“Endocrine therapies: the point of view of the gynecologist”: this is the title of the speech by Dr. Gianluigi Bresciani, specialist in Gynecology in Humanitas, during Mamazone 2017, the seventh edition of “Paziente Diplomata”, a day dedicated to women with and without breast cancer, organized by Humanitas last 14 October.
Endocrine therapy interacts with the hormonal system and has a targeted action only on cells that have hormonal receptors (estrogens and progestins) on their surface. These drugs prevent estrogen from reaching neoplastic mammary cells, thus slowing their development, or reduce the amount of estrogen produced by the body in order to try to decrease the risk of relapse. However, taking them has some side effects, such as hot flashes and vaginal dryness.
Vasomotor symptoms and genitourinary syndrome
“A woman’s life is characterized by the presence of female hormones from birth, especially estrogen. Endocrine therapies act on the ovaries, blocking the production of estrogen by the ovaries themselves. The gynecologist is thus called upon to control the ovary and endometrium, the organs most prone to encounter problems, and to manage vasomotor symptoms (the so-called flushes) and genitourinary syndrome (commonly known as vaginal dryness),” explained Dr. Bresciani.
“Flashes affect 70-80% of women in menopause and are perceived and reported by patients as sudden sensations of heat mostly to the face, whose duration can vary from a few seconds to several minutes, often followed by sensations of cold. They are prevalent at night, associated with sweating and sometimes palpitations. Flashes depend on vasomotor instability caused by estrogen deficiency at the centers of the hypothalamus regulating body temperature,” said the specialist.
Some tips to deal with them
Warm environments increase body temperature by allowing the threshold that causes the blaze to reach faster; on the contrary, colder temperatures reduce its incidence. It is also good to pay attention to nutrition, reducing the consumption of alcohol, caffeine and spicy foods; keep body weight in normal condition and devote yourself to regular physical activity finding the right balance because insufficient exercise increases the number of flushes, but excessive exercise triggers the blaze more quickly. Relaxation techniques are also helpful and layered clothing is recommended. Dr. Bresciani also gave indications about drugs and natural remedies to combat hot flashes.
Genitourinary syndrome is also a characteristic symptom linked to endocrine therapy. Hormones manage the genital environment throughout their fertile life and stop producing them with the menopause. During menopause, within the first 3 years, about 40% of women complain about symptoms attributable to vaginal dryness; endocrine therapies, which interrupt hormonal production prematurely or rapidly, determine the same symptoms already after the first 6 months from their onset. It is thought that 74% of women complain of mucosal atrophy and vaginal dryness, 67% report dyspareunia (sexual pain) and 77% report itching and burning. Dryness is therefore not the only symptom, but there are several: vaginal symptoms (dryness, burning, irritation, whitish and sometimes odorous vaginal losses), urinary symptoms (urgency of urination, dysuria, infections with recurrent cystitis, post-coital cystitis) and sexual symptoms (lack of lubrication, introverted dyspareunia and loss of libido).
What to do?
“To combat the genitourinary syndrome we have several local therapies, such as lubricating gels (aqueous, silicone, oily); aliamide-based gels that can both lubricate and make the superficial nerve endings a little less sensitive, thus reducing the feeling of pain and discomfort; creams based on hyaluronic acid and local estriol, indicated only on patients selected for a defined time,” Dr. Bresciani pointed out.
Another help can come from special underwear made with silk fibroin, a protein substance with a structure very similar to our skin barrier and which acts as a second skin, protecting the skin and mucous membranes. Other options include a pharmacological approach and the use of lasers.
Watch the full intervention of Dr. Bresciani, click here