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Topic: MonaLisa Therapy for vaginal atrophy

Forum: HER2+ (Positive) Breast Cancer —

Testing, treatment, side effects, and more.

Posted on: Apr 30, 2015 02:24AM

Sydneybased wrote:

Hi, wondering if the Mona Lisa laser therapy which is said to help a considerable amount with vaginal atrophy is safe / proven. Anyone tried it? Anyone planning to? Any advice would be most welcome.

Dx 10/5/2010, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2+
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May 4, 2015 09:47PM Sydneybased wrote:

Here's a link to an article

http://www.medicaldaily.com/fda-approves-mona-lisa...


Dx 10/5/2010, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2+
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May 15, 2015 08:49AM Jubby wrote:

Hi Syndeybased, I am doing it at the moment. I had my second treatment on Tuesday here in Melbourne. I did not have noticeable results after the first treatment but the doc administering the laser says it will get better. I have to wait another 4 days before sex so will check in to let you know if session #2 has helped. I have TERRIBLE vaginal atrophy since BC. I was willing to try ANYTHING! I am 43 and BC has done a number on my vajayjay. I am hoping it will help. Even a 20% improvement would be good. Watch this space............

Dx 11/30/2012, IDC, 1cm, Stage IIA, Grade 2, 1/17 nodes, ER+/PR+, HER2- Surgery 12/13/2012 Lymph node removal: Right, Sentinel, Underarm/Axillary; Mastectomy: Right Chemotherapy 1/23/2013 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Surgery 8/22/2013 Prophylactic mastectomy: Left; Reconstruction (left): SIEA flap; Reconstruction (right): SIEA flap
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May 17, 2015 09:54PM Sydneybased wrote:

Hi Jubby,

Thanks for responding. It's a cutting edge treatment, so the evidence base on whether or not it works - and whether benefits are sustained - is still quite weak. But if it does work, it will be game changing for a lot of people.

I'm going for a consultation tomorrow, so will report back also. I understand how you feel regarding the atrophy. I'm sure it happens to more people than is at first apparent. It's not really something that woman feel able to talk about openly.

Good luck! x

Dx 10/5/2010, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2+
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May 29, 2015 02:58AM Sydneybased wrote:

Have started my treatment. Will feed back on whether it's worth the hassle / investment :)

Dx 10/5/2010, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2+
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May 29, 2015 01:29PM rleepac wrote:

I'm 43 and was diagnosed 6 months ago. I'm doing chemo now so I'm in chemo-pause. Over the last month or two I've noticed that sex is painful. I use coconut oil for lube so I don't think it's a lube issue. It just feels like something pinching along the lower (back) half of the vag opening during sex. Is that from atrophy? Is it going to get better after chemo? I've heard of dilators - is that something I should be considering? I want to please my husband and I wouldn't mind enjoying sex again for my own pleasure. Help!

Bekah 1/6/15: Excisional biopsy 2.1 cm IDC in axillary tail, Age 42 at diagnosis. Dx 1/6/2015, IDC, Right, 2cm, Stage IIB, Grade 2, 1/2 nodes, ER+/PR+, HER2+ (IHC) Surgery 1/6/2015 Lumpectomy; Lymph node removal Chemotherapy 3/5/2015 AC + T (Taxol) Targeted Therapy 4/30/2015 Herceptin (trastuzumab) Targeted Therapy 4/30/2015 Perjeta (pertuzumab) Surgery 8/18/2015 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 11/13/2015 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant Hormonal Therapy 11/18/2015 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 3/28/2016 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant Surgery 9/8/2016 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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May 31, 2015 10:30PM Sydneybased wrote:

Hi rleepac,


I've sent you a private message.

Dx 10/5/2010, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2+
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Jun 1, 2015 04:00AM Lily55 wrote:

i have it, cannot even be examined,good old aromasin.....

