Managing Menopausal Symptoms in Cancer Survivors

• Vaginal oestrogen is safe at any age, including over 70, with regular review

• Use vaginal oestrogen cautiously in younger women; rule out other causes such like vulval dermatitis

• In breast cancer survivors, vaginal oestrogen is off-label; prefer estriol and involve oncology

• Vaginal DHEA (Intrarosa) is effective with minimal absorption; lacks long-term safety data; no washout needed when switching

The questions answered in this podcast are listed below.
They were compiled by GPs and health professionals around Australia who attended Healthed’s face-to-face seminars.

1. What are the main symptoms for women with vaginal atrophy, and what is the general approach when a woman comes to talk about these symptoms?
2. How long can women use vaginal oestrogen for?
3. If you saw a woman over the age of 70, would you feel comfortable allowing her to continue using vaginal oestrogen?
4. Is it safe to use vaginal oestrogen in a younger woman who might be breastfeeding or taking the combined oral contraceptive pill and experiencing vaginal dryness or discomfort?
5. Do you need to take the same precautions for side effects as you would with systemic hormone therapy? For example, if there was a woman who was prone to venous thromboembolism (VTE), is it safe for her to use vaginal oestrogen?

6. Is there any role for vaginal oestrogen in reducing the frequency of recurrent genital herpes outbreaks?

7. Are there situations where you would use vaginal oestrogen in combination with a non-hormonal product for better results?
8. Thoughts on laser treatments, microneedling, or PRP for vaginal or vulval symptoms?
9. In women who present with urethral caruncles, is there a role for vaginal oestrogen as part of the treatment? How long would you try using vaginal oestrogen for that?
10. What about the doses of oestrogen when treating someone who's had breast cancer? What do we have to be mindful of? 
11. What about women with a history of endometrial, cervical, or vulval cancer? Can we use vaginal oestrogen if they've got symptoms?
12. Can DHEA (Intrarosa) be used safely in women with a history of cancer?

13. For women without breast cancer, when would you use DHEA instead of oestrogen?

14. Would you ever use both oestrogen and DHEA together?

15. What about using DHEA in conjunction with systemic menopausal hormone therapy?
16. Are there any thoughts around the improvements in libido with the use of DHEA?

17. If you had tried someone on Ovestin (estriol) and wanted to switch to Intrarosa, is a washout period required before starting?

Host: Dr Marita long | Total Time: 33 mins

Expert: Dr Terri Foran, Sexual Health Physician

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