Dr. Kim Capone, Lead educator of SHWI and Chief Science Officer for Vaginal Biome Science.
For many breast cancer survivors (BCSs), the end of cancer treatment doesn’t necessarily signal the end of challenges. One significant, yet often unaddressed issue is the impact of treatment on vaginal health, particularly the development of urogenital atrophy or genitourinary syndrome of menopause (GSM). These conditions present with common symptoms of vaginal dryness, irritation, painful intercourse, and recurrent urinary tract infections—symptoms that significantly reduce quality of life and affect both physical and emotional well-being.
More than half of breast cancer survivors experience vaginal atrophy due to cancer therapies like chemotherapy, tamoxifen, and aromatase inhibitors (AIs). In fact, according to surveys, 42% to 70% of postmenopausal BCSs report symptoms of vulvovaginal atrophy (VVA) as a consequence of their cancer treatment (1).
Among pre-menopausal survivors, as many as 39% also experience these symptoms (1). These therapies drastically reduce estrogen levels, which in turn affects the tissues of the vulva, vagina, and urinary tract. The loss of estrogen diminishes vaginal moisture and elasticity, causing the vaginal lining to thin and become more prone to irritation, burning, and discomfort during sexual activity.
Unlike typical menopausal women who can turn to estrogen-based therapies to alleviate symptoms, BCSs often cannot use hormone replacement therapy (HRT) due to concerns about cancer recurrence. For survivors treated with hormone-sensitive cancers, the risks associated with even local estrogen treatments are significant. In one survey, 70.8% of oncologists indicated their reluctance to prescribe vaginal estrogen therapy due to the potential for increased cancer recurrence and interference with tamoxifen or AIs (1). Oncologists and patients alike fear that estrogen, even in small amounts, might interfere with these treatments and could potentially increase the risk of cancer returning.
Non-Hormonal Solutions for Improving Vaginal Health
With these concerns, many BCSs turn to non-hormonal options such as vaginal moisturizers and lubricants, which have shown promise in managing vaginal atrophy symptoms and are typically the first line of defense. Hyaluronic acid (HA), a substance naturally found in human tissues, is a common ingredient in vaginal gels and suppositories to enhance vaginal moisture. In clinical trials, HA suppositories were shown to significantly improve symptoms like dryness and urinary discomfort in women post-breast cancer treatment (2). HA presents a safe alternative for BCSs worried about hormone-related risks. It can also be used continuously, which may be beneficial for women who prefer consistent treatment over periodic interventions like laser therapy.
Laser therapy, specifically Erbium lasers, offers a non-ablative option that stimulates collagen production and tissue regeneration within the vaginal walls and improves moisture, elasticity, and overall vaginal health. Studies have demonstrated that laser therapy can significantly alleviate the discomfort of vaginal atrophy, including reducing symptoms like dryness, dyspareunia (pain during sex), and even some urinary issues such as overactive bladder. A recent study found that 86.4% of women with dyspareunia experienced improvement after laser treatment (2). While this treatment is effective in the short term, the long-term safety and efficacy of vaginal laser therapy are still under investigation, and it remains under consideration for broader clinical use.
A recent randomized controlled trial compared the use of intravaginal laser therapy to HA suppositories for treating symptoms of vaginal atrophy in BCSs (2). HA and laser treatment both significantly improved vaginal dryness and pain during intercourse after three months. Importantly, both treatments proved equally effective, offering two strong non-hormonal options for women seeking relief from these symptoms.
Looking Forward: Patient-Centered Solutions
With the rise in breast cancer survival rates, it’s crucial to focus on long-term quality of life. For many survivors, vaginal health issues are deeply intertwined with their overall well-being, affecting relationships, self-esteem, and sexual health. Non-hormonal treatments like laser therapy and HA-based products empower women to manage their symptoms safely and effectively and improve their overall quality of life.
As more research emerges, we aim for even better solutions—ones that address the specific needs of breast cancer survivors while also restoring the delicate balance of the vaginal microbiome for optimal outcomes. For now, these emerging treatments offer hope and relief for those grappling with the long-lasting side effects of breast cancer treatment.
References
- Biglia, N., Bounous, V. E., D'Alonzo, M., et al. (2017). Vaginal Atrophy in Breast Cancer Survivors: Attitude and Approaches Among Oncologists. Clinical Breast Cancer, 17(8), 611-617. https://doi.org/10.1016/j.clbc.2017.05.008
- Gold, D., Nicolay, L., Avian, A., et al. (2022). Vaginal Laser Therapy Versus Hyaluronic Acid Suppositories for Women with Symptoms of Urogenital Atrophy After Treatment for Breast Cancer: A Randomized Controlled Trial. Maturitas, 164, 75-82. https://doi.org/10.1016/j.maturitas.2022.08.013