Hi Nas, thank you for updating us & I'm really glad you had a comprehensive consultation with a sympathetic & knowledgeable menopause-oriented GP
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Great to know your Oncologist is happy for you to use Vagifem - do keep a copy of any correspondence documenting that, to produce should any new medics question your use.
The lowest dose cream for external use is Estriol 0.01%. This is a weak form of oestrogen in very low dose & is applied thinly, but can make a make a huge difference to comfort levels. There is a stronger formulation - Ovestin & I was prescribed this for external use initially, but I would ask for the weaker Estriol to start with, as this may well be quite enough if you are using Vagifem internally. Either Estriol or Ovestin can be used internally with the appropriate applicator as an alternative to Vagifem, should you find after a reasonable trial period that Vagifem doesn't do all you hoped.
As for your question about risk of BC recurrence, your Oncologist should have access to stats relevant to your type of & treatment for BC. It may be difficult for them to give a definitive answer & you may want to request a consultation with him/her to ask questions in detail.
If you are considering systemic HRT, no-one can make the decision for you, but if you research as best you can & seek advice from relevant medics, this should help you arrive at a decision you feel comfortable with. Some forms of HRT are considered more breast-friendly than others.
Assuming you still have a uterus so cannot take oestrogen alone, it's generally recommended to keep progesterone exposure to a minimum - so sequential rather than conti regimes. The latter are anyway not usually used until postmenopause - sorry can't remember where you are on that. Micronised progesterone in the form of Utrogestan is currently thought less harmful to breast tissue than synthetic forms of progesterone, known as progestogens. However the Oestrogen Matters book I think I mentioned earlier also suggests that women who cannot tolerate the "gold standard" regimes using Utrogestan with a transdermal form of oestradiol (gel or patch), need not worry unduly.
Unfortunately there are not enough good quality, long-term studies of HRT use after breast cancer. Please do read up as much as you can though & maybe ask to discuss it with your Oncologist who will be best placed to advise according to the type of BC & subsequent treatment you had. It is a difficult situation to be in, so I do feel for you & wish you all the best.
I have no experience of Femarelle, but hopefully someone who does will be along soon to help with that.
Wx