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All TopicsForum: Hormonal Therapy - Before, During and After → Topic: Vagifem

Topic: Vagifem

Forum: Hormonal Therapy - Before, During and After — Risks and benefits, side effects, and costs of anti-estrogen medications.

Posted on: Nov 25, 2008 07:07AM

Nanda wrote:

I developed a pretty bad urinary tract infection and my oncologist prescribed Vagifem. I was very hesitant because I'm also taking Arimidex. She said the amount of estrogen that gets into the bloodstream from Vagifem is negligible and does not contradict the effects of the Arimedex. I don't want any more infections, but I'm leery of taking anything that provides any estrogen at all after having gone through bc.

Has anyone had a similar experience? Would sure appreciate thoughts/opinions on this. Thanks.

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Nov 25, 2008 07:43AM AnneW wrote:

I had frequent bladder infections and vaginal irritation (all attributed to what's called vaginal atrophy, a side effect of estrogen loss.) Sex was painful enough, then I'd get the UTI.

I got on a product called FemRing. It stays in the vagina for three months, emitting a very small amount of hormone to the tissues. It has been a godsend. My oncologist is fine with it, and that's good, because this is a huge quality of life issue for me.

From what I've read, there is an initial surge in estrogen levels when you first use the product. That tapers way off as the tissues become saturated.

I would not be a happy girl without my vaginal estrogen!

Anne

2002 IDC stage 1, grade 1, rads & AI

Dx 9/18/2007, ILC, <1cm, Stage I, Grade 1, 0/1 nodes, ER+/PR+, HER2-
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Dec 1, 2008 04:27PM RobinWendy wrote:

I could really benefit from some vaginal estrogen right now... how's that for TMI!!! But, my onc said no to the Femring and Vagifem because I am strongly ER+.  I am with a different onc now and I wonder if I should reexamine the issue with him.  Talk about a quality of life issue, Anne, it could save my marriage!!! (or at least its' sex life).  I'm so glad I saw this thread.  I'll let you know what my current onc has to say!!

Robin

dx Stage II primary BC in Jan. 2001;dx with DCIS on other breast in Jan. 2003; dx with mets to lungs in Jan. 2004 and in May 2007, mets spread to liver.

Dx ER+/PR+, HER2-
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Dec 1, 2008 05:49PM Lynn12 wrote:

My gyn prescribed Femring for me as well.  I felt as though my wall was paper thin. He said that femring is the product that releases the least amount of estrogen and it pretty much stays local.  It has been fabulous for me.  I've only had it in for about 6 weeks, but what a difference.  I have my appt. with Onc on Friday of this week, hopefully he'll be ok with it.

Lynn

Dx 11/7/2006, ILC, 6cm+, Stage IIb, Grade 1, 0/1 nodes, ER+/PR+, HER2-
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Dec 13, 2008 09:45PM elaine38 wrote:

 Well I just wanted to say that i also have been getting really bad dry and even cracked skin around the vaginal area and the dr prescribed the estring vaginal ring also releases a very low dose of estrogen i'm only a week into this and Ireally hope it does the jog I hate being uncomfortable and in pain 

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Dec 14, 2008 03:20AM kerry_lamb wrote:

Girls, can the Femring be used if I have had a hysterectomy ie no cervix to place it around. I am imagining it is literally a 'ring'?

Go hard or go home :)

Dx 2/15/2008, IDC, 3cm, 2/8 nodes, ER+/PR+, HER2-
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Dec 14, 2008 05:45AM sam52 wrote:

Myy gynae said that Vagifem was a very low dose and would only be needed for about 6 DAYS......I am more inclined to go with that , than with something that would need to be in place for several months.

