breast cancer
Research
Treatment
Source: Breast Cancer Research and Treatment
Does endocrine therapy affect sexual function in breast cancer?
In a nutshell
This paper studied the impact of endocrine therapy on sexual function in postmenopausal patients with breast cancer.
Some background
Endocrine therapy is used in the treatment of hormone receptor positive early breast cancer. Hormone receptor positive breast cancer is cancer which has an abundant presence of the estrogen or progesterone hormone receptors, specific proteins on the surface of the cancer cells.
While endocrine therapy is beneficial to treating breast cancer, it is also associated with various gynecological symptoms. Examples of gynecological symptoms are vaginal dryness, decreased libido (desire for sexual activity) and hot flashes (feelings of warmth in the upper parts of the body). These symptoms can compromise sexual health and quality of life. Thus, it is important to assess the impact of endocrine therapy on sexual function.
Methods & findings
66 women with hormone positive breast cancer were analyzed. Patients had to complete a questionnaire about their sexual problems, sexual distress and gynecological symptoms at the start of the study and 6 months after starting endocrine therapy.
With regards gynecological symptoms, symptoms increased after endocrine therapy.
With regards to sexual problems, sexual desire, arousal, lubrication, satisfaction and level of pain were studied. There were no significant differences between the start of the study and 6 months after starting treatment. 85% of women reported having at least 1 sexual problem at the start of study. 86% of women reported having at least 1 sexual problem 6 months after starting treatment.
With regards to sexual distress, there was no change from the start of the study to 6 months after starting treatment. 28.8% of women had sexual distress at the start of study while 30% of women had sexual distress 6 months after starting treatment.
The bottom line
The authors concluded that women are unlikely to experience a decline in sexual function due to endocrine therapy in the short term.
Disclaimer:
This information should not be relied upon as a substitute for personal medical advice, diagnosis or treatment. Use the information provided by Medivizor solely at your own risk. Medivizor makes no warranties or representations as to the accuracy of information provided herein. If you have any concerns about your health, please consult a physician.
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My personal experience is that these findings do not reflect my own experience. Perhaps it is the short time period of endocrine therapy or the average age in the study or even a matter of degree but my experience is decidedly different. Fortunately my doctors were able to recommend a very low dose rx that essentially remains local and reversed my "atrophy" due to AIs. I thought I was facing a choice between recurrence and no sex at age 59. Reply
I agree with Anonymous and I would add that 6 months is not long enough to study any side effect when this class of drugs is typically prescribed for 5 years for early stage cancers. I would also argue that many women are likely in a heightened state of stress at the time of initial use, given they have probably undergone surgery, and/or radiation and/or chemotherapy.
Anonymous, would you share the drug name you are referring to that reversed your atrophy? Thanks. Reply
Thank you both for sharing your experiences. It is always very important to hear how treatment in real life may differ from treatment under the strict parameters of a clinical trial! Reply
Vagifem 10 mcg twice a week. According to my oncological OB-GYN the standard therapy starts with intensive dosing but this is contra-indicated for hormone-receptive BC patients; it should only ever be used twice a week. She also cited recent studies that indicate little if any is absorbed Iinto the bloodstream. Unfortunately this is an expensive Rx under my insurance but I think it's well worth it. It reversed what she termed my atrophy pretty quickly.
It quickly did what all the lubricants and moisturizers could not and eliminated the new troubling tendency to UTIs. Reply
I question what can really be learned from studying 6 months of endocrine therapy when this therapy is prescribed for 5-10 years! And 66 people is hardly a large enough population to draw meaningful conclusions. Reply
I can't believe the results of this study. My experience is so very different and I have yet to find anything that offers any real help. It is so distressing to have sexual function impacted. No medical professional has ever mentioned this to me at any stage and has headed off any discussion I have tried to raise. I think they just don't want to know. Reply
Ahhh.... I have a survey going on right now with over 100 replies. Not "official" just as basis of a personal project. This is a case where the researchers should have had patient input from the start. They could have done a far more effective and patient centered study had they asked those of us in the trenches.
A HUGE thank you to Medivizor for bringing this study to my attention so I can shine a light on this!!!
Reply
I would love for someone to figure out how to bring my sexual functions back to normal or at least normal for my age. I am just very thankful I have an understanding man in my life. 66 people for 6 months?!?! It needed to have been about 200 people for at least 3 years. I noticed anonymous mentioned UTIs. Is anyone else having trouble with UTIs? It seems like every time I turn around, I have another one. Really getting sick and tired of them. Reply
The UTIs are all part of the same problem - that atrophy. All the skin in the area thins out, dries out, is more easily torn or abraded. This makes it easier for infection to set in. Do some research - there can be a causal relationship here with the UTIs but I had to hunt to find it. I don't think a lot of health care professionals are aware - or are comfortable addressing it.
Keep using products like Replens on a regular basis, 2 or 3 times a week, whether sex is a factor or not. Keeps tissues moisturized from the inside. Use a lubricant on both of you for sex. (I didn't need the lube after I started vagifem) And again I recommend vagifem if you're comfortable with the idea of adding estrogen locally. It has made a huge difference for me and I have not had a repeat UTI since starting it. Reply
My cancer was E+ and P+, so using any hormones is not an option for me. I will just have to keep looking. But thank you for your insight on the UTI problem, it really helps. Reply
Hi Beth. Mine also was both ER and PR positive. The gynecologist who prescribed the hormones is part of the cancer center group; she specializes in ovarian cancer. She cited recent studies that indicate that the very low dose does not reach the bloodstream and is safe for me. (It's a tiny slow release pill inserted vaginally. At my last exam there was still some present after being inserted 2 days before so it truly is slow release.) She cautioned against taking it more often than the prescribes twice a week. Of course you and your doctor have to decide what's right for you. But before talking to her I too thought any hormones were not an option. Reply
Thanks, Anonymous. What is the name of this medication? I would like to talk to my oncologist when I go see her in May. Reply
Just wanted to add that while I used Vagifem pre-BC at the higher dosage (25mcg 3xweek) with success, once the dosage was lowered to 10 I went back to getting UTI's after sex. My gyn gave me a script to get the 25mcg from Canada, and that worked, but once I was diagnosed, she recommended I go back to the 10. My onc was also okay with 10. But it does not help with the UTI's for me. I need more estrogen, that is the problem for me. I have read research on PubMed that says "very little" estrogen is absorbed systemically once the vaginal walls have been plumped up with estrogen, but I know most of us are skittish about any estrogen floating around. Maybe I will try adding Replens along with the 10mcg Vagifem. I sure hate getting UTI's after sex, particularly since I rarely get the opportunity (I'm single). And haven't had the desire since going on Aromatase Inhibitors. Reply
Hi, I concur with several of your bloggers, six months is far too short a time frame after beginning AI 'S , for a survey ( even as a pilot study) to have any validity. At this time my symptoms, with side affects/ toxicity were just beginning. Reply