Is Vaginal Estrogen Safe for People With Breast Cancer?

Vaginal estrogen can help treat vaginal dryness. It replaces the estrogen your body stops making during menopause. — whether it’s natural or brought on by breast cancer treatments.

Since vaginal estrogen is topical (applied to the skin; also known as local), you absorb less estrogen into your bloodstream than you would if you took estrogen in pill form. It mostly stays in the area where it’s applied — in this case the vagina.

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

However, studies^1,2 show that the amount of estrogen the body takes in from vaginal treatment is tiny, and a growing body of research suggests that there’s no difference in how long people with a history of breast cancer live after they use vaginal estrogen.

Vaginal estrogen comes in a few different low-dose forms: creams, vaginal rings, and vaginal tablets or suppositories. 

Estrogen creams

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. It’s usually applied 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 creams that contain estrogen-like substances, there isn’t enough research on their safety or effectiveness. It’s best to avoid these OTC estrogen-like creams, but if you’re 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.

Vaginal rings

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. You can also choose to have the ring placed by a healthcare provider. 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. 

Estrogen tablets and suppositories

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 about two weeks, then twice a week after that.

Research has shown vaginal estrogen is safe for people with breast cancer — regardless of age or whether the cancer is hormone-sensitive. In fact, The 2018 American Society of Clinical Oncology (ASCO) guidelines on treating sexual problems in people with cancer recommend vaginal estrogen to treat vaginal dryness.

If your symptoms are severe and haven’t improved with non-hormonal treatments, talk to your doctor about vaginal estrogen.