The small syringes stored in brown bags at a local pharmacy have proved a boon to women across the country with cancer that has taken a toll on their sex life.
A new gel created by a Bismarck pharmacist aims to combat the vaginal dryness that can accompany breast and other gynecological cancers.
“When women are starved for estrogen such as in the case of breast cancer and maybe some other gynecologic cancers, that affects the integrity of the vaginal wall, causing it to dry,” said Mike Riepl, a registered pharmacist and director of compounding services at Gateway Pharmacy North.
His pharmacy is the only one in the nation with authority to create DHEA bioadhesive vaginal gel. It’s available over the counter in North Dakota, and people in other states can receive it via mail with a prescription.
The Mayo Clinic contacted him two years ago after working with him on another project and asked him to develop a gel for a study on vaginal dryness in women with cancer.
“What they wanted was a particular dosage form that would not leak,” he said. “With creams and suppositories, the dose will leak, and they wanted more control over that.”
Women without breast or gynecological cancer who experience vaginal dryness typically rely on drugs that contain estrogen. But a woman with one of those diseases has few options.
“If they have an estrogen-dependent cancer and if they are in remission, it could cause them to come out of remissions and they could develop cancer all over again,” Riepl said.
He worked for several weeks to develop the drug and came up with a bioadhesive gel filled with the hormone DHEA that sticks to the vaginal wall. The adhesive nature of the gel gives women more freedom to chose when to use it, he said.
“They can use it any time of the day,” he said. “They can use it in the morning or at noon — whenever they happen to think about it — instead of having to use it at bedtime.”
Debra Barton, a nursing professor at the University of Michigan, led a clinical trial of the drug, testing 441 women throughout the country and Canada.
Researchers found that the drug helped ease vaginal dryness, atrophy and pain during sex in most cases, though it’s not effective in 100 percent of women. The drug comes in one of two doses and the higher-strength dose can increase a woman’s sex drive, which sometimes disappears with cancer.
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“That resolved a lot of issues with their partner and some of the emotional aspects of the disease itself,” Riepl said.
Rhonda Jolliffe, a nurse practitioner at Bismarck’s Lifeways Clinic who has recommended the gel for her patients, has seen some success. About 80 percent of the 25 patients who have used it say it’s effective, she said.
“It’s definitely another option if an estrogen cream didn’t work or they are at a higher risk, like a breast cancer patient,” she said.
The gel also can help people without cancer, pre- or post-menopausal.
It’s intended to be used every day for 30 days, at which time some women chose to use it less frequently, Riepl said. The gel starts at $36.
Jolliffe said it’s her go-to drug for patients who have breast cancer or are at a high risk of developing it. She also said she would recommend it to smokers, who should avoid hormones as they can lead to blood clots.
This particular drug mimics the body’s own chemistry, whereas other medications have different chemical makeups, she said. Drugs like this gel pose fewer risks, she said.
The gel should be used while also making lifestyle changes, she said. She tells patients to reduce their sugar intake, eat natural foods and reduce their stress level to help manage hormones.
Some people who have used the gel experience a vaginal discharge, as is common with other vaginal creams and gels, Riepl said. Others feel a warming sensation or notice that their voice has deepened.
So far, Riepl fills 2,200 syringes with the gel each month in his Bismarck lab, where he uses two machines to stir the gel and squeeze out the air.
The North Dakota Board of Pharmacy approved the drug to be sold over the counter a month ago. People interested in using it can ask for it at the Gateway Pharmacy counter and receive application instructions from Riepl.
“I like to talk to anyone that comes up to get it because if they have had cancer, I would want them to loop their physician in and get their authorization also,” he said. “I don’t want to take any chances that we are doing something that would interfere with the current regimen that the physician has.”