another question to your reply...

[rascal]

Dear Doctor,
Thank you so much for your quick response. I thought I would post another question. I did return a comment re: no std's as I am married to the same man over 20 yrs, and QUITE happily :).
Can't have estrogen in ANY form as I am high risk for breast cancer.
My thyroid TSH is checked every 3 mo bc my MD noticed that I am so "sensitive" to meds. Even though my TSH has dropped from 12 to 2.74, he still increased my dose from 45mg to 60mg over the past two weeks. He felt that my TSH would still stay within the lower levels, and that I would feel better. When I started on Thyroid over a year ago, I saw the endocrinologist who did tests and said my "antibodies" were elevated which pointed to the "garden variety" hypothyroidism, and that my MD to increase the Armour as needed (in small increments). Since the burning seemed to start concurrently with the increase in thyroid I didn't know if they could be related. I'm not due for the TSH for 4 more weeks. Should I continue and wait until then to have it checked or check it sooner? On Armour, the peaks are much quicker than the synthetics. Anyway, if you still think the atrophic Vaginal problem (which I would lean toward that as well) is there anything us "unable to use estrogen women" can do?
Thank you again,
Xedowner (my new name is Fire down Under :) ) We must keep our sense of humor, huh?

[Forum-M.D.-DT]

Yes... keeping your sense of humor is very good indeed  :o)

By "high risk" for breast cancer, I would assume you mean that a first degree relative (mother, aunt, grandmother, sibling) has been diagnosed with breast cancer. In this case, yes, oral estrogen (i.e. Premarin) should be avoided. I have a few other thoughts here. Firstly, the use of topical estrogen cream in patients felt to be "high risk" for breast cancer is somewhat controversial. It has no where near the systemic absorbtion of a oral medication.
There are other options to consider. The first is Evista. This medication does help many post-menopausal women with many of the "symptoms" they experience and does not cause an increase in breast cancer risk. (in fact, it is felt by many experts to REDUCE breast cancer risk). The main drawback of this medication is that it causes hot flashes in some women.
Another option to consider is the use of Xylocaine cream. Now, this is not a "mainstream" treatment for atrophic vaginitis (dry vaginal mucosa in postmenopausal women), but I have seen it used in many cases with very very good success. This is another option you may need to consider.
Like I tell my patients ... there is always an answer, sometimes you just have to be persistent and keep looking for it.
If you need anything else or have further questions ... you know where to find me :o)

Regards,
Dean M. Tomasello, M.D.

[rascal]

Dear Doctor,
Yes, My mother and one sister died of breast/ovarian cancer. I will talk to my md about it, however.
Any thoughts on the thyroid "connection"?
Thanks a million,
Xedowner

[Tomasello]

There is a close relationship between thyroid hormone and estorgen. That being, thyroid hormone and estrogen are carried through the bloodstream by the same protein. Fluxuations in estorgen levels (which occur around menopause) can affect the levels of circulating thyroid hormone and vice versa. Inadequate thyroid hormone (i.e. being "hypothyroid") could technically cause increased vaginal dryness (along with dry skin, hair, etc.) So, if the thyroid has any contibuting part here, it is possible that your have NOT ENOUGH thyroid hormone. Ask your doctor if increasing your Armour thyroid would be beneficial. The blood tests are merely a "guide". If you have symtoms of being hypothyroid (weight gain, dry hair, dry skin, fatigue, feeling cold all the time), even if your blood test shows your thyroid levels are in the "normal range" you may still need an increase in the Armour Thyroid. The "normal range" is very wide, it is the SYMPTOMS that are key in treating hypothyroidism.

All the best to you!
Dean M. Tomasello

[rascal]

Dear Dr. Tomasello,
I had decided yesterday to have my regular TSH drawn, before I read your comment. It turns out that my MD called me today, and wants to see me on Tues bc my TSH indicates that my thyroid is still low despite the increase in the Armour several weeks ago. You are correct in your comment. Thank you again. It's nice to access this site.
P.S. How do you find time for this forum and your patients? :)
Sincerely,
Xedowner

[Tomasello]

I was glad I was able to be of some help here.
I have time for my patients and really enjoy being able to help people nationwide in forums such as these. I also have my own website at www.NetLiveMD.com - stop by and see us some time there as well!
The internet gives me the ability to help so many people, who otherwise, seemingly would have no where to turn.
Thank you for visiting the Family Practice Forum and stop by NetLiveMD!

Regards,
Dean M. Tomasello, M.D.