Sam

dx Oct 2001 IDC 1.6cm, stage II, grade 3, 3/11 nodes, ER+/PR+, HER2-

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Dec 14, 2008 11:58AM mawhinney wrote:

I tend to blame my breast cancer on Vagifem which I used for 5 years. There is no history of breast cancer in my family.  I noticed the warnings on the Rx were getting stronger & stronger about the possible connection of breast cancer & Vagifem.  Everytime I talked to my gyn. she said that very little estrogen got into my bloodstream & that I should continue using it.  Have had mammos every year. Seven months after my last mammo they found breast cancer. Oncologist said there is no way of telling what caused my cancer but I no longer take Vagifem.  I'm using over the counter Replens & /or KY gel inserts.  They are not perfect but relieve some of the discomfort.  I also took over the counter Extra Strength Estroven to help with hot flashes.  It is just vitamins and herbs that did help but dr. said that the quality of the ingredients are unknown & that sometimes the black cohash & soy interacts with other things in the body to increase estrogen.

Dx 5/18/2008, IDC, <1cm, Stage Ib, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Dec 14, 2008 12:03PM Marple wrote:

Before I was diagnosed with b.c. my Dr. wanted me to use Vagifem or the Estring.  I balked because both mentioned b.c. as a possible side effect albeit very small.  So don't blame yourself mawhinney..........it was likely going to happen anyway.

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Jul 1, 2010 10:38PM amym159 wrote:

I just did a google search on using vaginal estrogen after having estrogen receptor + BC, and this thread popped up:) I am wondering  what info I can get about this  from this knowledgeable group of women. I had a hysterectomy and oopherectomy about 5 years ago and found vaginal estrogen so helpful. My oncologist told me to stop, but my friend sees his partner and he told her it was fine. So I'm guessing this is one of those issues on which there is disagreement.

Dx 9/15/2009, IDC, 2cm, Stage IIa, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Jul 2, 2010 06:41AM Member_of_the_Club wrote:

I was also on vagifem when i was diagnosed and while I don't think it necessarily caused my bc, I do think it fueled it.  I was told to immediately go off of it when I was diagnosed.  I've read that it actually releases quite a bit of estrogen into the bloodstream and that the ring is safer.

Dx 9/30/2004, IDC, 3cm, Stage IIb, Grade 2, 1/17 nodes, ER+/PR+, HER2-
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Jul 2, 2010 10:44AM NatsFan wrote:

I'm on an estring and it's been soooo helpful.  I'm ER+/PR+, but I found a research paper that showed that the maximum amount of estrogen released in the system from an estring peaks after 2 weeks, then calms down to the point where 8 weeks later any increase is barely measurable.  (I'm going from memory so the number of weeks might be off a bit, but that was the gist of the article.)  The theory is that the vaginal tissue is very dry when you first start using the estring, and it absorbs a lot of estrogen (think of that first coat of primer you put on raw drywall) but once the tissue "plumps up" it absorbs a lot less (think of that 2nd-3rd coat of paint on that same wall and how much less paint you use).  Unfortunately, I lost the citation to that article so I can't give you the link.  But my onc said basically the same thing.  But I had to search long and hard to find that article as this whol area has not been well-researched, so I think that's why oncs are so divided on the issue.

As with everything, it's a calculated risk, but QOL issues are important.  FWIW, I've had two different oncs in two different practices give me their blessing to use an estring given the severe vaginal atrophy and QOL issues I was having.  

I never used vagifem, estring, or anything like that and still got b/c, so who knows what caused any of us to get it.  Plain dumb luck?  Frown

Amy - as MOTC says, you may want to check with your onc about an estring rather than vagifem.  

Mary

Dx 12/31/2007, IDC, 2cm, Stage IIb, Grade 3, 1/15 nodes, ER+/PR+, HER2-Surgery 01/30/2008 Mastectomy (Both); Lymph Node Removal: Axillary Lymph Node Dissection (Right); Reconstruction: Tissue expander placement (Both)Chemotherapy 03/04/2008 Adriamycin, Cytoxan, TaxotereHormonal Therapy 07/01/2008 FemaraSurgery 10/09/2008 Reconstruction: DIEP flap (Both)
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Jul 7, 2010 09:24PM amym159 wrote:

Thanks so much NatsFan.  That's really helpful.

