Information You Need: Vaginal Estrogen Q & A

In this blog, we’ll take a closer look at the role of vaginal estrogen in treating a variety of symptoms and who is a candidate for it. 

Frequently Asked Questions About Vaginal Estrogen

Q: What symptoms can be treated with vaginal estrogen?

A: This is prescribed to treat what is now called the genitourinary syndrome of menopause, or GSM. GSM occurs due to declining levels of estrogen after menopause, and it can be painful and distressing. Here are some of the symptoms: 

• Vaginal dryness, burning, irritation
• Pain during sex, decreased lubrication
• Burning during urination, increased urinary frequency or urgency
• Recurrent UTIs

The first-line treatment of GSM includes non-hormonal methods such as vaginal lubricants and moisturizers, many of which are available without a prescription. But when those methods fail, estrogen provided vaginally can provide a lot of relief. 

Q: Will it help with hot flashes?

A: No. Menopausal symptoms such as hot flashes, mood swings, and difficulty sleeping require treatment with systemic estrogen, which achieves higher blood levels of estrogen. Women with a uterus are also prescribed a progestin to protect the uterine lining.

Q: Who is a candidate for it?

A: Almost everyone. This is a local therapy, meaning it acts directly on the tissues to which it is applied. Low-dose vaginal estrogen is absorbed into the body at very low levels that vary from not at all to just slightly above normal postmenopausal values.

Q: Can I use vaginal estrogen if I have a history of breast cancer?

A: As mentioned above, non-hormonal methods are the first-line treatment for GSM. But if those methods fail, a low dose can be used in patients with a history of breast cancer. In some cases, this requires a conversation between your gynecologist and your oncologist. 

Q: Can I use systemic estrogen and vaginal estrogen at the same time?

A: Yes! If you have started systemic estrogen and still have bothersome vaginal or urinary symptoms, ask your doctor about starting vaginal estrogen. 

Q: Is it too late for me to start?

A: No. Unlike systemic estrogen, it can be started at any age and can be continued for as long as it is needed. 

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