A 55 yo female recently completed 6 cycles of chemotherapy for breast cancer. She is having hot flushes 3 times daily and severe vaginal dryness and irritation. Intercourse is painful. She has tried water-based lubricants and moisturizers without relief. What is the intervention most likely to reduce her vaginal symptoms?
Menopausal symptoms can start in women with breast cancer either due to chemotherapy effects on ovarian function or hormonal treatments
Oral or transdermal hormone therapy is usually avoided due to potential for an estrogen-responsive tumor
First line therapy for vulvovaginal atrophy is moisturizers and lubricants (helps about 50%)
No increased risk of breast cancer recurrence has been documented with the use of vaginal estrogen. This is a reasonable option in someone who fails non-hormonal management. Use the lowest dose to provide symptom relief. This should be done in consultation with oncology.
Estrogen creams may have increased absorption systemically so tablet or silastic ring is preferred