@bmalsch
Osphena seems to be a pill based replacement for estrogen in the vaginal area, but with greater side effects than estrogen, especially estriol vaginally. Many women do not like the vaginal creams so osphena was developed for that group of women.
Osphena is generally not considered safer than vaginal estriol (or estradiol) and it is more costly than those treatments. Indeed, Osphena is an oral pill that travels through the entire body (systemic), whereas vaginal estriol/estradiol stays largely within the vaginal area. This means that osphena is subject to the first pass problems in the liver and also the systemic impact on the whole body. Whereas, vaginal creams do not pass thru the liver and they are less likely to impact other portions of the body like the breast.
Ai overview of the available literature and research:
Osphena (ospemifene) is an oral, non-hormonal (SERM) tablet for moderate-to-severe vaginal atrophy, offering similar efficacy to local estrogen with risks of hot flashes, blood clots, and endometrial stimulation. It is generally not considered safer than low-dose vaginal estriol, which has minimal systemic absorption, but it provides a convenient, non-messy, pill-based alternative for those avoiding creams
I looked this up because it is new for me. While reading about it I began to wonder if you had explored bhrt with your health provider. Can you share a bit of information about yourself. Age, when you entered menopause, Osteoporosis, vaginal atrophy and dryness?
@bmalsch
Osphena seems to be a pill based replacement for estrogen in the vaginal area, but with greater side effects than estrogen, especially estriol vaginally. Many women do not like the vaginal creams so osphena was developed for that group of women.
Osphena is generally not considered safer than vaginal estriol (or estradiol) and it is more costly than those treatments. Indeed, Osphena is an oral pill that travels through the entire body (systemic), whereas vaginal estriol/estradiol stays largely within the vaginal area. This means that osphena is subject to the first pass problems in the liver and also the systemic impact on the whole body. Whereas, vaginal creams do not pass thru the liver and they are less likely to impact other portions of the body like the breast.
Ai overview of the available literature and research:
Osphena (ospemifene) is an oral, non-hormonal (SERM) tablet for moderate-to-severe vaginal atrophy, offering similar efficacy to local estrogen with risks of hot flashes, blood clots, and endometrial stimulation. It is generally not considered safer than low-dose vaginal estriol, which has minimal systemic absorption, but it provides a convenient, non-messy, pill-based alternative for those avoiding creams
@bmalsch
Ah, that makes more sense; there is always a piece of the puzzle missing isn't there. 🙂
While low-dose vaginal estrogen is often considered the first-line, low-risk approach, Osphena acts as a selective estrogen receptor modulator (SERM)—similar to tamoxifen—meaning it has an anti-estrogen effect on breast tissue, which theoretically makes it safe for the breast. However, it is not universally considered "safer" than topicals, as it carries different risks, such as a black box warning for blood clots and endometrial safety, similar to oral estrogen-alone therapy.
For breast cancer survivors, the safest form of Hormone Replacement Therapy (HRT) for managing severe vaginal symptoms is localized, low-dose, non-systemic vaginal estrogen (creams, tablets, or rings), which minimally affects breast tissue. Non-hormonal vaginal moisturizers are preferred first-line treatments. Systemic HRT is generally not recommended due to increased recurrence risk.
As a side note, I correspond with a breast cancer survivor who is a patient at Sloan-Kettering; she tells me that the doctors there recommend hyaluronic acid suppositories and vit e suppositories. Personally, the hyaluronic suppositories have had a large impact for me especially when added to the estriol vaginal cream. Estriol cream has research behind its use for breast cancer patients. https://pubmed.ncbi.nlm.nih.gov/21226657/ https://pubmed.ncbi.nlm.nih.gov/39521301/. https://pubmed.ncbi.nlm.nih.gov/25427450/
@bmalsch
Ah, that makes more sense; there is always a piece of the puzzle missing isn't there. 🙂
While low-dose vaginal estrogen is often considered the first-line, low-risk approach, Osphena acts as a selective estrogen receptor modulator (SERM)—similar to tamoxifen—meaning it has an anti-estrogen effect on breast tissue, which theoretically makes it safe for the breast. However, it is not universally considered "safer" than topicals, as it carries different risks, such as a black box warning for blood clots and endometrial safety, similar to oral estrogen-alone therapy.
