So many of you have asked…
My number one intention for all women is to optimize their quality of life, and to always do so safely taking into consideration their unique medical history and current health status.
Women having had a history of breast cancer need to be particularly diligent about anything – even natural products – that they put in or on their bodies.
I’ve had hundreds of women asking me about the use of Julva® given their history of breast cancer. It is such an indicator of the huge toll that breast cancer has exacted on women…that so many need to ask these questions. For those who may not use or be familiar with Julva, it is a restorative feminine cream for the vulva, used to address vaginal dryness, urinary leakage issues, libido and more…you can read about Julva here.
I always recommend women discuss any new prescription, supplement or over-the-counter product with their primary care doctor. In the case of women having a previous breast cancer diagnosis and/or treatment, I strongly suggest women always talk with their oncologists.
I make this same recommendation relating to the use of Julva.
Julva is a topical restorative cream intended for the vulvar area containing pure, natural ingredients to improve vaginal dryness and reverse the symptoms of aging.
DHEA is the only ingredient in Julva that may concern women with breast cancer because it is a bio-identical hormone and women may fear using a ‘hormone’. DHEA is naturally secreted by the adrenal gland and ovary and is a very protective hormone with research indicating it is beneficial for brain health, bone health and breast health.
A growing amount of supportive research
Here I share with you some of the research which is very supportive of DHEA in regards to women having had breast cancer:
- Local versus systemic effect: Research shows that “topical DHEA (even when applied vaginally) does not cause an increase in intrinsic estrogenic or androgenic activity however it is transformed intracellularly into androgens and estrogens only in the cells in the vulvar and vaginal layers physiologically in need of these sex steroids.” (Menopause, 2009 ) What does this mean? It means that DHEA impacts local cells and tissue where it is applied, and has not been found to circulate systemically throughout the blood.
- DHEA may provide a protective role against cancer: According to a recent paper published in Cancer Biology & Therapy (September 2016) (https://www.ncbi.nlm.nih.gov/pubmed/27260851) “DHEA, an adrenal hormone, has a protective role against cancer.” The authors go on to state, “that DHEA inhibits the proliferation and migration of cell lines derived from breast cancer.”
- DHEA was determined to be “useful in the treatment of breast cancer” in yet another study published in Eur J Pharmacol, in 2011. In this study researchers concluded that, “DHEA also suppressed the migration of all breast cancer cell lines, independently of the presence of estrogen receptors and decreased the expression of ECM-1 protein in Hs578T cells. These results suggest that the mechanism of DHEA actions against breast cancer involves the inhibition of cell proliferation and the suppression of migration, indicating that DHEA could be useful in the treatment of breast cancer.” (https://www.ncbi.nlm.nih.gov/pubmed/21497598 Eur J Pharmacol. 2011 Jun 25;660(2-3):268-74).
- Vaginally applied DHEA has been shown to treat vaginal dryness, pain and other vaginal atrophy symptoms (including libido) especially in women having had breast cancer. This 2014 clinical trial has not yet been published however I am including a link to the ASCO (American Society of Clinical Oncology) abstract presentation (http://meetinglibrary.asco.org/record/93533/abstract ) as well as an article on the study (http://www.theoncologynurse.
com/ton-issue-archive/2014- issues/september-october-vol- 7-no-5/16248-vaginal-dhea-may- improve-sexual-function-in- women-with-breast-gynecologic- cancer-ton ).
I also wanted to share a snippet of one terrific discussion that I had with Mike Riepl, a pharmacist and researcher, about this research. I caught up with Mike while I was speaking about the use of DHEA in treating vaginal atrophy at a recent conference in Vegas, a forum on HRT (Hormone Replacement Therapy) sponsored by the PCCA (Professional Education Services Group).
We had a brief opportunity to talk about the DHEA Bioadhesive vaginal gel in the noted study as having been found effective for women who have had breast and other gynecologic cancers for the treatment of atrophic vaginitis, vaginal dryness, low libido, and dyspareunia.
The study looked at an alternative for estrogen preparations for the treatment of atrophic vaginitis, vaginal dryness, low libido, and dyspareunia. In June of 2011, at the request of North Central Cancer Treatment Group (NCCTG) in collaboration with the National Cancer Institute (NCI) and Mayo Clinic, the DHEA bioadhesive vaginal gel was developed by Gateway Pharmacy for the FDA-approved; Phase III clinical trial (NCT01376349). The abstract was released from embargo in June 2014 at the ASCO meeting in Chicago and is currently in the peer review process for publication.
I’ll continue to post new updates on this blog as I become aware of them.
Women with uncontrolled PCOS
In earlier research (1999) women with uncontrolled PCOS and abdominal obesity may be associated with late promotion of breast cancer stimulated by prolonged intake of DHEA. Typically women with PCOS have elevated circulating levels of DHEA and additional oral DHEA would not be warranted.
Women using Tamoxifen
As a precaution, if you are currently using Tamoxifen I do not recommend using Julva without your oncologist’s approval. The research on Tamoxifen has shown:
ORAL DHEA (systemic) converting to estrogen can interfere with Tamoxifen use and can decrease its effectiveness when blood serum levels of DHEAS are > or = 90 microg/dL (https://www.ncbi.nlm.nih.gov/pubmed/12727558
Once off of Tamoxifen, I have no hesitation in recommending Julva to breast cancer survivors.
Women using Femara/Letrozole
Femara/Letrozole (an aromatase inhibitor) does not appear to be affected by DHEA use and may be a better alternative should your oncologist agree. Some studies have in fact shown that breast cancer patients on aromatase inhibitors appear to benefit from higher levels of DHEAS and experience less musculoskeletal pain. (https://www.ncbi.nlm.nih.gov/pubmed/21647676 )
Women concerned about the risk for blood clots
If you are concerned about the risk for blood clots: Consult with your primary care physician before trying Julva. We know that oral estrogen can increase blood clots; however trans-dermal estrogen, progesterone, & DHEA have not been shown to increase blood clots at all.
Please let me know if you have any questions relating to this information, you can always email me at Team@DrAnnaCabeca.com . Note that I can’t answer questions specific to your medical condition or treatment…please direct those questions, as always, to your physician.
If you didn’t have the opportunity to read my companion blog to this piece, on breast cancer prevention and steps we women need to make to maintain optimal health, you can find that blog here. Please share with the other women in your life.