Tuesday, April 15, 2008

Estring and breast cancer

"If you run out of estrogen," a menopausal expert once told me, "you WILL dry up." As in symptomatic-genital-shrink-and-shorten sort of dry up. Yet many women are uncomfortable about the use of estrogen, particularly as it is associated with a slightly increased risk of breast cancer. For those of you passing up hormones or for those of you with a personal history of breast cancer, here's some important information.

Estring is a product that delivers estradiol locally right into the appropriate female passage via a silastic ring which is left in place for 3 months. During this time, the ring releases 2 mg of estradiol which is the equivalent of 1-2 days' worth of full-dose, oral estrogen therapy.

Menopause experts Drs. Nicole Brooks and Andrew Kaunitz note that they prescribe this treatment to a number of patients in their practices who are breast cancer survivors due to the ultra-low levels of estrogen that are absorbed via this route. Estradiol tablets--sold as Vagifem--are also effective in improving vaginal symptoms, but estrogen absorption into the general circulation is higher with their use compared to that with the ring. Some women complain of breast tenderness with the use of Vagifem. Estrogen creams produce the highest systemic levels of estrogen of all the local treatments and are sort of gooey.

While the estrogen absorption of Estring is ultra-low, the price is ultra-high.


Mauigirl said...

This is great news - I'll be sure to ask my doctor about it!

needsadvice said...

I have what I think is a unique situation... I am 27 years old and was diagnosed four years ago with endometriosis. I had a large cyst on one of my ovaries which was visible on a sonogram. I was switched to seasonale birth control and since then my sonogram was showing no cyst and my ovaries looked healthy. In the last 6 to 8 months, I have experienced vaginal discomfort, itchiness and pain during intercourse. The doctor did a vaginal culture and determined that my estrogen levels were low in that area similar to a menopausal woman. Being that the seasonale is working for the endometriosis (and I want to have children in the next few years so I want my ovaries as healthy as possible), they didn't want to switch my birth control pills. They suggested using a local estrogen. I chose the ring. I think they said it would not affect my endometriosis or cause any other bad effects but any advice is greatly appreciated due to the fact that I am not yet going through menopause.

femail doc said...

Dear Needsadvice,
It sounds like you are indeed in a unique situation AND your doctor has come up with a good interim solution. I agree with their choice of therapy.