Low-Dose Vaginal Estrogen Therapy

Local estrogen is used to treat urogenital atrophic skin changes. This is a medical term that describes the skin changes that occur in the vagina, urethra (tube from the bladder) and vulva when the ovaries no longer produce estrogen after menopause. This can lead to changes in the acidity of the vagina leading to the skin becoming dry, thinned, sore, and less lubricated.

Women who have vaginal atrophy can present with discomfort or pain with intercourse, increasing vaginal discharge and irritation, or a burning sensation. The aim of low dose vaginal estrogen is to relieve these symptoms.

The skin changes that take place occur in the tube from the bladder (urethra) and in the base of the bladder (the trigone). These changes may result in symptoms of urinary frequency or urgency and discomfort passing urine. You may also be more prone to urinary tract infections. Local intravaginal estrogen can help to relieve these symptoms.

This involves estrogen being applied directly to the vagina, where it works locally to improve the quality of the skin by normalizing its acidity and making it thicker and better lubricated. The advantage of using local therapy rather than systemic therapy (i.e. hormone tablets or patches, etc.) is that much lower doses of hormone can be used to achieve good effects in the vagina, while minimizing effects on other organs such as the breast or uterus. Vaginal estrogen comes in several forms such as vaginal tablet, creams or gel or in a ring pessary.

Vaginal estrogen preparations act locally on the vaginal skin, and minimal, if any estrogen is absorbed into the bloodstream. They work in a similar way to hand or face cream. If you have had breast cancer and have persistent troublesome symptoms which aren’t improving with vaginal moisturizers and lubricants, local estrogen treatment may be a possibility. Your Urogynecologist will coordinate the use of vaginal estrogen with your Oncologist. Studies so far have not shown an increased risk of cancer recurrence in women using vaginal estrogen who are undergoing treatment of breast cancer or those with history of breast cancer.

Your doctor will be able to advise you on this but most women tolerate all forms of topical estrogen. Studies have shown that all preparations are equally as effective in relieving symptoms.

Not usually, but if you continue to have vaginal symptoms despite using HRT, your doctor may prescribe vaginal estrogen as well. This is especially common if you are on a very low dose of HRT. In this way you can improve your vaginal symptoms without the need for a higher dose of HRT. Vaginal lubricants may also be helpful if your main symptom is vaginal dryness during intercourse and vaginal moisturizers may help restore moisture and can be used every few days as needed.