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Estrogen vaginal creams safe?

Page last modified on: September 22, 2008
Question from Dermnurse: How safe are estrogen vaginal creams for breast cancer patients? I am 4 years post-diagnosis of breast cancer. I had a wide-excision lumpectomy, radiation, and am in my fourth year of tamoxifen. I had a hysterectomy 1 year ago.
Answers —Sandra Schnall, M.D.: Most estrogen vaginal creams are relatively safe. They have minimal absorption of the estrogen so there's not much absorption into the bloodstream. Something like Vagifem (chemical name: estradiol) can be used for 2 weeks straight and then just twice a week. That can be very helpful to decrease the vaginal dryness, etc. So I think it's safe to use, and I recommend this if deemed necessary.
Marisa Weiss, M.D., president and founder: You can also use the Vagifem estrogen tablet, inserted in the vagina, as an alternative to the estrogen creams.

Another product to check out is the Estring, which is a small plastic ring that's got estrogen in it. It is placed inside the vagina for 3 months at a time. Slowly, the estrogen comes out of the ring and "feeds" the vaginal walls. Some doctors may prefer this over the creams because the amount of estrogen that gets into the blood might be less. Also, it helps avoid the messiness that creams can cause in terms of dripping out of the vagina.

If you need wetness in the vagina, try lubricants before you go to any type of estrogen product. My patients' favorites are Slippery Stuff and Astroglide. Good old K-Y Jelly or the new gels are also popular.
Sandra Schnall, M.D.: People also like Replens.
Marisa Weiss, M.D., president and founder: Replens is described by its maker as a vaginal moisturizer, providing moisture that supposedly holds on to the walls of the vagina, so it's different from other lubricants. Replens tends to be more expensive that the other lubricants, so if what you need it just a lubricant, you might want to try a cheaper product, like those I mentioned before.
Sandra Schnall, M.D.: One possible downside to the ring is that some women may notice some difficulties with the ring and may therefore prefer the creams.
Marisa Weiss, M.D., president and founder: You might need to make sure that the ring is in the proper position before intercourse, just like a woman who uses a diaphragm. If it's not in the right spot, it can be uncomfortable.

On Wednesday, April 21, 2004, our Ask-the-Expert Online Conference was called Hormonal Therapy Updates. Sandra Schnall, M.D. and Marisa Weiss, M.D. answered your questions about hormonal therapies and answered questions about which ones work best in different situations, how they might fit into your treatment sequence, how to deal with side effects, and more.

The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Meet the Experts

Sandra F. Schnall, M.D.Sandra F. Schnall, M.D. is a medical oncologist/hematologist who practices at Bryn Mawr Hospital in the Thomas Jefferson University Health System outside of Philadelphia, Pennsylvania.

Marisa Weiss, M.D. is a radiation oncologist specializing in breast cancer and the founder, president, and guiding force behind Breastcancer.org.

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