Annals of Oncology Advance Access originally published online on January 27, 2006
Annals of Oncology 2006 17(4):584-587; doi:10.1093/annonc/mdj127
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© 2006 European Society for Medical Oncology
Caution: Vaginal estradiol appears to be contraindicated in postmenopausal women on adjuvant aromatase inhibitors
1 Academic Department of Biochemistry and 2 Department of Medicine, Royal Marsden Foundation NHS Trust, London, UK
* Correspondence to: Prof. I. Smith, Department of Medicine, Royal Marsden Foundation NHS Trust, Fulham Road, London SW3 6JJ, UK. Tel: +020-7808-2751; Fax: +020-7352-5441; E-mail: Ian.smith{at}rmh.nhs.uk
Background: Aromatase inhibitors (AI) are increasingly used in early breast cancer and there is a growing interest in associated long-term side-effects of profound estrogen suppression. Urogenital side-effects due to atrophic vaginitis are often managed with vaginal estrogen preparations. These are generally perceived to result in minimal systemic absorption of estrogen. We followed serum estradiol, follicle stimulating hormone (FSH) and luteinising hormone (LH) levels in seven postmenopausal women using vaginal estrogen preparations whilst on AIs for breast cancer.
Patients and methods: Serum was analysed for estradiol, FSH and LH at baseline then 2, 4, 7–10 and 12 weeks since commencement of vaginal estradiol. Estradiol was measured on an assay specifically developed for measuring low levels in postmenopausal women.
Results: Serum estradiol levels rose from baseline levels 
5 pmol/l consistent with AI therapy to a mean 72 pmol/l at 2 weeks. By 4 weeks this had decreased to <35 pmol/l in the majority (median 16 pmol/l) although significant further rises were seen in two women.
Conclusions: The vaginal estradiol tablet Vagifem significantly raises systemic estradiol levels, at least in the short term. This reverses the estradiol suppression achieved by aromatase inhibitors in women with breast cancer and is contraindicated.
Key words: adjuvant, aromatase inhibitors, breast cancer, vaginal estrogen, hormone replacement therapy
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. B. Mac Bride, D. J. Rhodes, and L. T. Shuster Vulvovaginal Atrophy Mayo Clin. Proc., January 1, 2010; 85(1): 87 - 94. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Beslija, J. Bonneterre, H. J. Burstein, V. Cocquyt, M. Gnant, V. Heinemann, J. Jassem, W. J. Kostler, M. Krainer, S. Menard, et al. Third consensus on medical treatment of metastatic breast cancer Ann. Onc., November 1, 2009; 20(11): 1771 - 1785. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. C. Olson, J. S. Link, J. R. Waisman, and T. C. Kupiec Breast Cancer Patients Unknowingly Dosing Themselves With Estrogen by Using Topical Moisturizers J. Clin. Oncol., September 10, 2009; 27(26): e103 - e104. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Hickey, M. Peate, C.M. Saunders, and M. Friedlander Breast cancer in young women and its impact on reproductive function Hum. Reprod. Update, May 1, 2009; 15(3): 323 - 339. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. A. Martin and J. E. Manson Approach to the Patient with Menopausal Symptoms J. Clin. Endocrinol. Metab., December 1, 2008; 93(12): 4567 - 4575. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Hickey, C. Saunders, A. Partridge, N. Santoro, H. Joffe, and V. Stearns Practical clinical guidelines for assessing and managing menopausal symptoms after breast cancer Ann. Onc., October 1, 2008; 19(10): 1669 - 1680. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Trinkaus, S. Chin, W. Wolfman, C. Simmons, and M. Clemons Should Urogenital Atrophy in Breast Cancer Survivors Be Treated with Topical Estrogens? Oncologist, March 1, 2008; 13(3): 222 - 231. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. R. Schover Premature Ovarian Failure and Its Consequences: Vasomotor Symptoms, Sexuality, and Fertility J. Clin. Oncol., February 10, 2008; 26(5): 753 - 758. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. D. Kauff and R. R. Barakat Risk-Reducing Salpingo-Oophorectomy in Patients With Germline Mutations in BRCA1 or BRCA2 J. Clin. Oncol., July 10, 2007; 25(20): 2921 - 2927. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S Beslija, J Bonneterre, H Burstein, V Cocquyt, M Gnant, P Goodwin, V Heinemann, J Jassem, W. Kostler, M Krainer, et al. Second consensus on medical treatment of metastatic breast cancer Ann. Onc., February 1, 2007; 18(2): 215 - 225. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. R. Schover Is the Fault in Our Steroids or in Our Selves? J. Clin. Oncol., August 1, 2006; 24(22): 3519 - 3521. [Full Text] [PDF]
|
|
E-letters:
Read all E-letters
- A premature and potentially harmful conclusion
- Lian S G Ulrich
- Annals of Oncology, 27 Feb 2006 [Full text]