Dx 4/2012, ILC, 5cm, Stage IIIA, Grade 2, 7/14 nodes, ER+/PR+, HER2- Surgery 5/2/2012 Lymph node removal: Right, Underarm/Axillary; Mastectomy: Right Radiation Therapy 8/14/2012 Breast, Lymph nodes Hormonal Therapy 7/18/2013 Aromasin (exemestane) Radiation Therapy 3/7/2019 External: Bone Chemotherapy Taxol (paclitaxel)
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Jun 1, 2015 01:12PM kareenie wrote:

Hi just wanted to mention there is another thread on this in the Sex Matters section.

https://community.breastcancer.org/forum/150/topic...


ILC 1994 & 2009, Endometrial CA 2005, DES dau, Chemo, Rads, Femara, Prolia, MRM L, ALND, PNSMX R, LE, FG
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Jun 3, 2015 08:50PM Sydneybased wrote:

Well, I'm 7 days out from my first laser treatment, and have noticed improvements.

Will the improvements last? Exactly how improved am I? Not sure yet.

Dx 10/5/2010, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2+
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Jun 10, 2015 02:24AM Sydneybased wrote:

14 days out and happy to report that I feel very improved!! Laser therapy works - yes it does!!!

Dx 10/5/2010, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2+
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Jun 11, 2015 09:15PM rleepac wrote:

Happy to hear it! Thanks for the positive report!!!

Bekah 1/6/15: Excisional biopsy 2.1 cm IDC in axillary tail, Age 42 at diagnosis. Dx 1/6/2015, IDC, Right, 2cm, Stage IIB, Grade 2, 1/2 nodes, ER+/PR+, HER2+ (IHC) Surgery 1/6/2015 Lumpectomy; Lymph node removal Chemotherapy 3/5/2015 AC + T (Taxol) Targeted Therapy 4/30/2015 Herceptin (trastuzumab) Targeted Therapy 4/30/2015 Perjeta (pertuzumab) Surgery 8/18/2015 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 11/13/2015 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant Hormonal Therapy 11/18/2015 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 3/28/2016 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant Surgery 9/8/2016 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Jun 18, 2015 11:47PM Sydneybased wrote:

Gearing up for my second treatment. Three weeks out from first treatment. I haven't had to use oestrogen cream over this period. My day to day discomfort has disappeared. I feel liberated. All I can say is that it's working for me.... I'd urge others in a similar position to try it. Of course, no guarantees, but I'd describe it as a GAME CHANGER for women left with distressing symptoms post cancer treatment.

Nice to share some good news for once :)


Dx 10/5/2010, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2+
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Jun 19, 2015 06:24PM froggy12 wrote:

So happy to hear this! I went for a consultation visit today. Was it painful? After what I have read on this site, I think I have to give it a try!

Surgery 6/15/2012 Lumpectomy: Left Dx 6/19/2012, DCIS, 5cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR+ Dx 6/20/2012, LCIS, Grade 2 Surgery 7/27/2012 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 11/7/2012 Reconstruction (left); Reconstruction (right) Surgery 2/6/2013 Reconstruction (left); Reconstruction (right)
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Jun 20, 2015 01:33AM Sydneybased wrote:

No more than a cervical smear...so fine really.

Dx 10/5/2010, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2+
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Jul 6, 2015 08:02AM Jubby wrote:

I am 3 sessions down and not seeing great results from the Mona Lisa laser treatment :(

The doctor administering the laser says things look better but I am still really struggling with sex. It's the 'ring of fire' issue. Bloody awful. I bleed after sex every time.

Going to have another treatment next week which will be #4. I think the plan is to keep going until I see results. I sure hope some are forthcoming!

J

Dx 11/30/2012, IDC, 1cm, Stage IIA, Grade 2, 1/17 nodes, ER+/PR+, HER2- Surgery 12/13/2012 Lymph node removal: Right, Sentinel, Underarm/Axillary; Mastectomy: Right Chemotherapy 1/23/2013 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Surgery 8/22/2013 Prophylactic mastectomy: Left; Reconstruction (left): SIEA flap; Reconstruction (right): SIEA flap
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Jul 23, 2015 10:13PM froggy12 wrote:

I am 4 weeks out from my first treatment. I can tell there has been some improvement in the day to day discomfort but not in the sex department. It is still very painful. I will have another treatment in 2 weeks, hoping for more improvement!