For breast cancer survivors, the safest form of Hormone Replacement Therapy (HRT) for managing severe vaginal symptoms is localized, low-dose, non-systemic vaginal estrogen (creams, tablets, or rings), which minimally affects breast tissue. Non-hormonal vaginal moisturizers are preferred first-line treatments. Systemic HRT is generally not recommended due to increased recurrence risk.
As a side note, I correspond with a breast cancer survivor who is a patient at Sloan-Kettering; she tells me that the doctors there recommend hyaluronic acid suppositories and vit e suppositories. Personally, the hyaluronic suppositories have had a large impact for me especially when added to the estriol vaginal cream. Estriol cream has research behind its use for breast cancer patients. https://pubmed.ncbi.nlm.nih.gov/21226657/ https://pubmed.ncbi.nlm.nih.gov/39521301/. https://pubmed.ncbi.nlm.nih.gov/25427450/
@kathleen1314
“Me too”
2006 Breast cancer survivor, stage II.
I am struggling with severe vaginal atrophy. I am terrified to take any type of estrogen. My oncologist is against it.
I plan to speak to my oncologist about Estriol.
Taking that also, twice weekly, and you can get the pill insert Yuvafem 10 mcg if your rx covers it which is handy. Also, my obgyn nurse practitioner found I had granulation tissue from a prior hysterectomy and she used silver nitrate in 5 visits to cauterize/burn the tissue—I have vag atrophy and noticed some slight hemorrhage, so I knew no reason for at the time since no uterus, but all is better now. Ask your obgyn about? Wish you the best!
@bmalsch
Ah, that makes more sense; there is always a piece of the puzzle missing isn't there. 🙂
While low-dose vaginal estrogen is often considered the first-line, low-risk approach, Osphena acts as a selective estrogen receptor modulator (SERM)—similar to tamoxifen—meaning it has an anti-estrogen effect on breast tissue, which theoretically makes it safe for the breast. However, it is not universally considered "safer" than topicals, as it carries different risks, such as a black box warning for blood clots and endometrial safety, similar to oral estrogen-alone therapy.
For breast cancer survivors, the safest form of Hormone Replacement Therapy (HRT) for managing severe vaginal symptoms is localized, low-dose, non-systemic vaginal estrogen (creams, tablets, or rings), which minimally affects breast tissue. Non-hormonal vaginal moisturizers are preferred first-line treatments. Systemic HRT is generally not recommended due to increased recurrence risk.
As a side note, I correspond with a breast cancer survivor who is a patient at Sloan-Kettering; she tells me that the doctors there recommend hyaluronic acid suppositories and vit e suppositories. Personally, the hyaluronic suppositories have had a large impact for me especially when added to the estriol vaginal cream. Estriol cream has research behind its use for breast cancer patients. https://pubmed.ncbi.nlm.nih.gov/21226657/ https://pubmed.ncbi.nlm.nih.gov/39521301/. https://pubmed.ncbi.nlm.nih.gov/25427450/
@kathleen1314
My experience, based on labs, there is no “ non-systemic” estrogen vaginal creams”.
Back in 2007, my GYN had me try 1/2 gram weekly of vaginal Estrace cream and so my oncologist would check labs for my estrogen levels . I discontinued using creams b/c YES , while small, labs did show estrogen was being systemically absorbed.
Her concern wasn’t just with breast, but the risk of metastasis to other parts of the body .
I still plan to speak to my doctors about the lower dose cream estriol . Hopefully, that will work . 🙏🏻
@kathleen1314
My experience, based on labs, there is no “ non-systemic” estrogen vaginal creams”.
Back in 2007, my GYN had me try 1/2 gram weekly of vaginal Estrace cream and so my oncologist would check labs for my estrogen levels . I discontinued using creams b/c YES , while small, labs did show estrogen was being systemically absorbed.
Her concern wasn’t just with breast, but the risk of metastasis to other parts of the body .
I still plan to speak to my doctors about the lower dose cream estriol . Hopefully, that will work . 🙏🏻
@kensiejames
Bless your heart. Interesting. I was concerned about the cream or suppository, so I asked. All of my health care providers, including the ob/gyn, have always reassured me that cream or suppository types are not systemic, and therefore, not harmful as those taken in tablet form by mouth would be. I will ask them about this again. The estradiol 0.1% (or Yuvafem 10 mcg if suppositories are preferred) twice weekly along with the “in office” procedure done (about 5 visits for granulation tissue from a partial (ovaries still intact) hysterectomy years ago (due to severe endometriosis) was identified in office via a pelvic exam, for which silver nitrate was administered to burn the tissue off and it has helped me with the vaginal atrophy tremendously thus far. No more bleeding. Also, was often allergic to many lubricants. I am so sorry you are going through this, and I will keep you in my prayers for a solution.
