Question

I've got a question about estrogen creams. My provider has recommended I use Estrace vaginal cream and I wanted to check in about the carcinogenic effects of doing something like this.

Answer

Some postmenopausal women experience vaginal pain or discomfort when they have intercourse or a gynecological exam. Vaginal tissues can become thinner after menopause, causing dryness and itching. For some women, regular intercourse or other sexual stimulation is enough to keep the vagina supple, while other women find that vaginal lubricants prevent discomfort that might otherwise happen.

There are a variety of over the counter moisturizers and lubricants to treat vaginal dryness, but in some cases they do not fully relieve symptoms. For women who do not experience relief from over the counter products, low-dose vaginal estrogen is an option. Low-dose vaginal estrogen is available in three forms: creams, tablets, and rings. While the NWHN has warned women about about the effects of long-term menopause hormone therapy (MHT) usage, including cancers and cardiovascular events, low-dose vaginal estrogen could be a safer, effective way to treat vaginal symptoms.

Recent studies have shown that low-dose vaginal estrogen use does not have the same risks as hormone therapy. Data from the Women’s Health Initiative Observational Study showed that for postmenopausal women who used vaginal estrogen, the risk of invasive breast cancer, colorectal cancer, endometrial cancer, stroke, and blood clots was the same as those that did not. Using vaginal estrogen did not increase the risk of many problems associated with hormone therapy. The same findings held true for women who had had a hysterectomy.

Vaginal estrogen is a local treatment, which means that it is only administered to the exact place it is trying to treat, and less estrogen enters the bloodstream. While some estrogen will enter the bloodstream from a local treatment, it is far less than with an oral treatment such as hormone therapy (HT). This reduces the risk of cancers and cardiovascular events associated with HT taken via pill or patch. Most of the estrogen will stay in the vaginal tissue so this type of topical treatment will not help with hot flashes or osteoporosis.  

Most studies cited in vaginal estrogen recommendations are observational studies, meaning that not all risk factors are controlled for. Clinical trials are necessary to determine the exact safety risks associated with a treatment. In the North American Menopause Society 2017 statement on hormone therapy they stated that “low-dose vaginal estrogen preparations are effective and generally safe for the treatment of VVA [vulvovaginal atrophy], with minimal systemic absorption, and preferred over systemic therapies when ET [estrogen therapy] is considered only for GSM [genitourinary syndrome of menopause].” The NWHN believes that, as the research currently stands, it appears that vaginal estrogen is a safe and effective treatment for vaginal discomfort due to menopause.  

Also, if you or a family member have a history of cancer, blood clots, and/or heart problems it is important to talk with your doctor when considering a vaginal estrogen treatment. It’s also important to get checked if you experience vaginal bleeding while using estrogen cream, as it can be caused by an overgrowth of the lining of the uterus (the endometrium).

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