Vaginal Estrogen Safe for Women With Breast Cancer

Using vaginal estrogen helped ease genitourinary syndrome of menopause, including vaginal dryness and irritation, in women diagnosed with breast cancer, and didn’t increase the risk of dying from breast cancer, according to a study.

The research was published online on Nov. 2, 2023, by the journal JAMA Oncology. Read the abstract of “Vaginal Estrogen Therapy Use and Survival in Females With Breast Cancer.”

Genitourinary syndrome of menopause is a long name for the constellation of symptoms that the decrease in estrogen that comes with menopause can cause in the vagina and bladder. It includes vaginal dryness and irritation, painful sex, urinary tract infections, needing to pee more often, and incontinence.

Hormonal therapy, which is used to treat hormone receptor-positive breast cancer, can bring on many of these symptoms and make them more intense than they would be if a woman were going through natural menopause. The symptoms of genitourinary syndrome of menopause are the reason why many women stop taking hormonal therapy medicine early.

Hormone replacement therapy (HRT) can effectively treat many menopausal symptoms. Still, if you’ve been diagnosed with breast cancer, you shouldn’t take types of HRT that affect the entire body, called systemic HRT. This is because systemic HRT travels through the bloodstream to all parts of your body, and the hormones can increase the risk of recurrence (breast cancer coming back).

Vaginal estrogen is considered topical or local estrogen, which means it mostly stays in the area where it’s applied, in this case the vagina. Vaginal estrogen comes in the forms of creams, rings, or tablets.

Small studies suggest that vaginal estrogen doesn’t increase breast cancer recurrence risk or breast cancer mortality in women who’ve been diagnosed.

2018 American Society of Clinical Oncology (ASCO) guidelines on treating sexual problems in people with cancer recommend vaginal estrogen to treat vaginal dryness.

The researchers did this larger study to add more evidence to the discussion.

The researchers analyzed the health records of two large groups of women, one from Wales (22,275 women) and one from Scotland (26,962 women). The 49,237 women were aged 40 to 79.

The Welsh women were diagnosed between 2000 and 2017 and the Scottish women were diagnosed between 2010 and 2017.

Overall, 5% of the women used vaginal estrogen and 1% used systemic HRT.

The Welsh women were followed for five to 12 years and the Scottish women were followed for three to seven years.

During follow-up, 5,795 women died from breast cancer.

The researchers found that there was no increase in the risk of dying from breast cancer between women who used vaginal estrogen and women who didn’t use vaginal estrogen or systemic HRT.

When the researchers looked only at women diagnosed with hormone receptor-positive breast cancer, the results were the same: using vaginal estrogen didn’t increase the risk of dying from breast cancer.

“This finding may provide some reassurance to prescribing clinicians and support the guidelines suggesting that vaginal estrogen therapy can be considered in patients with breast cancer and genitourinary symptoms if non-hormonal treatments are unsuccessful,” the researchers wrote.

If you’re being treated for breast cancer and are having any of the symptoms included in genitourinary syndrome of menopause, the results of this study are very good news.

Vaginal estrogen can safely and effectively treat these symptoms without affecting your prognosis.

If you’re taking hormonal therapy for breast cancer, you can learn more about treatments for the most troublesome sexual issues hormonal therapy can cause by listening to The Breastcancer.org Podcast episode featuring Dr. Kristin Rojas discussing better sexual health for women taking hormonal therapy.

Better Sexual Health for Women Taking Hormonal Therapy

Jun 7, 2023

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