@kathleen1314
My experience, based on labs, there is no “ non-systemic” estrogen vaginal creams”.
Back in 2007, my GYN had me try 1/2 gram weekly of vaginal Estrace cream and so my oncologist would check labs for my estrogen levels . I discontinued using creams b/c YES , while small, labs did show estrogen was being systemically absorbed.
Her concern wasn’t just with breast, but the risk of metastasis to other parts of the body .
I still plan to speak to my doctors about the lower dose cream estriol . Hopefully, that will work . 🙏🏻
@kensiejames
Yes, I was quoting from the cited research, but I have also found that most vaginal suppositories have the ability to go systemic. How much depends on the strength, type of estrogen etc. and the person's individual body.
The uterus is a giant sponge so much of the product concentrates there which is why you hear more about bleeding than say breast tenderness, with a vaginal product.
Europe even limited certain higher estrogen vaginal products for only a month of use because they were seeing a higher level than expected of systemic overlap.
But...
Estrogen vaginally is changing to a less concentrated form for most women and those higher level estrogens are used less and less.
I believe that this is because doctors are seeing that women especially with a uterus/ovaries are reacting with bleeding and see that the levels which they have been giving are just too high.
Estradiol is in a unique place in this scenario because even at low levels of use it will concentrate at 8 to 10 times a higher rate than estriol in uterine and vaginal tissue. Because of this, many women with a uterus/ovaries experience bleeding with any estradiol topically or vaginally. So the use of estriol becomes a good option.
I hope that the estriol cream works for you; adding a vaginal progesterone might also help. For several years I used both with good results.
Now in my 70s with falling estradiol, I find that I can tolerate estriol with just topical progesterone to counter and have even added a very, very small amount of estradiol topically.
I, personally, find that a uterine ultrasound every 6 months is invaluable to me. I can plan my vaginal hormones better when I see what they are doing to my uterus. https://www.ema.europa.eu/en/news/four-week-limit-use-high-strength-estradiol-creams https://pmc.ncbi.nlm.nih.gov/articles/PMC4354766/
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@bmalsch
Osphena seems to be a pill based replacement for estrogen in the vaginal area, but with greater side effects than estrogen, especially estriol vaginally. Many women do not like the vaginal creams so osphena was developed for that group of women.
Osphena is generally not considered safer than vaginal estriol (or estradiol) and it is more costly than those treatments. Indeed, Osphena is an oral pill that travels through the entire body (systemic), whereas vaginal estriol/estradiol stays largely within the vaginal area. This means that osphena is subject to the first pass problems in the liver and also the systemic impact on the whole body. Whereas, vaginal creams do not pass thru the liver and they are less likely to impact other portions of the body like the breast.
Ai overview of the available literature and research:
Osphena (ospemifene) is an oral, non-hormonal (SERM) tablet for moderate-to-severe vaginal atrophy, offering similar efficacy to local estrogen with risks of hot flashes, blood clots, and endometrial stimulation. It is generally not considered safer than low-dose vaginal estriol, which has minimal systemic absorption, but it provides a convenient, non-messy, pill-based alternative for those avoiding creams
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1 Reaction@gravity3 Thank you for your interest. I had stage 2 breast cancer in 2005 so I can’t use HRT. My Dr. prescribed after much consideration.
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1 Reaction@kathleen1314 Thank you for your reply. I’ll share your data with my Dr. Also I was hoping to hear from patients who’ve used it.
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1 Reaction@bmalsch
Ah, that makes more sense; there is always a piece of the puzzle missing isn't there. 🙂
While low-dose vaginal estrogen is often considered the first-line, low-risk approach, Osphena acts as a selective estrogen receptor modulator (SERM)—similar to tamoxifen—meaning it has an anti-estrogen effect on breast tissue, which theoretically makes it safe for the breast. However, it is not universally considered "safer" than topicals, as it carries different risks, such as a black box warning for blood clots and endometrial safety, similar to oral estrogen-alone therapy.
For breast cancer survivors, the safest form of Hormone Replacement Therapy (HRT) for managing severe vaginal symptoms is localized, low-dose, non-systemic vaginal estrogen (creams, tablets, or rings), which minimally affects breast tissue. Non-hormonal vaginal moisturizers are preferred first-line treatments. Systemic HRT is generally not recommended due to increased recurrence risk.
