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Dear Dr. Roach: You recommended estrogen cream for UTI problems. I had breast cancer, and it was estrogen-positive. I was on tamoxifen for six years; it is an estrogen blocker.
As a result, I am reluctant using any medicine that pertains to estrogen. Do you think this cream is safe to use in spite of my history of estrogen-positive breast cancer? -- R.E.
Answer: To be specific, I recommended considering estrogen cream in post-menopausal women who have recurrent urinary tract infections due to vaginal atrophy.
Although a recent opinion by the American College of Obstetrics and Gynecology stated that "Data do not show an increased risk of cancer recurrence among women currently undergoing treatment for breast cancer or those with a personal history of breast cancer who use vaginal estrogen to relieve urogenital symptoms," neither I nor they recommend using any kind of estrogen preparation, vaginally or by mouth, without a thorough discussion with the woman's oncologist.
Nonhormonal treatments certainly should be tried first, and the risks of estrogen need to be carefully balanced against the possible benefits.
Dr. Roach Writes: A recent column on PVCs, a type of irregular premature heartbeat, generated several letters.
One person advised stopping caffeine.
This is good advice, and may solve the problem. Others recommend magnesium supplements. I looked this up and was able to find a study showing that symptomatic PVCs were reduced by taking magnesium; however, every person in the study had had his or her magnesium level checked, and people with kidney disease or who were taking any medications were excluded, which limits the generalizability of the study.
I don't recommend magnesium supplementation unless magnesium levels have been tested and were found to be low.