Dx 9/15/2009, IDC, 2cm, Stage IIa, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Jul 17, 2010 09:15PM Cafelovr wrote:

This forum has been very helpful. I have severe dryness and atrophy due to my chemopause. Gyno suggested I speak to Onc about vag estrogen because of QOL issues. According to him, as long as I am taking tamoxifen, I can use Vagifem. After 5 years, I'm on my own.

Linda J

Dx 10/19/2009, IDC, 6cm+, Stage IV, Grade 3, 0/2 nodes, mets, ER+/PR-, HER2+Targeted Therapy 01/23/2010 HerceptinHormonal Therapy 07/11/2010 TamoxifenSurgery 05/29/2013 Prophylactic Ovary Removal (Both); Reconstruction: Tissue expander placement, Breast implants (permanent), Latissimus Dorsi flap, Nipple reconstruction (Both)
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Jul 18, 2010 02:06AM mcgaffey wrote:

I can't live without estriol cream, period. I  have had a hysterectomy and bladder repair, have been on Arimidex for over 3 years. What I thought were periodic bladder infections were really due to vaginal dryness and urethra irritation. The episodes were awful. I began to use it before bladder surgery and afterwards to help everything heal properly. I have found using the cream once every 7-10 days keeps everything working properly. QOL!

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Jul 21, 2010 07:45AM, edited Jul 22, 2010 08:59AM by Erica

I have been on Vagifem since before my ER+ breast cancer diagnosis (I had been through a hysterectomy/oophorectomy and hence was post-menopausal). My oncologist at a major Harvard teaching hospital said the amount of estrogen released was negligible and she was fine with my staying on the Vagifem. 

It's now been seven years since my diagnosis and I'm still using Vagifem. Otherwise, I have extreme vaginal atrophy, including even painful bumps in the vaginal area, plus urinary tract infections, and intercourse was extremely painful.

Just the other day, when I filled my prescription, the pharmacy notified me that the current dose of Vagifem will no longer be available. Now, instead of 25 mcg, each dose will only be 10 mcg. Years ago, I read that the 10 mcg dose was available in Europe, but until now I wasn't aware that it was available here. I assume the dose reduction means that the 10 mcg dose has been found to be sufficiently effective, so that the higher dose isn't necessary.

My PCP just wrote me a prescription for the new lower dose and I'm looking forward to trying it. Even though the amount of estrogen released in the 25 mcg dose is very small, I'm delighted to use even a smaller dose if it's effective.

mcgaffey, have you ever considered Vagifem or E-string? I believe they're considered to be less likely to enter the bloodstream than estradiol cream, while still providing excellent vaginal and bladder relief.

Barbara

BreastFree.org (breastfree.org); BreastFree Blog (breastfree.blogspot.com); Twitter @BreastFree

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Jul 22, 2010 06:47AM Cafelovr wrote:

Barbara, you just made me feel so much better. I've been doing the Vagifem for a week, and was nervous. I too take 10mcg and can already tell a difference. I'm only 5% ER+, and was wondering if I was doing the right thing.

 Thanks--Linda

Linda J

Dx 10/19/2009, IDC, 6cm+, Stage IV, Grade 3, 0/2 nodes, mets, ER+/PR-, HER2+Targeted Therapy 01/23/2010 HerceptinHormonal Therapy 07/11/2010 TamoxifenSurgery 05/29/2013 Prophylactic Ovary Removal (Both); Reconstruction: Tissue expander placement, Breast implants (permanent), Latissimus Dorsi flap, Nipple reconstruction (Both)
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Jul 22, 2010 10:15PM mcgaffey wrote:

Barbara, I don't use estradiol, I use estriol. A difference. I can't get vagifem where I live. I can't even get estriol. Recently, I have had to fill prescriptions in England. Hopefully, they will start to import again into my tiny country.

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Jul 22, 2010 10:29PM Erica wrote:

Sorry, mcgaffrey, I misread what you wrote as estradiol. But I believe what I said holds true for all estrogen creams. Any chance you could try to get a prescription for Vagifem or E-string in England? What tiny country are you from?

