The Facts About Vaginal Estrogen

Vaginal dryness is an incredibly common experience for women around menopause, typically beginning in perimenopause and worsening after menopause. Depending on the source, research estimates that it affects at least half and up to 90% percent of postmenopausal women.

Vaginal dryness is part of a group of symptoms described as genitourinary syndrome of menopause (GSM). GSM, which results from low estrogen levels, can lead to dryness, pain, lost vaginal elasticity and recurrent UTIs.

While lubricants and vaginal moisturizers can improve mild vaginal dryness, many women eventually need to move to stronger treatments. Vaginal estrogen is the next best option for most people to explore.

Vaginal Estrogen vs. Menopausal Hormone Therapy

Menopausal hormone therapy (MHT) is a good choice for managing multiple symptoms of menopause, including hot flashes and night sweats, bone density loss, mood and sleep disturbance. It also lessens the symptoms of GSM.

Estrogen products applied directly to the vagina, on the other hand, effectively treat GSM but don’t significantly affect other menopause symptoms.

It’s not uncommon for people on MHT to feel ongoing vaginal dryness. If you feel like your GSM symptoms are still an issue despite taking hormone therapy, talk to your prescribing provider about adding vaginal estrogen.

Not everyone can take systemic hormone therapy, but many people can safely use local estrogen for vaginal dryness under the supervision of a healthcare provider.

Because vaginal estrogen is focused in one area and very little ends up in the circulatory system, it is considered safer for people with certain at-risk medical histories. This makes vaginal symptom management available to more people.

Breast Cancer and Vaginal Estrogen

There is a great deal of debate among experts about the safety of different hormonal medications in people who have had estrogen-dependent cancers such as breast, ovarian, and uterine.

Although most vaginally applied hormone therapy remains localized, a trace amount can be absorbed into the bloodstream. Experts have raised concerns about the risk of breast cancer recurrence due to the use of vaginal estrogen, but research finds the risk to be minimal.

Your health experience is unique, and so are your medication decisions. If you currently or previously have had breast cancer and are not getting relief from non-hormonal treatments for GSM, talk to your oncologist about whether the benefits of vaginal estrogen outweigh the risks for you.

Some people with a cancer history choose to use vaginal DHEA instead of estrogen after talking to their providers. DHEA, which does not contain estrogen, is effective in treating GSM and also does not appear to increase estrogen levels in people with cancer.

Vaginal Estrogen Options

All vaginal estrogen application methods are equally effective at managing GSM. The right choice for you depends on your preferences.

While it doesn’t cause major side effects for most people, some experience sore breasts, non-odorous thick white discharge, or mild nausea when starting vaginal estrogen.

Vaginal Estrogen Cream (Estrace, Premarin)

Vaginal estrogen cream is inserted into the vagina with an applicator. It’s usually prescribed for daily use for the first two weeks and then twice a week for long-term maintenance. It’s easy to use, but can be a bit messy. Many users put it on before bed and use a pantiliner to catch any extra.

Vaginal Estrogen Suppositories (Vagifem, Yuvafem, Imvexxy)

Vaginal suppositories slowly dissolve to release estrogen into the vagina. They are inserted into the vagina with an applicator or with clean hands. Like topical creams, suppositories are usually prescribed for daily use for the first two weeks and then twice a week for long-term maintenance.

Vaginal Estrogen Ring (Estring, Femring)

Estrogen rings are made of soft, flexible plastic imbued with a dose of estrogen that slowly releases over time. Users replace the ring every three months with a new dose. You can insert and remove the ring yourself or ask your healthcare provider for assistance.