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Dr. K.
Dr. K., Board Certified OB/GYN
Category: OB GYN
Satisfied Customers: 4668
Experience:  OB/GYN with 20 years of experience.
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I am 62 and was diagnosed with breast cancer in July 2011.

Customer Question

I am 62 and was diagnosed with breast cancer in July 2011. I have a family history of breast and Ovarian cancer. I take Tamoxifen . After a recent pelvic ultrasound showed endometrium thickening I had a hysteroscopy which showed that I had cystic atrophy. I have been advised to take local oestrogen for cystic atrophy and have been told there is no need for me to be seen again. I have been advised to use Vagifem for the cystic atrophy and dryness but do not feel comfortable about this having had hormone (and HER2) positive breast cancer. I have burning symptoms down below and have been using Sylk, but this no longer seems to be helping. I do not wish to use anything containing parabens, lavender or aloe vera. I have been given samples of Yes by my breast care nurse, but notice that the water-based gel contains aloe vera which I understand is oestrogenic. I have read that oil based lubricants are not recommended. Can you tell me whether tamoxifen will completely protect me against any escaping oestrogen should I decide to use Vagifem? Also can you recommend a product for me to use which would have none of these ingredients? Would a non-oestrogen moisturiser help the cystic atrophy of the endometrium?
Regards,
Margaret
Submitted: 2 years ago.
Category: OB GYN
Expert:  Dr. K. replied 2 years ago.
Hello, this is Dr K.. Answers are not medical advice and do not constitute a doctor/patient relationship. I look forward to helping you today.
Vagifem does not get absorbed into the bloodstream to any degree. Women who use it have the same estradiol levels as postmenopausal women who do not. You would be safe using it. And yes the tamoxifen would counter any that was absorbed.
There is no over the counter product that would work as well. Over the counter products add moisture and seal the skin surface. Estrogen in the vagina changes the vaginal tissue and causes physiological change that is not attained with anything else.
Customer: replied 2 years ago.

Thank you. So is it definitely the case that tamoxifen would offer 100 per cent protection from any oestrogen that escaped into the bloodstream, even though minimal?

Expert:  Dr. K. replied 2 years ago.
No Tamoxifen never offers one hundred percent protection from any estrogen. Most experts on breast cancer do not oppose the use of Vagifem because of its proven lack of absorption.
Customer: replied 2 years ago.

Thank you Dr K. I have just one more question: is it possible for you to give me an idea of how much protection Tamoxifen would give me, i.e. 40%, 60%? Since my diagnosis I have been extremely careful with my diet, exercised regularly, avoided carcinogenic chemicals and want to make sure I am making the right decision.

Expert:  Dr. K. replied 2 years ago.
First of all an aromatase inhibitor is really the first choice in postmenopausal women, not Tamoxifen. (Arimidex)
Tamoxifen decreases the risk recurrence by 50 percent. It also decreases the risk of cancer in the other breast by 50%
Taking one of these medications is the single best thing you can do for your self. It is wonderful to follow a healthy diet, exercise, and avoid carcinogens. Unfortunately, this does very little to change breast cancer risk at all. Taking one of these medications does. I hope this helps.
Customer: replied 2 years ago.

Thank you. Before I sign off, I am still unclear. In your first reply you mentioned that tamoxifen would counter any oestrogen that was absorbed into the bloodstream from tamoxifen, but later that it would not give me 100 per cent protection. Can you clarify this for me?

Expert:  Dr. K. replied 2 years ago.
Tamoxifen does not give anyone 100 percent protection. In large studies, it reduces recurrence of breast cancer and breast cancer in the other breast by 50 %. In other words, it cuts the risk in half. It does not eliminate it.
Customer: replied 2 years ago.

Hi Dr K

I will aim to make this my last question, and I appreciate your patience.

I made an error in my last post which should have read "you mentioned that tamoxifen would counter any oestrogen absorbed into the bloodstream from VAGIFEM (not tamoxifen).

Do you still feel that it would be safe for me to use Vagifem and that tamoxifen would counter any oestrogen absorbed?

i apologise for asking so many questions but I have built up my life since my diagnosis and this is very important to me.

NB The italics key has got stuck on my keyboard.

Expert:  Dr. K. replied 2 years ago.
Tamoxifen cannot counter 100 percent of any estrogen. But since Vagifem does not get absorbed, you are safe.
Dr. K. and other OB GYN Specialists are ready to help you
Customer: replied 2 years ago.

I have given an OK rating because you have stated that vagifem does not get absorbed, whereas medical information sites online state that very small amounts of estradiol do get absorbed.

This leaves me still in doubt. I appreciate the rest of your help.

Expert:  Dr. K. replied 2 years ago.
Sure. Studies show that women on vagifem have the same estradiol levels as those who are not. While tiny amounts may or may not get absorbed, there is no way to prove that, and it is not of clinical significance. Thank you.