Surgery 6/15/2012 Lumpectomy: Left Dx 6/19/2012, DCIS, 5cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR+ Dx 6/20/2012, LCIS, Grade 2 Surgery 7/27/2012 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 11/7/2012 Reconstruction (left); Reconstruction (right) Surgery 2/6/2013 Reconstruction (left); Reconstruction (right)
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Aug 10, 2015 03:03AM Sydneybased wrote:

Without getting into too much detail, perhaps try positions other than missionary :) These may be less painful because they take the pressure off some areas that are fragile / sensitive.

After two sessions, I am living without oestrogen cream (which is a huge relief because of doubts about its safety). This is a great step forward....


Dx 10/5/2010, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2+
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Aug 19, 2015 11:41AM TallyLassie wrote:

This is exciting. Until yesterday when I visited my gyn, I had never heard of this therapy. He just got the machine a couple of months ago and says that the patients who have used it report great results. I have used laser on my face and it helped me there, so I'm inclined to give this a try. However, it costs $1500 for three treatments (though he gives a discount to breast cancer survivors). I'm going to call my insurance company and start bothering them about this. If I try it, I will report results.

Also, I wanted to add that both the gyn and my oncologist confirmed to me that since I have HER2 driven cancer, estrogen should not be a concern for me. That said, neither one of them would prescribe estrogen for me "just in case they are wrong." I'm also battling osteoporosis, made significantly worse by chemo (I had dexa scans in the 6 months before and after chemo). Not sure if it's from loss of estrogen or the chemo, but we decided to keep up with daily calcium and vitamin D plus weight bearing exercise (which I did all through chemo) and see if the numbers change. I also do yoga, which I feel helps me maintain balance to prevent falls, and help me fall "better" when I do.

Dx 10/9/2014, IDC, Right, 1cm, Grade 3, 0/5 nodes, ER-/PR-, HER2+ Dx 10/30/2014, IDC, Right, 1cm, Grade 3, 0/5 nodes, ER-/PR-, HER2+ Targeted Therapy 11/10/2014 Perjeta (pertuzumab) Targeted Therapy 11/10/2014 Herceptin (trastuzumab) Chemotherapy 11/10/2014 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 3/11/2015 Lymph node removal: Sentinel Surgery 3/30/2015 Mastectomy: Right; Reconstruction (right): DIEP flap
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Aug 24, 2015 08:54PM froggy12 wrote:

Thanks for the advice sydneybased! I am off the estrogen cream and have had the second procedure. Things are better, I have high hopes!


Laura

Surgery 6/15/2012 Lumpectomy: Left Dx 6/19/2012, DCIS, 5cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR+ Dx 6/20/2012, LCIS, Grade 2 Surgery 7/27/2012 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 11/7/2012 Reconstruction (left); Reconstruction (right) Surgery 2/6/2013 Reconstruction (left); Reconstruction (right)
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Aug 28, 2015 07:14AM Sydneybased wrote:

I've had all three treatments now. My conclusion, at this stage, is that the laser therapy helps quite a lot, but it doesn't take you back to where you started (before chemo and before tamoxifen). The main benefit is that I'm surviving, just about, without the oestrogen cream. That's got to be worth the investment in the laser therapy. However, I do think that the benefits are overplayed - testimonials that claim that the treatment rights all wrongs. It doesn't. But I will continue to monitor progress and post it up here!!

Dx 10/5/2010, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2+
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Sep 1, 2015 06:09AM Yazmin wrote:

Sydneybased: Thanks for this assessment.

Please question more. And then more.
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Sep 4, 2015 04:50PM froggy12 wrote:

Thank you for the update. Things have gotten better, hoping for more improvement with the third treatment.

Surgery 6/15/2012 Lumpectomy: Left Dx 6/19/2012, DCIS, 5cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR+ Dx 6/20/2012, LCIS, Grade 2 Surgery 7/27/2012 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 11/7/2012 Reconstruction (left); Reconstruction (right) Surgery 2/6/2013 Reconstruction (left); Reconstruction (right)
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Sep 21, 2015 12:47AM Sydneybased wrote:

I said I'd continue to post up my experience with the Mona Lisa laser therapy. Four months after I stopped using the oestrogen cream, I'm back on it. So, all in all, the treatment didn't have any lasting benefits for me. Sorry to say this - I had such high hopes.

