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[Ann B]

I had a surgical menopause 23 years ago, this necessitated low-dose transdermal oestrogen therapy. 

I experienced and was treated for oestrogen-sensitive breast cancer 3 years ago, so the oestrogen therapy immediately stopped.  I believe I now have VA which may be contributing to persistent high leucocytes in my urine, and 2 possibly 3 UTIs over the past 2 years.

My most recent UTIs were already resistant to a number of the popular UTI ABs.

I practice all the sensible precautions and am considering dealing with the foregoing through a multi-pronged strategy ie probiotics, d-mannose, vit c, and possibly the lowest dose of vaginal oestrogen pessary.   I am a bit apprehensive regarding the latter because my low-grade BC tumour was classified as +8 oestrogen sensitive.

I utilised a nomogram regarding my personal risk for recurrence and opted not to take any endocrine therapy, essentially to avoid effects that I am now experiencing due to lack of oestrogen.

I would be most interested to hear from those who have experienced BC and are using vaginal oestrogen, and what their regime is to deal with VA and UTIs, as well as general advice.

There is additional background information in my other post regarding urine p.h.

Ref.   https://pharmaceutical-journal.com/article/news/vaginal-oestrogen-therapy-in-breast-cancer-may-not-be-linked-with-recurrence

[CLKD]

Quality of Life!

Vaginal atrophy mimics repeated urine infection-type symptoms really really well.  If a urine sample is sent to a Lab to be grown for bugs and returns 'no growth' then VA treatment should be offered.  It is such a small amount of active ingredient that it really should not impact on breast tissue etc..

The idea is to use the appropriate prescribed VA treatment for 2-3 weeks initially then as necessary: some require every night, others can get symptoms under control then use every 3rd and 5/6th night. 

Personally I would use VA treatment.  My breast disease was treated in the 1990s and my GP didn't hesitate to prescribe 'ovestin'. 

[Ann B]

Many thanks for the quick reply CLKD.

I absolutely agree with QOL, which is why I took ERT for 20 years after my surgical menopause, and opted not to have Tamoxifen post BC.

Re  VA mimicking a UTI, you may be on to something.   I was on holiday in France when my symptoms of a UTI flared.  I presented a urine sample to a local French lab.  The report was bacteria not significant, but extremely high for leucocytes.   When I returned to the UK and still experiencing significant discomfort, I requested a urine test (with difficulty) and once again it came back even higher in leucocytes at 1076/ul, but bacteria only 4/ul as per the French report.  Nevertheless, the GP prescribed 7 days Nitrofurantoin.  I thought along the same lines as you, and because the irritation was also intermittent during the day.  I delayed taking the AB, and sought advice from a private uro/gyn to clarify if I had in fact a UTI.  He said yes, and take the AB.  Given the foregoing, I remain unsure!

I would add that I experienced UTI symptoms approximately 8 weeks earlier and was treated with 3 days of Nitrofurantoin.  The urinalysis indicated bacteria 24/ul and leucocytes (pus cells) 289/u/l.  I assumed (now perhaps incorrectly) that the 3 days of Nitrofurantoin had been insufficient to eradicate the UTI.  However, curiously, since recently completing the 7 day course of AB the high leucocytes are no longer registering on the dipstick.  They had been at the maximum when testing recently, and over the past 2 years.  The GPs are not interested in high leucocytes, and I believe choose to classify them in the absence of bacteria, as sterile pyuria, which they ignore under the protocols.

Following your response and my own deductions, I am inclined to think that I have been misdiagnosed as having UTIs, and the issues I have been experiencing, including the high leucocytes stem from VA, which require to be addressed properly.  That, therefore, takes me full circle, back to my post regarding vaginal oestrogen and BC.

I assume from your reply that you are a BC survivor and currently taking vaginal oestrogen?

I am hesitant following my 20 years of oestrogen therapy then having ER+ BC.  I must say that I miss the benefits of the systemic ERT even though it was a very low dose.

If I was to proceed I would consider a 10mcg pessary.  I would be interested in feedback on type and mode.

Given my fuller explanation do you believe we are still on the right track?

Thanks again.

