How safe is vaginal estrogen cream?

Q. I have a lengthy history of urinary-tract infections (UTIs) that occur approximately every five months. I have seen a few urologists and had multiple tests, which have come out normal. Both my current urologist and my gynecologist are pressuring me to use Premarin vaginal cream to reduce UTIs. Due to the fact that my mother, her sister and my sister all have had breast cancer, I have refused. Last month at my annual exam, my gynecologist insisted that the vaginal cream is not absorbed into the blood and will not promote breast cancer. When I mentioned the warnings I’ve seen in pamphlets and on the Internet, my doctor got very angry and said the warnings are for the “old HRT” and do not pertain to the vaginal cream. I filled the prescription for Premarin cream but found in the literature insert that the top side effect listed is breast cancer. I have always been told with my family history to avoid all estrogen, even soy products, but I don’t want to be foolish by damaging my health with continual UTIs.

A. More than three decades ago, there was evidence that vaginal estrogen cream (Premarin) could be absorbed rapidly and efficiently into the bloodstream (Journal of the American Medical Association, Dec. 14, 1979). More recent studies have confirmed that estrogen in vaginal creams or tablets (Vagifem) is readily absorbed into the body (Annals of Oncology, April 2006; Menopause, January 2009). There are concerns that vaginal exposure to estrogen might increase the risk of breast cancer in susceptible women.

Q. I am suffering from such severe diarrhea, I am sometimes afraid to leave the house. I also have bad gas and bouts of abdominal pain. I suspect the metformin I take for diabetes, but my doctor says my symptoms are not from my medicine. The Prevacid I take for my heartburn isn’t helping enough to justify the expense. I also am experiencing pain and tingling in my toes. I need a remedy like cinnamon to help me control my blood sugar, and foods that will help with my gas and heartburn.

A. Metformin (Glucophage) can cause diarrhea, nausea, heartburn, flatulence and stomachache. Acid-suppressing drugs such as lansoprazole (Prevacid), omeprazole (Prilosec) and esomeprazole (Nexium) won’t solve the problem completely and may interfere with absorption of vitamin B-12. Metformin also is linked to reduced levels of vitamin B-12. Because this vitamin is crucial for nerve function, deficiency can contribute to numbness, tingling or pain of the toes, feet or fingers, trouble walking, memory problems, depression, confusion and burning tongue. Cinnamon shouldn’t be substituted for your diabetes drug, but it may be helpful. We are sending you our book “Favorite Foods: Mother Nature’s Medicine” for more recommendations on foods to help control blood sugar, cholesterol and heartburn. It is available at www.peoplespharmacy.com.

2011 King Features Syndicate Inc.