Clinical Edge

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Use of Vaginal Estrogen & Safety Concerns

ACOG recommendations for women with BC history

The American College of Obstetricians and Gynecologists (ACOG) Committee of Gynecologic Practice has issued recommendations on the use of vaginal estrogen in women with a history of estrogen-dependent breast cancer. The committee opinion is intended to address the safety concerns about the use of local hormone therapy in women who currently have breast cancer or have a history of breast cancer. The ACOG makes the following recommendations and conclusions:

• Nonhormonal approaches are the first-line choices for managing urogenital symptoms or atrophy-related urinary symptoms experienced by women during or after treatment for breast cancer.

• Among women with a history of estrogen-dependent breast cancer who are experiencing urogenital symptoms, vaginal estrogen should be reserved for those patients who are unresponsive to nonhormonal remedies.

• The decision to use vaginal estrogen may be made in coordination with a woman’s oncologist. Additionally, it should be preceded by an informed decision-making and consent process in which the woman has the information and resources to consider the benefits and potential risks of low-dose vaginal estrogen.

• Data do not show an increased risk of cancer recurrence among women currently undergoing treatment for breast cancer or those with a personal history of breast cancer who use vaginal estrogen to relieve urogenital symptoms.

Citation: The use of vaginal estrogen in women with a history of estrogen-dependent breast cancer. Committee Opinion No. 659. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016;127:393-6.