small doses. A women's health specialist or gynecologist may also offer helpful advice tailored to your situation.
Could you at some point talk about the role of testosterone in breast cancer? Both for cisgender men with male breast cances as well as for transmasculine (aka female-to-male transgender) people like me, who might be interested if cross-sex HRT is (still) an option for them.
I'm 40yo with tripple negative inflammatory breast cancer, just got a pCR but my oncologist was pretty evasive when I asked if testosterone HRT would be possible for me in the future.
Thank you for the question. Due to a great deal of neglect of this question scientifically, there are more unknowns than knowns. This is now an active area of investigation for trans people. Clinical programs and registries are being created to help answer these questions. In the meantime, balancing theoretical concerns about exposure to testosterone with the very real benefits of testosterone means that your preferences will play an important role. If you haven't already, seeking out specialty care may be helpful.
I am confused about the use of intrarosa also. My gynecologist suggested it but my oncologist said it’s estrogen so not a good idea due to my DCIS being estrogen positive. I’m taking anostrozole so it’s blocking estrogen production. Is intrarosa absorbed systemically?
Vaginal preparations do get absorbed into the body, so there is a theoretical concern. The key is that we have to balance quality of life with that theoretical concern.
Thank you for discussing this topic. I’m in my early 60th, have been on Letrozole for 4 years. How safe to use Intrarosa Prasterone to treat vaginal dryness for postmenopausal women with history of breast cancer as my GYN mentioned it?
I was suggested intrarosa by my gynecologist also but my oncologist said it wasn’t a good idea. I am confused about the absorption systemically when I am taking an AI that blocks estrogen’s effect on the breast. Does it stay local or get into the blood stream?
Data on the safety of intrarosa contains prasterone intravaginal (DHEA) use in breast cancer survivors is limited. However, some studies have found that prasterone has beneficial effects on dyspareunia, vaginal dryness, and signs of vulvovaginal atrophy without significant adverse effects in postmenopausal women.
Thank you for this response. I have researched this and will talk with my gynecologist about it further.
@@yerbba Thank you!
Greeting Dr ! I am 48 years old Since august 2023 .my oncologist has put me In tamoxifen , for 5 years..In 2 years time My oncoligist will later switch it to other anti estrogen ..So my question is if I am taking tamoxifen now is that Working for me ?? Then why would my Dr change it to other anti estrogen after 2 years
Thankyou !
I'm on the same plan as you (tamoxifen for about 2 years, then aromatase inhibitors for 3 years). I was told that peri-menopausal people are put on tamoxifen until they enter menopause, after which the aromatase inhibitors are more appropriate for post-menopausal people. Not sure why, but you should speak with your doctor about this, because this isn't the only option.
Interesting talk. Pl can you elaborate on low dose for SHORT term. How much short term is needed for DCIS as in my papillary cancer? I was told to take Tamoxifen 5 mg but for 5 years. But did not opt for such long period of drugs.Pl let me know.
Great question, and it's good to see you back here. Giving an aromatase inhibitor after a complete course of tamoxifen improves survival. It doesn't mean that the tamoxifen isn't working. In fact, being this far out probably means that your treatment is working. You may find our video on aromatase inhibitors to be helpful: th-cam.com/video/LuI1mCJU2_U/w-d-xo.html
You don't go into the differences between progesterone and progestin or natural sources of progesterone and how those have been used/confused with this topic (and how they are used in the studies that are out there. You REALLY need to look deep into these studies for the type and form of the specific thing they are giving participants to test.) Or the differences in types of estrogen (estradiol E2 vs. estriol E3 for example.) Particularly with topical/vaginal use of a product, E3 could be a far better option for many women with a history or risk of breast cancer that can help avoid uro-genital issues. It's really unfortunate that it's only available in the US with a specialist compounded product and there is so little info available to women in the US. This is the first thing you'd be offered (usually a cream or ovule, also containing hyaluronic acid, available with an easy prescription) elsewhere in the world, especially Europe (my personal experience is in the UK, the NL, Germany etc.) Even the non-hormonal moisturizing options are far better outside the US. I've been appalled at the ingredients in so many of these US products as well as the outrageous prices. A compounding pharmacy has been a savior for my quality of life, along with an exceptional naturopathic doctor. But then I am aware of my privilege in this area to have access to such and live in a state where naturopaths can prescribe medications. I still have to sacrifice to afford it (not covered by insurance) but it's better than monthly UTIs/antibiotics and physically painful intimacy.
Thanks for your thoughts. We agree that there are limited options for improving vaginal and vulvar health in the United States. Clinicians in the US are also highly "risk averse" as is the medical approval process. Clinical trials to investigate alternatives have been nearly impossible to conduct because of the requirements of the FDA to ensure safety. Hyaluronic acid is extremely expensive in the US and is not covered by insurance, so we have been reluctant to discuss this option.
@@yerbba Thank you for the response. Perhaps mention the potential expense, but also let the individual decide based on the information and their personal situation? People should know all the options if they want to and best from a reliable source like yourself. I'm able to acquire vaginal suppositories from a compounding pharmacy that include E3, hyaluronic acid and vit E in a fatty acid base (ellage) which also helps with vaginal pH for approx. $1.50 - 2 per dose (depending on how many I order at once.) I'm currently using 1 every 4th day. They are worth it to me for the quality of life improvement. My oncologist is OK with this in my situation (although I must say, the difference between E3 and E2 is something a patient needs to educate themselves on to be able to discuss.) Such things might be worth it to others too. Expense should not be a factor in information exchange, although I agree it should be pointed out.
I'd like to add a further thought, please, to back up the "knowledge is power" and "expense should be discussed but..." aspects. When I was first diagnosed & discussing procedures with my surgeon, I was told the lumpectomy included wire localization & I would have to deal with the wires being placed & potentially be taped to me for hours while waiting to go into the OR. It was presented to me as a fact & how it was done. Due to past medical trauma, this was highly upsetting to me. Then I spoke with other women who told me that part of the process had been the very worst for them & highly painful (while some were accepting & OK w/ it, most I spoke to had been unhappy about this but felt they had no choice & swallowed the pain and trauma it caused in silence.) I also found out from a friend in healthcare that there is another option: placement of a Savi scout seed, that actually provides a better outcome. For some reason, my surgeon decided not to offer or discuss this far less invasive, but more expensive, option with me. This made me wonder what else had not been discussed or offered to me that could have resulted in a better outcome. What else was being withheld from me. I didn't have time or capability to switch surgeons and this one has exceptional surgical skill, but it was NOT her place or job to make such choices for me. I did end up having the Savi scout, but I had to learn about it on my own and request it directly. So please, I would encourage you to NOT make assumptions on what people don't want to know about. If preferences matter in treatment decisions, my preference is to know ALL my options. Choices include not only treatment paths/options but also choices about where I spend my money/finances. (And many of us are already spending a lot of money on trying products because our health care teams are not supporting us in these matters--especially those that are related to potentially embarrassing topics like uro-genital issues and sexual intimacy. Wouldn't helping us target the best options, that have science behind them, be worthwhile?)If a doctor is an educational resource to help a patient make decisions & high quality decisions require high quality information, that information exchange shouldn't have monetary limits arbitrarily placed on it. Knowledge empowers choices and so often in this process, we don't know what we don't know or where to find reliable information. That's part of the value of your work here.
That didn’t help at all
We're sorry to hear the video wasn't helpful. We’re here to provide information support, and if there’s something specific you’d like us to cover, please let us know.