Should Women Use Vaginal Estrogen After Menopause?
Vaginal estrogen is commonly used after menopause to maintain vaginal and vulvar tissue health. When estrogen levels decline, many women notice that their vaginal tissue is drier, thinner, and tears easily during vaginal intercourse, leading to discomfort and pain. A low-dose supplement of estradiol (or in some cases, another hormone, DHEA) used a couple of times a week can reverse these changes for healthier tissue. This type of hormone therapy is most often prescribed in the form of a suppository or cream that is inserted into the vagina using an applicator. It is also available in the form of a ring, similar in appearance to a diaphragm, and after insertion can be left in the vagina. But is vaginal estrogen therapy safe?
The answer is a resounding YES, for most women. Vaginal estrogen, unlike other forms of hormone replacement therapy, is localized. This means the estrogen (estradiol), most often prescribed at 10 micrograms (a very low dose), is absorbed directly into the vaginal tissue where it is applied and does not enter the bloodstream and spread throughout the body in significant amounts. Women who are not eligible for “systemic” estrogen hormone therapy where it spreads through the body (most often taken in the form of a pill, gel, lozenge, or injection) may be able to use vaginal estrogen. Even women recovering from breast cancer may be eligible under certain circumstances, although anyone with a history of cancer should discuss this with their physician prior to starting therapy. Those who typically avoid vaginal estrogen treatment include women with active ovarian or cervical cancer, and those undergoing anti-estrogenic treatment for hormone-sensitive breast cancer.
Safety studies have shown vaginal estrogen may be beneficial for long-term use in women past menopause in the U.S. and England. Starting in 2022, women in the United Kingdom will be able to purchase vaginal estradiol tablet suppositories over the counter!
Talk to your doctor if you are experiencing symptoms of vaginal dryness or pain with intercourse. Maybe you are a candidate for vaginal estrogen!