BreastFree.org (breastfree.org); BreastFree Blog (breastfree.blogspot.com); Twitter @BreastFree

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Jul 22, 2010 11:00PM mcgaffey wrote:

I live in Cyprus. I believe estriol is weaker than any estradiol products. My sister in California is using the e-string I believe. She had cervical cancer and the docs can't even take scrapes to see how she is doing without her using some estrogen cream. My gynecologist says what I am using is very localized. But then, who knows. I am sure it has an effect. And the effect that I can experience right now is beneficial. I just won't live without vaginal estrogen treatment of some kind. I am trying to keep it at a minimum. I never used any estrogen therapy pre-breast cancer because I knew I had a history of breast cancer in my family. But that didn't seem to help me. :) By the way, I am 63 and 3 1/2 years out. Thanks for the response.

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Jul 28, 2010 06:12PM, edited Jul 28, 2010 06:14PM by Erika09

I had total hyst/ooph, and all the HORRIBLE SE followed. My onco put me on 2mg Estring and vaginal dryness and atrophy have miraculously improved in just 2 week using it. I've been on it for 2 months and don't want to even consider been off of it. My onco told me that it was very controversial but she had no problems prescribing it to me because I was diagnosed at a very early stage  BC and the amount of estrogen was localized and very small.

 Onco also put me on 37mg of Effexor for hot flashes and it is helping to reduce about 50-60% which is huge compared to the agony I was in prior to it. I'm a bit worried about dependency of antidepressants, though!

Kerry - I also removed cervix and the ring works very well if it is properly placed deep inside the vagina.

R: IDC4mm, IDC 2mm, DLCIS 4mm L: IDCIS 1.5mm,

Dx 11/2/2009, IDC, <1cm, Stage I, Grade 2, 0/4 nodes, ER+/PR+, HER2-
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Feb 9, 2011 11:05AM pixelpup wrote:

Just found this thread again.  I can't live without my Vagifem.  I used the 25 dosage before BC and now I've just started the 10 MCG and it makes such a difference...like having intimacy or not!  I feel that the amount absorbed systemically is negligible and it is a huge quality of life issue for me.  My Onc said NO!  But when I saw my female GYN she completely understood and prescribed it for me.  Then, I went to refill it, and guess what.  My Onc had cancelled the refills!  I'm SO angry.  This should be my choice and my risk to take!  Alison

BTW, does anyone use compounded Estriol Cream instead and how does it compare to Vagifem?

Dx 4/2010, ILC, 1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Feb 9, 2011 11:24AM Tiredofjourney wrote:

I am recently diagnosed with estrogen positive node negative BC. I am undergoing chemo due to 22 score on oncotyepDX test, plus Oncotype showed I was progesterone negative,different from the original biopsy. My ONC told me the hormone therapy drugs are not as effective when there is an estrogen+, progesterone- cancer. So chemo was recommended in addition to the hormone therapy I'll be getting. I used vagifem for a few months a few years ago. My gynecoligist had to talk me into it,as I avoided anything with hormones my whole life. Now that I have BC I'll always wonder if that was a factor in my BC. My ONC told me not to use it. I just think it must get into the bloodstream. I'll use other products.Too scary for me. The package warnings also freaked me out.

Dx 9/23/2010, ILC, <1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR-, HER2-Surgery 12/01/2010 Mastectomy (Right); Lymph Node Removal (Right); Reconstruction: Tissue expander placement (Right)Chemotherapy 01/27/2011 Cytoxan, TaxotereHormonal Therapy 05/08/2011 AromasinSurgery 07/22/2011 Reconstruction: Breast implants (permanent) (Both)Surgery 11/10/2011 Reconstruction: Breast implants (permanent) (Both)
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Feb 9, 2011 05:53PM rgiuff wrote:

Pixelpup, how is one doctor able to cancel another doctor's prescriptions?  And I agree, this should be your choice, especially since you have a doctor who said yes to it.  Maybe you can get a renewal from your Gyn?

