Vaginal estrogen is commonly used to treat genitourinary syndrome of menopause, but is it safe for women who have been diagnosed with breast cancer?
, a common condition associated with hypoestrogenism that impairs sexual function and quality of life.
Use of vaginal formulations does not result in systemic levels of estrogen above the normal postmenopausal range. Nonetheless, the US Food and Drug Administration lists a history ofIn premenopausal women, chemotherapy for breast cancer often results in early menopause.
No significant differences were noted in recurrence-free survival between the vaginal estrogen group and the no estrogen group. At 5 and 10 years of follow-up, use of vaginal estrogen was not associated with higher all-cause mortality. Among women with estrogen receptor–positive tumors, risk for breast cancer recurrence was similar between estrogen users and nonusers.
However, concomitant use of vaginal estrogen and aromatase inhibitors was associated with a higher risk for breast cancer recurrence than was use of vaginal estrogen alone. Although this important study's findings have the limitations characteristic of observational studies, its large size and careful analyses suggest that in selected well-counselled breast cancer survivors, off-label use of vaginal estrogen may safely improve their sexual function and quality of life.
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