Premarin usage after clear cell ovarian cancer stage 1C and proper followup for the cancer.

[Carol0131]

I am a 57-year-old who was diagnosed with Clear cell ovarian cancer stage 1C in December 2004.  Had radical hysterectomy and lymph node dissection and six treatments of chemo. I also had multiple large fibroids and extensive endometriosis (the surgeon thought it was metastasis at first). All path came back as only cancer being in the ovary. My CA 125 was 37 when we started and has remained at 4 ever since. That is all the GYN and Oncologist look at and I am wondering if I am getting the correct followup. My GYN wants me now to use Premarin cream twice a week because of vaginal thinning and dryness, but I am afraid of Premarin as I had endometriosis and I know endometriosis feeds off estrogen. Just need a second opinion about follow up care and Premarin. The two docs keep telling me my cancer had nothing to do with estrogen.
Thank you.

[Annekathryn Goodman, M.D.]

Dear Carol,
You ask an excellent question.
Yes endometriosis does grow with estrogen. So I would say that oral estrogen is not appropriate for you. However, is there a role for vaginal estrogen?

To answer that, one needs to know if vaginal estrogen can stimulate the growth of endometriosis. And a related question would be: how much estrogen gets absorbed in the body from vaginal estrogen?

I do not know if vaginal estrogen alone increases regrowth of endometriosis. I did a quick search and could not find anything. However, there is a small body of literature on vaginal estrogen and blood levels. the answer seems to be that there are not increased blood levels of estrogen if vaginal cream is used alone. I have pasted an abstract below. vaginal estrogen is used routinely in women who have experienced breast cancer and who have severe vaginal thinning. So by best available information at this time, the cream seems fairly safe
best wishes

Obstetrics & Gynecology 1994;84:215-218


Vaginal administration of low-dose conjugated estrogens: systemic absorption and effects on the endometrium
VL Handa, KE Bachus, WW Johnston, SJ Robboy, and CB Hammond


OBJECTIVE: To test the hypothesis tha a very-low-dose regimen of vaginal estrogen would provide effective relief from atrophic vaginitis without endometrial proliferation. METHODS: Twenty postmenopausal women with symptoms, signs, and cytologic evidence of atrophic vaginitis were enrolled. Each subject was treated with 0.3 mg of conjugated estrogens, administered vaginally 3 nights per week for 6 months. We examined the following outcomes: symptoms, vaginal cellular (cytologic) maturity, endometrial histology, sonographic evaluation of endometrial thickness, Doppler measures of uterine artery blood flow, and serum levels of estrone and estradiol. Pre- and post-treatment data were compared for each subject. RESULTS: Satisfactory relief of symptoms occurred in 19 of 20 cases. Vaginal cellular maturation improved significantly with therapy (P < .01). There were no significant changes in endometrial thickness, uterine artery blood flow, or serum estrogen levels. Endometrial proliferation was observed in one case. CONCLUSIONS: Relief from atrophic vaginitis can be achieved with 0.3 mg of conjugated estrogens administered vaginally three times per week. Endometrial proliferation may occur at this low dose, albeit rarely.

[Nancy222]

A related discussion, Premarin use after hysterectomy was started.

[Carol0131]

Thank you so much for your opinion. You have greatly reduced my anxiety. Thank you for being available.