Survivor With symptoms

Lets imagine our first patient, a breast cancer survivor who had endured hot flushes and sweats for 4 years but was struggling to function. Her sleep disturbance was significant and she had recently started an anti depressant with one of my colleagues for her low mood which she felt was caused by her sleep disturbance.  She started the conversation with apologising for asking for help because she knew she had to put up with these symptoms and was grateful to have survived her breast cancer.  

At the sound of these words my heart broke open with empathy.  This is why working in Women's health as a GP is so rewarding.  I get to give my patients hope.  I have the privilege of working with Women to hear their story.  Then I use my years of experience to explain and offer the options to support their symptoms.  

Together we established that there were 2 main issues causing the sleep disturbance; one the night sweats and two, getting up to wee several times during the night.  

Now the magic, I think in Women's health and treating Menopause symptoms is there are no must dos (other than on my part where I must fully explain the treatments and I must prescribe safely).  So we talked around the options and settled on treating with vaginal oestrogen to help the urinary symptoms and then I gave my patient information on medications which are proven to help hot flushes and night sweats which are not Hormone replacement therapy.  We made a decision to switch her antidepressant to another which is also shown to help hot flushes.  We did this after carefully checking her other health parameters.  

Suffering at night

The Second imaginary lady will pull at your heart strings even more.  She has active breast cancer with metastases to other parts of her body and her vaginal symptoms are making her life intolerable.  She knows she is due to start chemotherapy soon for the metastases and made an appointment to discuss sleeping tablets because her vaginal soreness and itching was keeping her awake at night.  She struggled to go for a walk and really didn't feel like leaving the house unless it was absolutely essential for medical care.  

Now for ladies suffering with vaginal symptoms there is good evidence for combination treatments and regular vaginal lubrication with vaginal moisturiser's (these go internally to provide comfort and aren't to be used only for sex) and low dose vaginal oestrogen also seems to be safe (although some oncologists and for Women with oestrogen dependant tumours there is evidence and still some misgivings in the Medical community.) We have recently seen anther scientific paper supporting safe use of vaginal oestrogen even in breast cancer survivors.  

As another option Vaginal DHEA is also used with good results.  

 

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Future options for Breast Cancer survivors

There's a new drug which has recently received approval from NICE (These are the clinical guideline experts in the UK which look at trials and efficacy of treatments.)  They tell us we can soon prescribe on the NHS. The drug is called Ospemifene and it belongs to the group of SERMs that has the ability to act positively or negatively on various organs.  Ospemifene has an agonist (think switch on) action on the brain, vaginal lining, and bone and an anti-oestrogenic activity on the breast; and it would appear to have no activity on the Womb lining or the cardio-circulatory system.

The activity on the vaginal epithelium (lining) favours epithelial thickening, encouraging its lubrication.  Remember the bit above where we said Ospemifene has an anti-oestrogenic activity in the breast, this means there is no data to say it's a problem for breast cancer survivors and in theory it could be protective against a possible breast cancer recurrence. Whilst it's not available on the NHS yet, Ospemifene will be prescribed privately from Spring 2024 in the. UK.  

 

At DoctoriumGP we will soon be offering other treatments for vaginal concerns.  

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