RoseG

Dx 4/2008, IDC, <1cm, Stage I, Grade 1, 0/4 nodes, ER+/PR+, HER2-Surgery 05/20/2008 Lumpectomy (Left)Radiation Therapy 08/20/2008 ExternalHormonal Therapy 11/19/2008 Tamoxifen
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Feb 10, 2011 10:09AM pixelpup wrote:

That really bothered me about one Dr cancelling another's prescription, but I guess that Onc trumps GYN.  At Kaiser (my health insurance) Drs have your complete record of all meds you are prescribed.  I can see where that would usually be a good thing, but not in this case.  I have made another appt with the GYN but it doesn't sound like she can do anything about it. 

Dx 4/2010, ILC, 1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Feb 10, 2011 02:10PM, edited Feb 10, 2011 02:11PM by painterly

Hi Pixelpup,

I am amazed that a doctor can override another one. I didn't tell my onc. about being prescribed vagifem by my gyn. However, I was somewhat afraid to use it and in the end went with my naturapathic doctor's advice and took E3 instead. The E3 isn't as convenient to use i.e. it doesn't come with applicators but I feel comfortable using it instead of the vagifem. The ingredients are whipped cocoa butter and bees wax with plant derived estriol and vit. e. The estriol is supposed to be the good estrogen as opposed to the estradiol in the vagifem.

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Feb 11, 2011 01:36PM pixelpup wrote:

I spoke with my Onc yesterday and now he says he'll prescribe the Vagifem again IF I start taking Tamoxifen. Nice bargaining chip...huh???  I am interested in the E3 though.  I've read that estriol is better, but when I went to order the suppositories online I got an email back telling me I couldn't use it with BC because "it contains estrogen."  I thought that was strange coming from the people selling it (?)  I know Fairy mentioned she had used them before?

Dx 4/2010, ILC, 1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Feb 11, 2011 07:46PM mawhinney wrote:

My surgical onc, medical onc, and gyn all conferred and discussed if I should use Vagifem or not.  Gyn provided enough updated indepth  info to the oncs that they are comfortable with my using Vagifem.  Very, very little of the estrogen is released into the body.  Vagifem has made a big, big difference for me and I would be hard pressed to give it up. 

Dx 5/18/2008, IDC, <1cm, Stage Ib, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Feb 11, 2011 08:17PM LadyinBama wrote:

Mawhinney: My gyn recommended it and I've got to run it by my onc. Does vagifem help with the desire or sensation? Or does it just help with the lubrication? I didn't ask my gyn many questions, this is just what he recommended when I mentioned problems with vaginal dryness and painful intercourse.

5/27/10 diagnosed Stage IIA, 1/14, Grade 2. BMX, Chemo FECx3, Tx3. Implants, ooph and AI. 2/9/11 diagnosed with second primary, stage 3, ovarian cancer, 5 surgeries, taxol/carbo X 6 finished 8/14/11.

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Feb 11, 2011 11:31PM LouLou40 wrote:

My Onc prescribed the Vagifem for vaginal dryness, he said it was safe to use as very little oestrogen is absorbed in the blood and QOL issues are important. I had to stop Arimidex due to worsening osteoporosis - I'm only 41, but my blood estridiol level is very low even without the Arimidex form being in menopause from the Chemo so he is happy for me to use Vagifem. It has made a big differnce to the dryness and atrophy 

Dx 2/11/2009, IDC, 2cm, Stage II, Grade 3, 2/10 nodes, ER+/PR+, HER2+Targeted Therapy HerceptinRadiation Therapy ExternalSurgery 02/11/2009 Lumpectomy (Left); Lymph Node Removal: Axillary Lymph Node Dissection (Left)Chemotherapy 03/11/2009 Adriamycin, Cytoxan, Taxol
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Dec 1, 2011 12:16AM Cyborg wrote:

They have got to come up with something that is safe for us ladies... Can't help but think if they found something to help men with sexual dysfunction - they could do something for the girls. I have been using coconut oil for lube and made my own suppositories ! I am desperate and serious about having good "safe" sex.

Winning!!!

Dx 2/23/2011, ILC, 2cm, Stage IIa, Grade 2, 2/5 nodes, ER+/PR+, HER2-

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