For women with a history of HR+ breast cancer on tamoxifen, what are alternatives to vaginal estrogen to treat vaginal atrophy and dyspareunia?

Unfortunately there is very little data regarding safety of prasterone in the history of HR+ breast cancer patient population, but limited serum hormone data show that estradiol stays very low. If the patient's oncologist is in agreement, this can be a reasonable option.

First line is use of vaginal ...

I would recommend Replens - can last 3 days per application and KY Jelly for intercourse and pelvic PT.

Intrarosa, as a precursor to estrogen, may be effective, but not sure safe for our breast cancer survivors, and would have to get the breast oncologist approval for that.

Although the current evidence indicates that topical/vaginal estrogen does not increase HR+ breast cancer recurrence or mortality, there are several alternatives to offer these patients for dyspareunia and vaginal atrophy. ACOG recommends offering non-hormonal treatment in this group of patients pri...