As a side note, I correspond with a breast cancer survivor who is a patient at Sloan-Kettering; she tells me that the doctors there recommend hyaluronic acid suppositories and vit e suppositories. Personally, the hyaluronic suppositories have had a large impact for me especially when added to the estriol vaginal cream. Estriol cream has research behind its use for breast cancer patients.
https://pubmed.ncbi.nlm.nih.gov/21226657/
https://pubmed.ncbi.nlm.nih.gov/39521301/.
https://pubmed.ncbi.nlm.nih.gov/25427450/
@kathleen1314
“Me too”
2006 Breast cancer survivor, stage II.
I am struggling with severe vaginal atrophy. I am terrified to take any type of estrogen. My oncologist is against it.
I plan to speak to my oncologist about Estriol.
-
Like -
Helpful -
Hug
1 ReactionTaking that also, twice weekly, and you can get the pill insert Yuvafem 10 mcg if your rx covers it which is handy. Also, my obgyn nurse practitioner found I had granulation tissue from a prior hysterectomy and she used silver nitrate in 5 visits to cauterize/burn the tissue—I have vag atrophy and noticed some slight hemorrhage, so I knew no reason for at the time since no uterus, but all is better now. Ask your obgyn about? Wish you the best!
Estradiol 0.1% twice weekly or Yuvafem 10 mcg tablet inserts twice weekly for vag. atrophy
@kathleen1314
My experience, based on labs, there is no “ non-systemic” estrogen vaginal creams”.
Back in 2007, my GYN had me try 1/2 gram weekly of vaginal Estrace cream and so my oncologist would check labs for my estrogen levels . I discontinued using creams b/c YES , while small, labs did show estrogen was being systemically absorbed.
Her concern wasn’t just with breast, but the risk of metastasis to other parts of the body .
I still plan to speak to my doctors about the lower dose cream estriol . Hopefully, that will work . 🙏🏻
@kensiejames
Bless your heart. Interesting. I was concerned about the cream or suppository, so I asked. All of my health care providers, including the ob/gyn, have always reassured me that cream or suppository types are not systemic, and therefore, not harmful as those taken in tablet form by mouth would be. I will ask them about this again. The estradiol 0.1% (or Yuvafem 10 mcg if suppositories are preferred) twice weekly along with the “in office” procedure done (about 5 visits for granulation tissue from a partial (ovaries still intact) hysterectomy years ago (due to severe endometriosis) was identified in office via a pelvic exam, for which silver nitrate was administered to burn the tissue off and it has helped me with the vaginal atrophy tremendously thus far. No more bleeding. Also, was often allergic to many lubricants. I am so sorry you are going through this, and I will keep you in my prayers for a solution.
-
Like -
Helpful -
Hug
1 Reaction@kensiejames
Yes, I was quoting from the cited research, but I have also found that most vaginal suppositories have the ability to go systemic. How much depends on the strength, type of estrogen etc. and the person's individual body.
The uterus is a giant sponge so much of the product concentrates there which is why you hear more about bleeding than say breast tenderness, with a vaginal product.
Europe even limited certain higher estrogen vaginal products for only a month of use because they were seeing a higher level than expected of systemic overlap.
But...
Estrogen vaginally is changing to a less concentrated form for most women and those higher level estrogens are used less and less.
I believe that this is because doctors are seeing that women especially with a uterus/ovaries are reacting with bleeding and see that the levels which they have been giving are just too high.
Estradiol is in a unique place in this scenario because even at low levels of use it will concentrate at 8 to 10 times a higher rate than estriol in uterine and vaginal tissue. Because of this, many women with a uterus/ovaries experience bleeding with any estradiol topically or vaginally. So the use of estriol becomes a good option.
I hope that the estriol cream works for you; adding a vaginal progesterone might also help. For several years I used both with good results.
Now in my 70s with falling estradiol, I find that I can tolerate estriol with just topical progesterone to counter and have even added a very, very small amount of estradiol topically.
I, personally, find that a uterine ultrasound every 6 months is invaluable to me. I can plan my vaginal hormones better when I see what they are doing to my uterus.
https://www.ema.europa.eu/en/news/four-week-limit-use-high-strength-estradiol-creams
https://pmc.ncbi.nlm.nih.gov/articles/PMC4354766/