Lokaal gebruik van dehydro-epiandrosteron voor de behandeling van vaginale atrofie na borstkanker

Abstract

Vaginal dehydroepiandrosterone for the treatment of vaginal atrophy in breast cancer survivors Vaginal atrophy is a common problem in breast cancer survivors, but often remains undiscussed with the health care professional. Vaginal oestrogens are the standard treatment, yet this treatment remains quite controversial in breast cancer survivors. Vaginal dehydroepiandrosterone (DHEA) appears to be a promising alternative. PubMed was screened for clinical trials on offering local DHEA for the treatment of vaginal atrophy in breast cancer survivors. Only 2 published articles, both covering 1 randomized double-blind controlled trial, were found. In that study, 443 participants were equally randomized into 3 arms: each participant receiving daily vaginal administration during 12 weeks of 3.25 mg DHEA, 6.5 mg DHEA and a plain moisturizer. All arms showed improvement in both vaginal dryness and dyspareunia, yet no dose of DHEA administration led to a statistically significant difference on both parameters compared to the plain moisturizer. Some significant self-reported side effects were observed. Serum DHEA sulphate and testosterone increased significantly depending on the DHEA dose in comparison to a plain moisturizer, yet still remaining within the normal postmenopausal range. Oestradiol amounts also increased in the 6.5 mg DHEA group, but not in the 3.25 mg DHEA group and, remarkably, not in women taking an aromatase inhibitor. Vaginal DHEA improves the symptoms of vaginal atrophy, especially in terms of sexual experience. However, further research is needed on the efficacy and safety of long-term use of vaginal DHEA in breast cancer survivors, especially in case of hormone-sensitive breast cancer.