[CLKD]

My breast disease in 1990s was discovered by palpation,  not mammogram.  Whilst washing I found the lump, saw a private Consultant 10 days later - needle biopsy OUCH showed no problems.  Even so he insisted that I underwent removal of the lump - no healtht breast has lumps !  - he told me after the 1st surgery "I had in my hand what I expected to find".  I didn't know him well enough to say "You were lucky!" 

At histology 'changes were found at the margins' so he went in to the op site the following week, took more cells as well as lymph nodes.  The drain site remains tender to touch.

I underwent a body scan, 4 weeks of radiation treatment and regular follow ups.  Although the lump wasn't seen on mammogram initially I had 1 every 6 months, after 3 years it was back to annually for 3 years.  'Tamoxifen' almost killed me.

I chose not to take any preventive treatments as these drugs aren't guaranteed to prevent future disease.  Also, why is HRT is so dangerous, aren't women who require treatments advised to have bilateral mastectomy  .

Sometimes VA can be so bad that surgical intervention is required to part the vaginal lips.  Many find that sitting and walking is impossible which makes life miserable.  I always think that 'the bus might creep up behind me ....... ' long B4 cancer returns if I use vaginal atrophy treatment.  After the initial loading weeks U may find that twice a week is enough to keep symptoms under control.

There are moisturisers too: Yes and Sylc and I use KY Jelly around the vulva if it is itchy/dry.   

[Ann B]

Thanks for your background story. 

[CLKD]

I'm a lot older than most on here  so am more inclined to use what relieves the various symptoms ;-)

[Ann B]

Two related questions.

I haven't absolutely decided to use vaginal oestrogen, I am still mulling things over.

Which mode of delivery and which brand of vaginal oestrogen would you recommend? 

I am a little apprehensive that using V.O. isn't straightforward for some.

[Flossieteacake]

I personally would go for a cream so you can apply a tiny bit to see how you find it. I use Ovestin which is a cream. I apply it internally and to the outer area mixed with Yes moisturiser.

If you try a VA treatment and do not like it then it is okay as there are other options. It can take time to find one you get on with best.

[CLKD]

GPs usually prescribe 'ovestin' which is delivered with a washable applicator so that the correct dose is inserted each time; or 'vagifem', which I think is a pessary.  These are designed to replace the oestrogen locally that the body loses as we age.  The idea [I may have said already] is to insert every night for 2-3 weeks then see how comfortable the vulva/vagina is.

HRT can protect bones and heart.  For those who can't take it, it is important to get as much info as possible to ease any symptoms.

Some require moisturisers such as 'sylc', 'yes' which won't replace oestrogen but can ease dryness and itchiness.

[Ann B]

Thanks for your replies.

Thankfully, I have never had a problem with dryness or itchiness.  I want to avoid those and hope the treatment doesn't promote them. 

I am, however, quite sensitive and fragile.  Both the GP and a urologist said I have V.A.

I am reasonably convinced that V.A. is the cause of the persistent leucocytes in my urine, and UTI symptoms, which only V.O. may/will resolve.  I cannot risk HRT due to +8 ER BC.  I hope that 10mcg of vaginal oestrogen would pose a very minimal threat.  However, the latest Danish research found that there was no recurrence with V.O. when also taking Tamoxifen.  I have avoided endocrine therapy.

With the cream, how can you ensure a minimum dose of 10mcg?  I have never seen either, but I assume there is a 10mcg sized pessary?

[CLKD]

I think the pessary is a specific dose as is the 'ovestin' which has a red line on the applicator.  MayB put the product names into GOOGLE which may well show you the different ways of delivery.

I wish that I could remember the name of the surgeon who recommends HRT for patients who have had breast disease - >blames age< 

[CLKD]

I've searched and bumped the thread for you - 'what to do if you can't take oestrogen and are anxious' I think it's titled. 

IN "all things menopause "

[Ann B]

I think the pessary is a specific dose as is the 'ovestin' which has a red line on the applicator.  MayB put the product names into GOOGLE which may well show you the different ways of delivery.

I wish that I could remember the name of the surgeon who recommends HRT for patients who have had breast disease - >blames age< 

Avrum Bluming? - American Oncologist

[Flossieteacake]

Ovestin comes with an applicator. It ensures you get the right dose. I think the dose is actually 1g.

[CLKD]

that's it Ann