Vaginal Estrogen

Vaginal estrogen is a common way of treating vaginal dryness. This topical treatment replaces the estrogen your body is no longer making because of menopause — whether it’s natural or brought on by breast cancer treatments. Vaginal estrogen comes in a few different low-dose forms: creams, vaginal rings, and vaginal tablets or suppositories. Since vaginal estrogen is topical, it means you absorb less estrogen into your bloodstream than you would if you took estrogen in pill form. 

Premarin and estradiol (brand name: Estrace) are two of the most commonly prescribed estrogen creams for vaginal dryness. You apply this cream directly into your vagina using an applicator, usually at bedtime. Follow your doctor’s directions for how much cream to use and how often you should apply it. 

Although there are over-the-counter (OTC) vaginal estrogen creams, there is not enough research on their safety or effectiveness. It’s best to avoid these OTC estrogen creams, but if you are interested in trying any of them, talk to your doctor first, especially if you have a history of breast cancer or are at high risk for developing the disease.

A vaginal ring is a thin and flexible ring that releases a low dose of estrogen once it’s placed into your vagina. You can insert a vaginal ring yourself, if you’re comfortable with it, by pinching the ring and pushing it up into the vagina. The ring can release estrogen for about three months before you need to replace it. There are two vaginal estrogen rings that doctors recommend: Femring and Estring.

Both rings are used to relieve vaginal dryness. But Femring releases more estrogen into your bloodstream, so doctors recommend it for other menopausal symptoms like hot flashes.

Doctors are more likely to recommend Estring instead of Femring for anyone with vaginal dryness and other vaginal-specific symptoms.

Vagifem is a vaginal estrogen tablet you place in your vagina with a disposable applicator. Vagifem is available as a generic tablet called Yuvafem. Follow your doctor’s directions for how often to insert the tablet. 

Your doctor might also recommend Imvexxy, a vaginal low-dose estrogen suppository. You place this vaginal suppository about 2 inches inside the vaginal canal daily for a couple of weeks and then lower the frequency to twice a week.

Many people — both healthcare providers and people with a breast cancer diagnosis — have concerns about vaginal estrogen. The worry is that, even in low doses, vaginal estrogen might increase the risk of recurrence (the cancer coming back) in people with a history of hormone receptor-positive breast cancer.

However, studies show that the amount of estrogen the body takes in from vaginal treatment is tiny, and research, which continues to grow, suggests that there's no difference in how long people are living if prescribed vaginal estrogen after breast cancer. If your symptoms are severe enough and have not improved with non-hormonal treatments, it might be time to address the possibility of vaginal estrogen with your provider.