Tamoxifen is a selective estrogen receptor modulator (SERM) often used as treatment or adjuvant therapy for estrogen-receptor-positive breast cancers. Although vaginal estrogen is useful for symptoms related to vaginal atrophy, such as urinary tract infections (UTIs), urinary incontinence (UI), and/or pelvic organ prolapse (POP), it is not recommended in patients with a history of estrogen-receptor-positive breast cancer due to risk of relapse. The literature on the effect of tamoxifen on the vaginal wall and these urologic problems is also scarce[1,2]; thus, we reviewed our experience in managing these hormonally deprived patients at a tertiary care center.

Following IRB approval for this retrospective study, the charts from women who had a current or previous history of tamoxifen use and were referred over the past 5 years to a tertiary care center with FPMRS expertise were reviewed. Patients whose reason for referral did not include UTI, UI, or POP were excluded from analysis. Data on demographics, urologic history, and tamoxifen usage was collected from an electronic medical record, as well as the results of any corrective surgical procedures. Response to treatment for UTI, UI, and POP were based on UDI-6 scores, IIQ-7 scores, and physical exam and symptom improvement, respectively.

From 2015 to 2020, 41 women had been treated with tamoxifen 10-40 mg, with a median treatment duration of 4 years. A total of 32 women were included in analysis. Nine were referred for UTIs, 10 for UI, and 8 for symptomatic POP. Five had more than one condition (one with UTI and UI, four with UI and POP). Median age was 73 (IQR: 66.75-80.5), with 83% Caucasian and all but two not currently on tamoxifen with remission from breast cancer.

UTI patients were treated with antibiotics and prophylactic supplements (Hiprex, D-mannose, etc.) with satisfactory response at a median follow-up of 1 year (IQR: 0.5-1), and 3 underwent electrofulguration with no recurrence of UTIs. Ten UI women chose intervention, 1 with Macroplastique injections, 2 fascial slings, and 1 a Burch procedure, all of whom had no self-reported UI recurrence at median follow-up of 2.5 years (IQR: 1-3).

Except for one treated with pessary, all POP patients underwent repairs (7 vaginally and 4 with open/robotic mesh), with satisfactory outcomes at a median follow-up of 3 years (IQR: 2–7).

The management of UTIs, UI, and POP in women on tamoxifen or unable to benefit from hormonal intake vaginally or systemically is challenging, but traditional interventions can be considered with satisfactory results.

Hasanov E, et al.: Case report and review of literature. 2017
Albeertazzi P et al., Climacteric. 2005