If you’re still having pain and discomfort while using moisturizers and lubricants, work with your gynecologist to figure out if there might be another cause, such as infection, vulvar skin disorders, or vaginal spasms (involuntary contraction of the vaginal muscles during penetration). If these and other possible causes can be ruled out, then local vaginal estrogen therapy may be a reasonable option. This involves placing low-dose estrogen directly inside the vagina, which helps to rebuild the vaginal lining and promote lubrication.
Treatments come in the form of:
- creams (Estrace, Premarin): Your doctor will tell you how much to apply and how often, depending on your needs. A typical dose would involve applying the cream inside the vagina daily for 2 weeks, then 1-3 times a week after that.
- vaginal ring (Estring): This is a soft silicone ring placed inside the vagina that slowly releases estrogen. The ring generally needs to be replaced every 3 months. Either you or your healthcare provider can insert and remove the ring.
- tablets (Vagifem): Vagifem is a pill placed inside the vagina once a day for 2 weeks, and then 2 times a week after that. It comes preloaded in an applicator that can help you place the pill, ideally somewhere in the lower half of the vagina.
Rings and tablets deliver approximately the same amount of estrogen; creams may deliver more, depending how much is used and where it is placed. You can work with your doctor to figure out which method best suits your needs.
You may be wondering why this form of estrogen could be considered OK for you, since women with breast cancer are cautioned against using estrogen in the form of hormone replacement therapy (HRT). (Visit Hormone Replacement Therapy for more information.) Vaginal estrogen is a local treatment; some estrogen does get into the bloodstream, but the amount appears to be lower than it is with HRT. Therefore, if you’re not getting relief from other strategies, vaginal estrogen may be a reasonable option for you.
Research on the safety of vaginal estrogen is ongoing. So far, studies suggest that the amount of estrogen released is not likely to increase the risk of recurrence. However, we need more studies to know for sure how safe vaginal estrogen use is, especially if you’ve had hormone-receptor-positive breast cancer.
Any decisions about using vaginal estrogen should be made in partnership with your healthcare provider and oncologist, your primary care physician, gynecologist, and oncologist. You may be able to use vaginal estrogens until your pain and irritation subside, and then use moisturizers and/or lubricants on their own. If you do choose to use vaginal estrogen therapy, you would not need to take a progestogen to protect your uterus, as women taking HRT do, because local estrogen doesn’t seem to increase the risk of endometrial cancer (cancer of the uterine lining).
Non-estrogen medications for vaginal dryness and irritation
In 2013, the Food and Drug Administration approved a medication called Osphena (chemical name: ospemifene) as a treatment for the vaginal dryness and irritation that can make penetration painful. Technically it’s not an estrogen, but it can mimic the effects of estrogen in certain parts of the body. As of right now, it’s not recommended for women with a history of breast cancer, because it hasn’t been studied enough in this group.
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