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[Nas]

Thank you Joanie.
I have bought some online and ordered a prescription too.
I hope it works! 

[Wrensong]

Hi Nas, thank you for updating us & I'm really glad you had a comprehensive consultation with a sympathetic & knowledgeable menopause-oriented GP    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

[Nas]

Hi Wrensong,
I would like to thank you for taking the time to write such an informative and comprehensive reply 

I am awaiting an appointment with my oncologist, so I will most certainly have many questions at the ready. I too am pleased that she has agreed to allow me the vagifem; is the estriol cream or ovestin available over the counter do you know, or are they strictly prescription creams only? I am hearing that once the 14 day load of vagifem has been administered, the then twice a week dose may may not be enough? IF this is the case for me, does that mean a continous prescription of vagifem forever?? I am hoping the vagifem and either YES or Replens will do the trick, but I guess it's a case of watching and waiting.

I think my sage and red clover tablets may be doing something, as the flushes don't seem so severe or frequent. Or maybe, I have been too preoccupied with my bladder (another thread) to notice!

It is indeed a dilemma all of this and more more complex and controversial than I ever imagined. To me it was so black and white. To the medics, it opens up a whole can of worms!

 

[Wrensong]

Hi Nas, you are most welcome 

Yaaay to the Oncologist appt!  Well done you for getting that sorted.  Should be the right person to help.  Some are anti-HRT some are more open-minded where quality of life is seriously affected & their advice may also depend on your particular history.

I think Ovestin & Estriol are prescription only.  Yes, it is possible that after the initial 2 week loading, twice a week Vagifem will not be enough, but equally possible that it will.  No way of knowing until you try it!  Some women are fine on 2 nights a week on a maintenance basis, some need more.  Yes - topical HRT for the lady bits is usually a long term medication.  Once we stop using it, the atrophy symptoms tend to return.  But not everyone needs topical HRT in the first place.  Some seem to get by with non-hormonal moisturisers & lubes.  Even with Vagifem, Estriol & systemic HRT for those ladies who need the lot, an additional lube may be necessary for sex.  There's a distinction between vaginal lubricants & moisturisers; lubes for sex, moisturisers for comfort from day to day, but some can be used for both - I think Yes market their water based product for both uses.  I've tried everything on the market & had both Replens & Yes VM on prescription at different times but nowhere near adequate without HRT.  You should be able to find an effective combination once the Vagifem gets to work though.  A little blue magic wand!

You may want to discuss the Sage & Red Clover tablets with the Oncologist - they may be perfectly harmless but I would be wary of anything that may work on hormone receptors.

You are absolutely right - it is hellishly complex & very controversial.  Never was there a bigger can of worms!  It is a lot to get your head around - the studies are conflicting & understandably most medics err on the side of caution.  No medic wants to cause any patient harm, so some shy away from getting involved altogether.  But some with a special interest in the area are brave enough to become highly informed in an effort to help patients who find themselves in the horrible situation of needing HRT after breast cancer.

Do PM me if there might be any way I can help & I don't seem to be around on the forum - not sure how often I'll be logging on.

Wx