It may be that the Mona Lisa therapy works better for women who are not on tamoxifen. I just don't know, and the medics using the therapy didn't have anything to share about who was more or likely to benefit from it.

It could be that I had lasting benefits from the oestrogen cream (confused with the impact of the laser) which wore off over time.

Either way, I'm $1,200 down and back to where I started.

Very, very disappointing.

My next question is, will I improve once I'm off tamoxifen? Does tamoxifen give you chronic atrophy, and when you stop taking it, this disappears or lessens? Anyone know?


Dx 10/5/2010, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2+
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Dec 5, 2015 12:37PM Sydneybased wrote:

Anyone have an answer to the last question in the previous post?

Dx 10/5/2010, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2+
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Dec 14, 2015 03:09AM LilacBlue wrote:

Been following this thread with interest since it opened. Went a week ago to see a private insurance gynecologist, rather than NHS nurse. I was informed the only way for me was estrogen and Mona Lisa would do nothing. Was offered Estring <--click link that she claimed does not get into the blood stream and these vaginal dilators. <--click link She sent a letter to my consulting onc and breast surgeon no response yet, but I don't think my breast surgeon will go for the Estring as I'm highly reactive to estrogen.

Nothing is ever the same as they said it was. It's what I've never seen before that I recognise. - Diane Arbus Dx 4/13/2012, DCIS/IDC, 1cm, Stage IB, Grade 2, 0/1 nodes, ER+/PR+, HER2- Surgery 6/12/2012 Lymph node removal: Sentinel; Mastectomy: Left; Reconstruction (left): DIEP flap, Nipple reconstruction
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Dec 15, 2015 06:49PM Sydneybased wrote:

Ovestin is supposed to be "safer" than vagifem. Might be worth mentioning it.

Dx 10/5/2010, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2+
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Feb 4, 2016 01:54AM coconut123 wrote:

omg....what Is this ..I had hysterectomy cause of her2.....just for piece of mind...I am like the desert...I have to use lube and lydocaine to get thru it..I'm only 43...I have that stabbing feeling on the back of the opening like skin tearing....I'm going to do this

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Feb 13, 2016 08:46AM DavisD wrote:

is anyone still following this thread?? I had problems identified as vulvodynia prior to BC but worse now. GYN gave me Estrace cream as long as I "assumed the risk" but not much help. My GYN said she has about 5 women with this condition but mine is the worst. Vaginal dryness and severe atrophy. This has severely affected my life and I have trouble even wearing jeans or sitting for very long. I've had Manual PT which helped minimally. I've never heard of this Mona Lisa laser tx but I'm going to research now. Breastcancer.organization is a wealth of information once again! Anyone else have difficulties prior to cancer tx?

DD Dx 7/11/2011, DCIS, 2cm, Stage 0, Grade 3, ER+/PR-, HER2- Surgery 9/7/2011 Mastectomy: Right; Reconstruction (right): Tissue expander placement Surgery 1/29/2012 Reconstruction (left); Reconstruction (right) Dx 2/2015 Surgery 2/22/2015 Lumpectomy: Right; Lymph node removal: Right, Sentinel; Reconstruction (right) Dx 2/26/2015, IDC, 2cm, Stage IIA, Grade 3, 0/1 nodes, ER+/PR+, HER2+ Targeted Therapy 3/15/2015 Perjeta (pertuzumab) Targeted Therapy 3/15/2015 Herceptin (trastuzumab) Chemotherapy 3/15/2015 Carboplatin (Paraplatin), Taxotere (docetaxel) Hormonal Therapy 10/19/2015 Radiation Therapy Whole-breast: Breast, Chest wall
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Feb 25, 2016 09:56PM Sydneybased wrote:

Hi guys,

This was posted by someone called "Lani" on the HER2 support.org website. (As an aside, I've been trying to join that site for a long time, but the administrators never answer my email requests).


OB/GYN 02.23.2016 0

ACOG: Vaginal Estrogen Safe for Breast Ca Survivors
No increased risk of cancer recurrence
SAVE
SAVED
by Molly Walker
Contributing Writer

Vaginal estrogen is safe for breast cancer survivors suffering from such urogenital symptoms as vaginal atrophy, vasomotor symptoms, and lower urinary tract infections, and there is no evidence of increased risk of cancer recurrence with the treatment, according to a statement from the American College of Obstetricians and Gynecologists (ACOG).
However, the decision to use vaginal estrogen should be made in consultation with a woman's oncologist, and only if "first-line choices" for managing urogenital symptoms -- which should be nonhormonal products such as lubricants -- are ineffective for breast cancer patients, reported ACOG's Committee on Gynecologic Practice, writing in Obstetrics and Gynecology.

Sexual medicine specialist Lauren Streicher, MD, of Northwestern University, who was not involved with the statement, said that although the treatment clearly eases vaginal dryness, many physicians are reluctant to prescribe it for breast cancer patients. But she said the response is quite different when gynecologists are asked about it.
"In 2011, I surveyed board-certified gynecologists about decisions they make regarding their own health care and asked, 'If you had breast cancer and had vaginal atrophy, would you personally use vaginal estrogen?' Ninety-three percent of female gynecologists said they would," Streicher wrote in an email to MedPage Today. "ACOG's position statement that it is safe to prescribe vaginal estrogen to women with breast cancer is long overdue, supported by solid data and is in fact a recommendation that many clinicians are already solidly behind."
The committee cited several studies that showed no increase in recurrence in cancer for breast cancer survivors using vaginal estrogen cream, and that vaginal estrogen may be appropriate for women using tamoxifen. The group cautioned, though, that "concerns remain about recurrence risk in women ... who use aromatase inhibitors." For this group, the statement said, urogenital symptoms not responding to nonhormonal therapies may benefit from "short-term use of estrogen with tamoxifen to improve symptoms, followed by a return to normal aromatase inhibitor therapy."
"These new recommendations are especially important and helpful because they provide the patient with the information needed to make an informed decision with the input of her health care provider," Diana Nancy Contreras, MD, chair, ACOG's Subcommittee on Gynecologic Oncology, said in a statement.
But there remains one major stumbling block to wider use of vaginal estrogen for breast cancer survivors: the current boxed warning on all estrogen products, including topical agents, indicating that increased risk of breast and endometrial cancer is a side effect.

"Even if a woman is given the go-ahead [to use vaginal estrogen], one look at the FDA black box warning is enough to dissuade all but the most motivated woman," said Streicher.
The North American Menopause Society (NAMS) recently presented evidence to the FDA in an effort to change the warning label. They argued that low-dose vaginal estrogen products, such as the type used to treat vulvar and vaginal atrophy, do not pose the same risk as higher doses of systemic hormone therapy.
The ACOG committee emphasized that decisions about treatment should include discussion of risks as well as benefits between a patient and her healthcare providers, so a patient can make an informed choice for herself. Vaginal estrogen should then be prescribed at the lowest dose and for a limited time, until symptoms improve.
Primary Source
Obstetrics & Gynecology
Source Reference: Committee on Gynecologic Practice "The use of vaginal estrogen in women with a history of estrogen-dependent breast cancer" Obstetrics & Gynecology 2016; Committee Opinion number 659.

Dx 10/5/2010, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2+
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Feb 26, 2016 01:57AM - edited Feb 26, 2016 01:59AM by LilacBlue

Sydney, thank you for your insightful post (Lani too). Seeing my breast surgeon today for yearly recall and feel better armed for our discussion after we discuss mammo conclusion.

Nothing is ever the same as they said it was. It's what I've never seen before that I recognise. - Diane Arbus Dx 4/13/2012, DCIS/IDC, 1cm, Stage IB, Grade 2, 0/1 nodes, ER+/PR+, HER2- Surgery 6/12/2012 Lymph node removal: Sentinel; Mastectomy: Left; Reconstruction (left): DIEP flap, Nipple reconstruction

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